Coding for Quitting

Cigarette smoking is the leading cause of preventable death according to the Centers for Disease Control and Prevention (CDC)[1].  The LEADING cause of PREVENTABLE death.  The CDC also states that cigarette smoking accounts for more than 480,000 deaths every year, or 1 of every 5 deaths.  Additionally, their statistics indicate that nearly $170 billion is spent annually in the United States[2] on medical care to treat smoking-related disease in adults.  This does not include what is spent to treat victims of secondhand smoke.

quitWhat does this have to do with coding?  Health care providers are positioned to have a positive impact on someone’s decision to quit smoking as well as their success.  The importance of encouraging patients to quit smoking led to the creation of two Current Procedural Terminology (CPT) codes just for smoking and tobacco cessation counseling.  CPT 99406 is used to report a smoking and tobacco use cessation counseling visit that lasts between three and ten minutes.  A counseling visit that lasts more than ten minutes is reported with CPT code 99407.  Either of these codes can be reported with an evaluation and management (E/M) code utilizing modifier 25 to indicate that the time spent on the E/M portion of the visit was distinctly separate from the time spent counseling for smoking and tobacco use cessation.  As with all services, there must be sufficient documentation in the medical record to support the charge for this counseling.  That documentation must include the face-to-face time, cessation techniques and resources discussed as well as planned follow up.

While encouraging people to quit smoking seems like a no-brainer, providing health care professionals with specific CPT codes to document their attempts is a huge step in the right direction for tracking the outcomes.  The combined impact of television and radio ads plus written health warnings and direct feedback from one’s healthcare provider will hopefully result in fewer smokers in the United States.

Go document those efforts.

Disclaimer: This Blog is for educational purposes only as well as to provide general information and a general understanding of the topics discussed.  The Blog should not be used as a substitute for legal advice and you are advised to seek additional information from your insurance carriers, Medicare and/or Medicaid agencies for additional criteria and regulations regarding these services.

Operation Vaccination

Did you know that August is National Immunization Awareness Month (NIAM)?  Per the Centers for Disease Control and Prevention, “NIAM was established to encourage people of all ages to make sure they are up to date on the vaccines recommended for them.” While the CDC uses this month to raise awareness about the important role that vaccines play in preventing serious, and sometimes deadly diseases, it is also a great time for coders to review the Current Procedural Terminology (CPT) and make sure they are applying them correctly.vaccine

There are several things to consider when coding for vaccinations including whether or not counseling was provided, how many components are administered, the age of the patient, and the route of administration.  For patients under the age of 18, CPT code 90460 covers the first component administered via any route with counseling by a physician or other qualified health professional. Code 90461 covers each additional vaccine or component.  Parents or guardians of patients in this age range typically have questions about the recommended vaccinations, thus the specific code.  However, the documentation for that date of service must include the vaccine administered, patient risk factors or concerns discussed, plus any information shared with the patient and/or family.  An example would be administration of a DTaP vaccine to a six-year-old patient when counseling is provided to the parent/guardian about possible side effects or other concerns.  This single injection consists of diphtheria, tetanus and pertussis components and should be coded as 90460 and 90461×2 to cover all three components and the counseling.

For patients over the age of 18 who do not require the detailed counseling, CPT code 90471 captures the first component administered via any type of injection (percutaneous, intradermal, subcutaneous or intramuscular) nasal sprayand 90472 should be used for each additional injected component.  Codes 90473 (first component) and 90474 (each additional component) are used for reporting only intranasal or orally administered vaccines.  All of these codes can by combined to report any number of vaccines or components administered via any route.  A provider can also report counseling related codes and non-counseling codes for the same encounter if the situation supports it.  An example would be if a patient under the age of 18 presented for a meningitis vaccine and influenza vaccine at the same time.  If counseling was provided for the meningitis vaccine, code 90460 would be correct. Since no counseling was necessary for the influenza vaccine, 90472 (second component, no counseling) should be reported.

Providers should also include charges and procedure codes for the vaccine supply plus the ICD-10-CM code of Z23 – encounter for immunization.  Coding for immunizations can be tricky; I hope this overview will help you master the task.

Happy coding!

Tips for Using the ICD-10-CM Code Book


The implementation of ICD-10-CM brought many changes to the world of coding.  Most notable was the increase in available diagnosis codes from 14,000 to 68,000 when ICD-10-CM was first implemented in October 2015. With the additions for FY 2017 now pushing 70,000, it is crucial to follow the conventions, symbols, and guidelines provided throughout the book.

The conventions are instructional notes incorporated within the ICD-10-CM codebook.  It is important to understand these conventions because they explain the format and structure of both the index and the tabular list.  These include abbreviations such as NEC (not elsewhere classified) and NOS (not otherwise specified), brackets enclosing synonyms or manifestation codes, parentheses enclosing supplemental words, and colons to signify an incomplete term.  “NOTES”, which is located immediately under a code title, is a convention clarifying the content of the category and often providing examples.  There are also instructions for ‘includes’, ‘excludes’, ‘code also’, and ‘code first’ which help guide you through the coding process.

There are also specific symbols and color-coding located in the tabular list.  The symbol seen most often is the ‘additional character required indicator’ placed in front of codes.  This will be a 4, 5, 6, or 7 in a red circle next to the code prompting the coder to read further for a more specific code choice.  There can also be a 7 within a blue circle to indicate the final code should include a seventh character following one or more “X” placeholders.  Some symbols appear to the right of the code columns and these may include age and/or sex conflict warnings.  An example would be an “A” in red next to the codes for age related cataract of the eye.  That “A” clarifies that the code may only be applied to a patient in the age range of 18 to 124.  A sex conflict symbol appears next to conditions that can only exist in male or female patients such as cervical or prostate cancer.  There are other symbols defined in the front of the ICD-10-CM codebook that should be referenced for correct coding practices.

The guidelines are extensive instructions provided by the Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics (NCHS) and approved by the American Hospital Association (AHA) and the American Health Information Management Association (AHIMA).  These four organizations make up the Cooperating Parties for the ICD-10-CM.  The coding rules defined in the guidelines were developed to accompany and compliment the conventions.  Each chapter of the ICD-10-CM has its own specific guidelines that clarify the conventions used in that chapter in addition to code sequencing instructions and other important information for that section of codes.

These are just some highlights of the instructional information provided for you. Please refer to your codebook for the complete information.  Having a clear understanding of the conventions, symbols and guidelines will help ensure the accurate selection of diagnosis codes.

My CPC Story

I began my career working for a small-town family practitioner.  He was rebuilding his private practice after spending many years working in a trauma center.  Initially, I was his only employee and responsible for many aspects of the practice – running the front desk, rooming patients and assisting with procedures.  As his practice grew and we added additional staff, I was elevated to role of office manager.  Billing and coding at that time was very different than it is today.  We did not have electronic health records (EHRs) or the technology to submit medical claims electronically.  I worked side by side with the physician to determine correct codes and entered the data on paper claims that were mailed to insurance carriers.  That early exposure to the world of coding sparked a desire to learn more and propelled me down a path I did not anticipate at the time.


After that first small practice I worked for another larger practice where I witnessed the implementation of EHRs and the use of clearinghouses to forward medical claims via the internet.  While these advances have helped streamline coding processes, coders must still adhere to their professional standards and ensure the accuracy of everything they submit.  It was while working with these new technologies that I realized I wanted to take my coding expertise to a higher level and obtain my certification.  After researching the different avenues to becoming a CPC, I decided to tackle it through a self-study course.  I joined a local AAPC chapter to take advantage of the networking opportunities and get to know the members since that is where I would be taking the exam – the five hour and forty minute exam.  After months of preparation and convincing myself I still wasn’t ready, the clock was ticking and it was time to sit for the exam.  Looking back, I realize how helpful it was to be in a familiar setting and with people I knew on that stressful day.  I used almost all of the allotted time checking and rechecking my answers before submitting the exam. It was a couple of anxiety riddled weeks before I learned my fate.  I passed!


Earning the CPC certification has opened many doors for me.  I advanced from medical coding to auditing and chart abstraction.  In April 2016 I earned the instructor certification and now get to share my passion for coding with others as they work towards their own certification.


What’s your CPC story?

Understanding the Importance of Your Clinical Summary

If you have been to see a doctor lately you’ve most likely been handed a sheet of paper (or several) at the end of your appointment. Do you take the time to review this document or do you just toss it aside? This document is called your clinical summary. In addition to providing the details of your appointment, these documents are a part of requirements set by the Centers for Medicare & Medicaid Services (CMS) known as “meaningful use”.

The American Recovery and Reinvestment Act of 2009 established incentive payments to eligible professionals, hospitals, critical access hospitals, and Medicare Advantage Organizations “to promote the adoption and meaningful use of interoperable health information technology (HIT) and qualified electronic health records (EHRs).” Tied to this Act is the EHR Incentive Program that provides incentive payments for certain healthcare providers to use EHR technology in ways that can positively impact patient care. To meet the objective of this program, and receive the incentive payments, providers can attest that they are meaningfully using their certified EHR systems by providing patients with an informative summary of their visit. Conversely, providers who did not meet the meaningful use requirements by 2015 are subject to a reduction in their Medicare reimbursements.

Now that you know why you are getting this document, what should you do with it? All of the information is pulled from your medical record with that provider, so you should review it for accuracy. Does it list your allergies correctly? How about your current medications? Most summaries also include the procedure and diagnosis codes used to bill for the services you received. It is important to review all of this information to prevent inaccuracies within your permanent medical record as well as to understand what will be submitted to your insurance company. I recommend saving this document to compare with the explanation of benefits (EOB) mailed to you from your insurer. To protect your privacy, most EOBs no longer display the actual procedure codes that are being processed – only a vague description such as medical care or lab services. By comparing the EOB to the clinical summary you should be able to justify what was billed on your behalf and potentially identify erroneous charges.

Most EHR systems are populated by checking boxes on a computer screen. Sometimes the wrong box is checked completely by accident; however, there are unscrupulous providers who submit incorrect claims for the sole purpose of increasing their revenue. That behavior constitutes fraud and can cost Medicaid, Medicare, and private insurance companies billions of dollars every year. Be an informed patient and take a look at that clinical summary.

Welcome to Code Words


Welcome to Code Words. I’m Cindy Jones, CPC, CPMA, CPC-I, a Coding Specialist here at Health Integrity. Each month I’ll be bringing you my thoughts on aspects of medical coding ranging from consumer basics to nitty-gritty CPC certification knowledge.  We’ll cover ICD-10 guidelines, fraudulent billing, new procedure codes, and a lot more.

All of our blog posts will be posted here and there’s lots more to come so check back often!

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