The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code set is vital for disease tracking and billing purposes. On the billing side, ICD-9-CM codes tell insurance carriers the “why” and support medical necessity for procedures being billed. The ICD-9-CM code set will no longer be in use in the United States once International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) is implemented. ICD-10-CM and its applicable guidelines are the required diagnosis reporting code set for all health care providers and covered entities under the Health Insurance Portability and Accountability Act. It is key that coders and physicians alike understand the changes since this will affect diagnosis reporting and health care quality metrics. This webinar will

• Explore the new ICD-10-CM code structure and how it differs from ICD-9-CM.
• Discuss guideline changes from ICD-9-CM to ICD-10-CM.
• Discuss some common pediatric codes for which increased documentation of the disease and disease process will be required of providers.
• Review the crosswalk of some common pediatric diagnoses from ICD-9-CM to ICD-10-CM.

Faculty: Jeffry Linzer Sr, MD, FAAP, FACEP
Jeffry Linzer Sr, MD, FAAP, FACEP, is the associate medical director for compliance for the Emergency Pediatric Group/Division of Pediatric Emergency Medicine, Children’s Healthcare of Atlanta and associate professor in the Departments of Pediatrics and Emergency Medicine at Emory University School of Medicine. Dr Linzer has been a member of the AAP since 1987 and is active in the AAP sections on Emergency Medicine and Transport Medicine. He is also a member of the AAP Committee on Coding and Nomenclature and serves as the AAP representative to the ICD-9-CM Editorial Advisory Board. Additionally, Dr Linzer has taken on the role as chair of the first ever pediatric topical advisory group (TAG) as ICD undergoes its 11th revision under the auspice of the World Health Organization. Dr Linzer is an expert in ICD guidelines and implementation and has been actively involved in the ICD-10-CM transition in the United States.

Coding for pediatric cardiology services can be confusing. Cardiac coding is extremely complex, and navigating your way through the guidelines can be a challenge at best. It is vital to understand the guidelines to increase compliance and revenue flow as well as reduce the burden of payer denials.

This webinar will

• Provide an overview of evaluation and management services relevant to pediatric cardiologists, including consultations and prolonged services.
• Briefly address National Correct Coding Initiative edits and the role of common modifiers in reporting physician services.
• Review the distinction between congenital and non-congenital as it relates to echocardiography and cardiac catheterization.
• Discuss cardiovascular monitoring services and coding.

Faculty: Ken Shaffer, MD, FACC, FAAP, and David Kanter, MD, FAAP
Ken Shaffer, MD, FACC, FAAP, is a board-certified cardiologist and Fellow of the American Academy of Pediatrics (AAP) and American College of Cardiology. Dr Shaffer chairs the newly formed Coding and Nomenclature Subcommittee under the AAP Section on Cardiology and Cardiac Surgery. He is a graduate of Johns Hopkins University School of Medicine. Dr Shaffer completed his residency at the Wilford Hall US Air Force Medical Center and received his fellowship training in pediatric cardiology at the Texas Children’s Hospital in Houston. He has served as a faculty member at the University of Texas Health Science Center in San Antonio. In 2004, Dr Shaffer joined Pediatrix Medical Group Cardiology as medical director of Children’s Cardiologist Associates in Austin, TX, where he currently practices.

David Kanter, MD, FAAP, has been a Fellow of the AAP for 26 years. He is a neonatologist who provided medical directorship of a large neonatology practice in West Palm Beach, FL, for which he continues to provide clinical support. For the past 3 years, he has served as vice president of medical coding for Pediatrix Medical Group, a national medical group focused on multiple collaborative service lines including neonatology; pediatric hospitalist, developmental, emergency, and intensive care; pediatric surgery; maternal-fetal medicine; and pediatric cardiology. Representing the country’s largest practicing group of pediatric cardiologists, the Pediatrix national medical group of cardiologists provides a full spectrum of care including fetal assessment, interventional catheterization, echocardiography, cardiovascular monitoring and stress testing, adult congenital and heart transplant support, and preventive care. Dr Kanter is board certified in pediatrics and neonatal-perinatal medicine, holds an MBA from the University of Florida, is CPC certified, and is a member of the AAP Perinatal Coding Committee under the Section on Perinatal Pediatrics.

When coding for pediatric hospital services, it can be confusing to navigate all of the Current Procedural Terminology (CPT®) guidelines. Pediatric patients can be normal newborns, sick, admitted under observation, intensive, or critical. Movement of patients from the emergency department (ED) to the intensive care unit or the floor to new or different physician groups complicates coding, as does the involvement of residents and advanced practice nurses. Hospital care requires knowledge of a wide array of codes and guidelines quite different from those that dominate office-based practice. This webinar will

• Provide you with an overview of guideline changes that affect newborn coding.
• Go over the differences between intensive and critical care.
• Discuss the issue of same-day admission and discharge to and from one level of illness to another and from one hospital site to another.
• Explain how to handle coding when a patient is admitted through your office, ED, observation, or other setting.
• Review hospital consultation coding.
• Identify when procedures can be reported separately and when they are bundled.
• Detail other hospital care coding guidelines and common issues.

Faculty: Richard Molteni, MD, FAAP
Richard Molteni, MD, FAAP, has had a career as a pediatrician, an academic neonatologist, and a physician executive in hospital administration. He is the former vice president and medical director of Seattle Children’s and former associate dean of the University of Washington and a professor of pediatrics. He continues to work part-time as a consultant for the Joint Commission Resources and Joint Commission International.

Dr Molteni was a charter member of the original American Academy of Pediatrics (AAP) Committee on Coding and Reimbursement (now Committee on Coding and Nomenclature [COCN]) and has been a member or consultant to the COCN throughout its existence. He was the first AAP pediatric member of the CPT Editorial Panel and an inaugural member of the CPT Assistant Board of Directors. He has authored chapters in the AAP Coding for Pediatrics manual and lectured widely in the areas of coding and payment.

Dr Molteni was past chairperson of the AAP Section on Perinatal Pediatrics (SOPPe) and long-standing member of the SOPPe Executive Committee, and a past member of the Committee on Fetus and Newborn. He is also currently a member of the Perinatal Pediatrics Speakers Bureau. He is a wealth of knowledge on CPT guidelines, particularly in the inpatient arena.

Pediatric encounters have become increasingly more complex. In order to relay that to payers, modifiers must be used and used appropriately to get paid for services rendered. Modifiers tell the payer that something out of the ordinary happened and you should be paid accordingly. In order to understand how to use modifiers appropriately you not only have to understand CPT guidelines, but payer edits systems as well. Recently Medicaid has been required to follow Medicare’s National Correct Coding Initiative (NCCI) edit system.

This webinar will

• Provide you with the explanation of the most commonly used modifiers in pediatrics
• Provide examples of when it is appropriate to use these modifiers
• Discuss how payer’s edit systems effect the use of modifiers and how you are paid
• Explain in detail the NCCI edit system and how to properly navigate it to be paid appropriately

Faculty: Joel Bradley, MD, FAAP
Dr Bradley is a pediatrician and fellow of the American Academy of Pediatrics (FAAP). He spent many years in private practice and now works as a Medical Director for a State Managed Medicaid. He has been a member of the AAP’s Committee on Coding and Nomenclature (COCN) since 1995. Dr Bradley is the past editor of the AAP’s “Coding for Pediatrics” and “Pediatric Coding Newsletter” and currently sits on COCN’s Editorial Advisory Board for all coding resources. He sat on the CPT Editorial Panel from 2004-2008 and is now the AAP’s CPT Advisor. Dr Bradley has given numerous coding presentations at the AAP’s National Conference and Exhibition and has always received exceptional marks.

The make up of pediatric practices is evolving, thanks in part to the medical home concept. Care plan teams are dominating the world of primary care and physicians are not alone in caring for their patients. Many practices have added nurse practitioners, physician assistants, care coordinators and other non-physician providers to help with the work load that is associated with caring for chronically ill, complex patients. In order to provide quality, comprehensive care physicians must rely on other pediatric providers to assist in the care coordination. However, while this care model makes sense, often times it comes with little financial support.

This webinar will

• Explain the CPT term “Other Qualified Health Care Professional”
• Discuss state scope of practice and how it impacts non-physician providers
• Explain how to integrate non-physician providers into the practice
• Address the confusing issue of “incident to” guidelines and challenges
• Go over issues with payer credentialing and associated payment

Faculty: Richard Tuck, MD, FAAP
Dr Tuck is a practicing pediatrician in a Federally Qualified Health Center and Medical Director for an innovative Physician Hospital Organization. He was a member of the AAP’s COCN from 1992 until June 2008. Dr Tuck was the AAP’s first representative to the RUC and, as such, a founding member of the RUC. Dr Tuck has given numerous coding presentations at the AAP’s National Conference and Exhibition and has always received high marks. In addition, Dr Tuck has extensive national experience in teaching Current Procedural Terminology (CPT) and International Classification of Diseases (ICD) coding to primary care physicians. Dr Tuck is also consulting editor for a well known pediatric coding newsletter.

Bright Futures is the gold standard for pediatric preventive medicine services. Knowing which services can and cannot be reported separately from the preventive medicine service exam code is vital for being paid appropriately for services rendered. It is also extremely important to understand how to code for each of the separately provided preventive medicine services as well as services provided on the same day that may be unrelated to the preventive medicine service.

This webinar will

• Provide you with a detailed understanding of the Bright Futures recommended preventive medicine services
• Explain all of the separately reportable preventive medicine services done in addition to the exam, including age-appropriate screenings
• Detail when it is appropriate and medically necessary to report a “sick” encounter in addition to a preventive medicine service
• Explain how to report non-preventive procedures done on the same day as a preventive medicine service

Faculty: Joel Bradley, MD, FAAP
Dr Bradley is a pediatrician and fellow of the American Academy of Pediatrics (FAAP). He spent many years in private practice and now works as a Medical Director for a State Managed Medicaid. He has been a member of the AAP’s Committee on Coding and Nomenclature (COCN) since 1995. Dr Bradley is the past editor of the AAP’s “Coding for Pediatrics” and “Pediatric Coding Newsletter” and currently sits on COCN’s Editorial Advisory Board for all coding resources. He sat on the CPT Editorial Panel from 2004-2008 and is now the AAP’s CPT Advisor. Dr Bradley has given numerous coding presentations at the AAP’s National Conference and Exhibition and has always received exceptional marks.

Evaluation and management (E/M) services are the main revenue-generating source for primary care physicians. That is why it is extremely important for physicians and their coding staff to understand E/M documentation guidelines and requirements for code levels. Over-coding and under-coding can be detrimental to a practice

By attending this webinar, you will

• Learn the Centers for Medicare & Medicaid Services E/M guidelines (1995 and 1997) and understand the differences and which to use in your practice.
• Learn the requirements to obtain specific code levels (eg, 99212 or 99213).
• Learn the 3 key components and understand the role played by each.
• Review common pediatric presenting problems (eg, asthma) and how different scenarios related to the problem are coded on the spectrum (eg, 99212 versus 99213 versus 99214).
• Understand the importance of medical necessity and how it affects E/M coding.
• Understand time-based E/M coding.
• Understand the pitfalls of electronic medical record use in coding E/M service levels.

Faculty: Joel Bradley, MD, FAAP
Dr Bradley is a pediatrician and Fellow of the American Academy of Pediatrics (AAP). He spent many years in private practice and now works as a medical director for a state-managed Medicaid program. He has been a member of the AAP Committee on Coding and Nomenclature (COCN) since 1995. Dr Bradley is past editor of AAP publications Coding for Pediatrics and AAP Pediatric Coding Newsletter™ and currently sits on the COCN Editorial Advisory Board for all coding resources. He sat on the Current Procedural Terminology Editorial Panel from 2004 to 2008 and is now the AAP’s CPT Advisor. Dr Bradley has given numerous coding presentations at the AAP National Conference & Exhibition and has always received high marks.

Increasingly, payers will extrapolate alleged overpayments and demand across-the-board repayments, even for valid claims. Worse, carriers will reduce payments on future claims as a means of correcting alleged overpayments on past claims. Most repayment demands are based on carrier mis-interpretation of CPT and ICD guidelines. Pediatricians need to be prepared to challenge inappropriate repayment claims. Otherwise, faced with unstable revenue and disbursements, pediatric practices will not be able to maintain operations. Knowing correct coding and having documentation to support the case against repayment demands will protect and preserve practice revenue and diminish charges of fraudulent billing. This webinar will provide pediatricians and practice staff with the tools needed to effectively minimize the occurrence of repayment demands as well as challenge inappropriate repayment claims. By the end of the webinar, participants will

• Apply key steps in responding to payer take-back demands.
• Use coding guidelines and documentation to build your case
• Learn how to include key provisions in contracts that protect the practice and define the scope of take backs and repayments.
• Be aware of state regulations on repayments.
• Incorporating appropriate coding and documentation to minimize carrier take back demand

Faculty: Kathleen Cain, MD, FAAP
Dr Cain is an entrepreneurial pediatrician who has built a thriving practice from the ground up. She learned business strategy and negotiation as a means of financial survival. For the last 6 years, she has been a member of the American Academy of Pediatrics (AAP) Private Payer Advocacy Advisory Committee (PPAAC). Her interest in the management of a financially successful practice and her relationship and successes with managed care have afforded Dr Cain opportunities to be a leader and teach others that good business is good medicine. As a member of the PPAAC, she has had the opportunity to address many coding and payment concerns of pediatricians. She has lectured and written articles for the AAP on coding, Current Procedural Terminology, and the Resource-Based Relative Value Scale.

As educated parents want more informed participation in all their children’s medical decision-making, there is a demand for convenient and timely access to non–face-to-face services including advice, consultation, and treatment by e-mail and telephone. Pediatricians find themselves dispensing more advice, prescriptions, and treatment over the phone during and after office hours. This webinar highlights codes you can report for non–face-to-face care. These services include prolonged physician service without direct (face-to-face) patient contact (CPT codes 99358–99359), medical team conference without direct (face-to-face) contact with patient or family (CPT codes 99367–99368), care plan oversight (CPT codes 99374–99375), telephone services (CPT codes 99441–99443), and online medical evaluation (CPT code 99444). There is also a section in CPT for nonphysician non–face-to-face services. These services include telephone services (CPT codes 98966–98968) as well as online medical evaluation (CPT code 98969). This webinar will provide guidelines for appealing for payment for non–face-to-face services and provide AAP resources to help you do so.

Faculty: Richard Tuck, MD, FAAP
Dr Tuck is a practicing pediatrician in a large pediatric practice. He was a member of the AAP’s COCN from 1992 until June 2008. Dr Tuck was the AAP’s first representative to the RUC and, as such, a founding member of the RUC. Dr Tuck has given numerous coding presentations at the AAP’s National Conference and Exhibition and has always received high marks. Dr Tuck is also a member of the Editorial Advisory Board for a well known pediatric coding newsletter.

In an effort to control costs, third party payer claims processing and Special Investigative Units (SIU) are conducting audits of claims to prevent improper payments and overpayments. Pediatricians, practice management, and coding staff need to be prepared to protect the practice from payer audits as well as be able to challenge audit results. Otherwise, faced with unstable revenue, potential fines, and liability, the viability of the pediatric practice will be threatened. This webinar will provide guidance on ways to minimize the risk of a payer audit as well ways to effectively challenge payer audit results. By the end of the webinar, participants will:

• Apply key steps in responding to payer audits
• Apply appropriate documentation
• Learn how to include key provisions in contracts that protect the practice and define the scope of payer audits and follow up activities
• Learn tips to minimize payer audits
• Learn tips to implement internal audits

Faculty: Richard Lander, MD, FAAP
Dr Lander is a managing partner in a four- person pediatric private practice in New Jersey. He attended the University of Cincinnati, received his M.D. from the Autonomous University of Guadalajara, Mexico, and completed his pediatric residency at the University of Medicine and Dentistry of New Jersey where he served as chief resident. He is currently a Clinical Professor of Pediatrics at UMDNJ.

As the President of the NJ-AAP Chapter, he initiated and remains as co-chair of the Pediatric Council that has met quarterly over the past five years with the medical directors who serve the New Jersey area. Nationally, Richard serves on the AAP Section on Administration and Practice Management (SOAPM) as immediate past chairperson, served on the Committee on Child Health Financing, and is SOAPM’s representative to the Private Payer Advocacy Advisory Committee (PPAAC). In addition, he represents the AAP on the MinuteClinic, Inc. quality advisory panel. Since 1989, he has been an AAP Regional CPT Trainer and has lectured on coding and practice management for the AAP, private enterprises, and Pediatric Residency Programs. He serves on and contributes to several coding newsletter editorial boards.