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HEALTHCAREBUSINESS MONTHLYCoding | Billing | Auditing | Compliance | Practice Management

June 2015

As Telemedicine Expands, Know Criteria: 22 It’s a cost-effective alternative to face-to-face encounters

Informed Consent Not Just a Signature: 38 Set treatment expectations to improve patient satisfaction

Escape “Incident-4” Billing: 42 When an RN bills under an NP, you’re liable

CHAPTER OF THE YEAR Albany, New York



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www.aapc.com June 2015 3

[contents]■ Coding/Billing ■ Auditing/Compliance■ Practice Management

[continued on next page]

Healthcare Business Monthly | June 2015

COVER | Chapter of the Year | 14

Albany Is Back and Better than Ever Michelle A. Dick

22 Get to Know Telemedicine Payment Criteria

Nancy G. Higgins, CPC, CPC-I, CIRCC, CPMA, CEMC

41 Coder Assists Physician in Developing a TCM Tool

Michelle A. Dick

44 Conduct a Security Analysis for Your Practice

Joette Derricks, MPA, CMPE, CPC, CHC, CSSGB

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navigating thE nEw frontiErdestination: Coding, billing and compliance excellence

Mark your calendars now for the 15th annual Optum360™ Essentials Conference. Whether you’re looking to focus on your continuing education, network with experts in your field, or ensure your skills stay current and relevant in this ever-changing world of coding, billing and compliance, Optum360 Essentials is truly, well, essential.

why should you go?

to learn more and register, visit optumcoding.com/essentials.

• Attend 40+ educational sessions.

• Participate in iCd-10 boot camps.

• network with industry experts.

• Explore strategies, techniques and best practices for hospitals and physician practices.

• Stay current with updates on 2016 iCd-10-CM/PCS, CPT, HCPCS and dRg codes, iPPS and OPPS.

• Learn from nationally recognized experts on medical coding, billing and compliance.

• Attend vetted presentations that are reviewed and approved by clinical experts.

• gain valuable insight during expert panel sessions and ask them your most difficult questions.

• We’re back in Vegas, baby!

4 Healthcare Business Monthly

Healthcare Business Monthly | June 2015 | contents

18

48

54

■ Conference10 Key Players Discuss

HEALTHCON 2015 Excitement Michelle A. Dick

■ AAPC Chapter Association

12 If Opportunity Doesn’t Knock, Build a Door

Peter Davidyock, CPC, CPMA

■ Coding/Billing18 Reporting an E/M Service on

the Same Day as a Procedure Faith C.M. McNicholas, RHIT, CPC, CPCD,

PCS, CDC

24 No Stress EUS Lynn Garrity, CPC, COC

26 Critical Thinking for Coding Critical Care Services

Lori Carlin, CPCO, CPC, COC, ACS-E/M

30 Get a Clear Picture of Myelography Reporting

G.J. Verhovshek, MA, CPC

32 ICD-10 Supports All Types of Hernias

Rhonda Buckholtz, CPC, CPMA, CPC-I, CENTC, CGSC, COBGC, CPEDC

36 58: The “Goes Beyond” Modifier G.J. Verhovshek, MA, CPC

■ Practice Management

38 Informed Consent: A Process, Not Just a Signature

Debra Cascardo, MA, MPA, CFP

■ Auditing/Compliance42 Don’t Let Incident-to Turn into

“Incident-4” Billing Michael D. Miscoe, JD, CPC, CASCC, CUC,

CCPC, CPCO

48 Risk Assessment High Priorities Marcia L. Brauchler, MPH, FACMPE, CPC,

COC, CPC-I, CPHQ

52 Building a HIPAA Toolbox Julie Roth

■ Added Edge54 Grow as a Pro Angela Clements, CPC, CEMC, COSC, CCS

■ Coder’s Voice56 Interview with a Coder Denis Rodriguez, COC, CASCC

DEPARTMENTS7 Letter from the CEO

8 Letters to the Editor

9 Healthcare Business News

13 Local Chapter News

29 A&P Tip

37 ICD-10 Quiz

66 Minute with a Member

EDUCATION58 Newly Credentialed Members

Online Test Yourself – Earn 1 CEU

www.aapc.com/resources/publications/ healthcare-business-monthly/archive.aspx

COMING UP: • Modifier 78 • Kidney Transplants • Autism • Inpatient • Coding Opportunities

On the Cover: Albany, New York, 2014 Chapter of the Year Award recipients look like a million bucks standing on the Million Dollar Staircase of the New York State Capitol building. Cover photo by Christina Primero Photography (www.primerophoto.com/).

ZHealth Publishing, LLCwww.zhealthpublishing.com


Volume 2 Number 6 June 1, 2015Healthcare Business Monthly (ISSN: 23327499) is published monthly by AAPC, 2480 South 3850 West, Suite B, Salt Lake City UT 84120-7208, for its paid members. Periodicals Postage Paid at Salt Lake City UT and at additional mailing office. POSTMASTER: Send address changes to: Healthcare Business Monthly c/o AAPC, 2480 South 3850 West, Suite B, Salt Lake City UT 84120-7208.

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CPT® copyright 2014 American Medical Association. All rights reserved.

Fee schedules, relative value units, conversion factors and/or related components are not as-

signed by the AMA, are not part of CPT®, and the AMA is not recommending their use. The

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Here are some great reasons:

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June 2015

Ask the Legal Advisory BoardFrom HIPAA’s Privacy Rule and anti-kickback statute, to compliant coding, to fraud and abuse, there are a lot of legal ramifications to working in healthcare. You almost need a lawyer on call 24/7 just to help you make sense of all the new guidelines. As luck would have it, you do! AAPC’s Legal Advisory Board (LAB) is ready, willing, and able to answer your legal questions. Simply send your health law questions to [email protected] and let the legal professionals hash out the answers. Select Q&As will be published in Healthcare Business Monthly.

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Letter from the CEO

Turn to AAPC as ICD-10 ApproachesI enjoyed meeting so many of you at

HEALTHCON, March 30 - April 1, in Las Vegas. I’m always impressed and grateful for the enthusiasm and interaction I see at our national conference. The breadth of exper-tise and curiosity about improving our field and healthcare is exciting. That same week, many of us anticipated a Senate vote on a plan to replace the Sustain-able Growth Rate (SGR), not only for the promised improvement in how healthcare providers are paid but also to see if anything regarding ICD-10 would be added, as it was last year.

Congress Remains Positive About ICD-10Last year, Congress postponed ICD-10 im-plementation due to provider, payer, and ven-dor preparation and testing worries. The ad-ditional year has allowed these groups to learn, equip, and test systems. The House Energy and Commerce Committee held a positive hearing this February. Finance Committee Chairman Orrin Hatch (R-Utah) responded to a report by the Govern-ment Accounting Office, saying, “Provid-er outreach and responsiveness to stakehold-er concerns by CMS have kept the agency on track to upgrade to the next level of health-care coding.” We were encouraged to see no mention of ICD-10 when President Obama signed the bill into law later in April, meaning the im-plementation date remains October 1, 2015. The new law promises a revised, more pre-dictable Medicare payment schedule for phy-sicians and discontinued use of Social Securi-ty numbers on Medicare identification cards.

What Does This Mean for You?We know that many are still learning ICD-10. There’s still time. AAPC has several print and online resources, onsite boot camps, and local chapter events to help you prepare. You can find them on our website or by calling us. The Centers for Medicare & Medicaid Ser-vices, Workgroup for Electronic Data Inter-change, and other organizations also offer free or low-cost resources. Members have until the end of the year to ei-ther pass an ICD-10 proficiency assessment or complete an online assessment course to retain AAPC credentials. This assessment proves to employers and peers that AAPC members are demonstrably proficient in ICD-10 coding. We are part of a tremendous movement in healthcare. Repealing the SGR payment sys-tem and implementing ICD-10 will benefit both providers and patients. It’s exciting to be a part of these momentous changes to our healthcare system. We’re in this together, and together we’ll persevere.

Sincerely,

Jason J. VandenAkkerCEO

We were encouraged to see no mention of ICD-10 when President Obama signed the bill into law later in April, meaning the implementation date remains October 1, 2015.


Please send your letters to the editor to: [email protected] to the Editor

Clarification on Incident-to RequirementsThe article “99211: Not So Simple” (April, pages 26-27) stated that to meet incident-to requirements, “The nurse must follow an established, written care plan for that particular patient, to which there may not be any changes.” To clar-ify, the article should have stated, “The

nurse must follow an established written care plan for that particular patient, to which only the physician may make a change.” The Centers for Medicare & Medicaid Services’ (CMS) precise re-quirement appears in chapter 15, section 60 of the Medicare Benefit Policy Manual (cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/bp102c15.pdf), as shown in bold text:

... to have …[a] service covered as incident to the services of a physician, it must be performed under the direct supervi-sion of the physician as an integral part of the physician’s per-sonal in-office service. As explained in §60.1, this does not mean that each occasion of an incidental service performed by a nonphysician practitioner must always be the occasion of a service actually rendered by the physician. It does mean that there must have been a direct, personal, professional service furnished by the physician to initiate the course of treatment of which the service being performed by the nonphysician practitioner is an incidental part, and there must be subsequent services by the physician of a frequency that reflects the physician’s continuing active participation in and management of the course of treatment. In addition, the physician must be physically present in the same office suite and be immediately available to render assistance if that becomes necessary.

There may be changes in the course of treatment over time, but a phy-sician — not the nonphysician practitioner (NPP) billing incident-to — is required to make those changes. In other words, the NPP can follow the physician’s instructions/course of treatment, but cannot independently revise the plan of care and still bill incident-to.

Felicia Owens, CPC, CEMC

Medical Necessity Doesn’t Always Equate to Medical Decision-makingRegarding “How Medical Necessity Fits Into E/M Leveling” (April, pages 28-29), I agree that medical necessity is the overreaching fac-tor when selecting an evaluation and management (E/M) service lev-el; however, one must keep in mind that medical decision-making (MDM) and medical necessity are not always equal, and it’s not al-ways true that medical necessity drives MDM.

For instance, you can calculate straightforward MDM using the point system, but the patient may still demonstrate medical necessity for a comprehensive or detailed interval history and exam.To cite one example, a comprehensive or detailed interval history and exam may be required to determine if an established patient with a chronic illness is in control of his or her condition. If the patient is in control, the MDM may be straightforward — but that does not mean there wasn’t medical necessity for the more extensive interval history and exams (and a higher level E/M). Medical necessity and nature of the presenting problem often equate to MDM, but not always. Many organizations require that MDM be one of the elements considered when calculating E/M levels for estab-lished patients; however, neither the American Medical Association (AMA) nor CMS require this. Instead, the rules state that you must consider two of three elements (history, exam, and MDM). If MDM were required to establish medical necessity, official guidelines would mandate you count MDM when selecting the level for all E/M services. Uncritically equating medical necessity with MDM penalizes pro-viders, forcing them to be paid for codes lower than the rules would support, just because the patient has achieved stability due to good outcome medical practice.

Barbara J. Cobuzzi, MBA, CPC, CENTC, COC, CPC-P, CPC-I, CPCO

B20 Is “With Symptoms”In the article “Review HIV, ARC, and AIDS-related Encounters” (January, pages 12-16), under Results of HIV Testing, No. 4: Posi-tive with symptoms, there is a typo that could confuse some of us. It says “Coding for HIV results - positive without symptoms” with the code assignment as “B20 for HIV disease.” It should be “positive with symptoms.” When a patient is symptomatic, we use B20 Human im-munodeficiency virus [HIV] disease.

Blanca M. Vasquez, CPC-A

NABReady to Listen. Prepared for Change.

www.aapc.com


April 2015

HEALTHCON AAPC National Conference Issue

2015 Pain Medicine Billing Changes: 36 Know code and epidural steroid injection updates

Therapy Setting Specialty Programs: 42 Mull over the benefits and drawbacks

Target Risky Billing Patterns: 46 Use benchmarking to compare your E/M levels

April2015_HBM.indd 1 12/03/15 2:23 am

AAPC’s 2014 Salary Survey

Pneumonia Vaccines Pose Conflict: 28 Medicare billing and CDC recommendations don’t align

Lead with Emotional Intelligence: 52 Let behavioral sciences motivate your practice

OPPS Trends Continue in 2015: 56 Another year of more packaging and greater payments

www.aapc.com


January 2015

See HowYour Salary Stacks Up

Per ICD-10-CM guidelines:

Apply Z21 Asymptomatic human immunodeficiency virus [HIV] infection status when the patient without any documentation of symptoms is listed as being “HIV positive,” “known HIV,” “HIV test positive,” or similar terminology. Do not use this code if the term “AIDS” is used or if the patient is treated for any HIV-related illness or is described as having any condition(s) resulting from his or her HIV positive status; use B20 in these cases.

Healthcare Business Monthly


Healthcare Business News

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In an April 6 press release, the Centers for Medicare & Med-icaid Services proposes a mental health parity rule for Med-icaid and the Children’s Health Insurance Program (CHIP). The proposed rule “will strengthen access to mental health and substance use disorder benefits for low-income Americans” by aligning benefits required of private health plans and insurance, according to the release.Provisions of the Mental Health Parity and Addiction Equity Act of 2008 ensures coverage for these services are no more re-strictive than for medical and surgical services.The proposed rule, according the press release, will ensure:

... all beneficiaries who receive services through man-aged care organizations or under alternative benefit plans have access to mental health and substance use disorder benefits regardless of whether services are pro-vided through the managed care organization or an-

other service delivery system. The full scope of the pro-posed rule applies to CHIP, regardless of whether care is provided through fee-for-service or managed care.

Currently, states have flexibility to provide services through a managed care delivery mechanism using en-tities other than Medicaid managed care organizations, such as prepaid inpatient health plans or prepaid ambu-latory health plans.

The proposal would continue this same flexibility for states and ensure enrollees of a Medicaid managed care organization “re-ceive the benefit of parity in services provided to them through these various means.”You can read the official Federal Register proposed rule notice online at https://s3.amazonaws.com/public-inspection.federalregister.gov/2015-08135.pdf.

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NATIONAL CONFERENCE

Key Players Discuss HEALTHCON 2015 ExcitementAAPC leaders share their thoughts about this year’s national conference.

By Michelle A. Dick

AAPC aims to provide a memorable national conference experience for members. What matters most is that members gather to share ex-pertise and to bond, and that they leave feeling smarter and inspired to do their best in their current situation, be that as a student, cod-er, biller, auditor, physician, or practice manager. To see if we hit the mark this year, Healthcare Business Monthly (HBM) sat down with National Advisory Board President Jaci Johnson Kipreos, CPC, COC, CPMA, CPC-I, CEMC, and AAPC Chapter Association Board of Directors Chair Barbara Fontaine, CPC, to discuss what they thought of HEALTHCON 2015 in Las Vegas.

HBM: What did you like about having HEALTHCON in Las Vegas?

Kipreos: There are so many great places to eat. Each time I go to Vegas, there are more new restaurants. I think it’s great to have ac-cess to so many shows all at one location. And if you like to people-watch, it’s a great location for that.Fontaine: It’s easy to get to and easy to get around. There’s a lot to do for everyone.

HBM: Did you like the venue being at Paris/Bally’s Las Vegas Hotels? If so, why?

Kipreos: I liked that Paris and Bally’s were connected and we had an opportunity to see both. The location was perfect on the strip; we had easy access to so many other sights.Fontaine: This was a more compact venue than most, so it made it easy to get around.

HBM: What was the best thing you ate and at which restaurant?

Kipreos: There was a lovely salad at Hexx in Paris. It was butter let-tuce with a simple vinaigrette and toasted cocoa beans. Also, I tried Giada’s restaurant and all the food was wonderful there.Fontaine: Bobby Flay’s Mesa Grill, and here’s what I had: New Mexican spice rubbed pork tenderloin with bourbon-ancho chile sauce and sweet potato tamale with crushed pecan butter. It was wonderful!

HBM: How was the food at the conference?

Kipreos: The breakfast selection had a nice variety and we had healthy options at every meal. The food at the exhibitor reception on Sunday was very tasty and the Paris bistro atmosphere was a re-ally nice touch.Fontaine: The awards dinner and dessert were great!

HBM: Did you see any shows or partake in any of the entertainment activities that Vegas offers?

Kipreos: No, not this time.Fontaine: Elton John and the Million Dollar Piano. It was fantastic!

HBM: Which general sessions and/or breakout sessions did you find most informative?

Kipreos: The legal roundtable is always a favorite of mine — and absolutely, Jason’s opening comments about all things AAPC is nev-er to be missed.Fontaine: Well, I’m an ortho geek, so I really enjoyed those sessions, and I also like the AAPC update at conference from CEO Jason VandenAkker. If you couldn’t find good education and information, you just weren’t looking!

HBM: Did you attend or participate in any of HEALTHCON fun activities, such as Run4One, ICD-10 Feud, the keynote address from the comedian (Laughter Is the Best Medicine), or any prizes and giveaways? If so, what is your reaction?

Kipreos: The Run4One had a very impressive debut. I thought it was a great idea to have an event that created an atmosphere of ca-maraderie for the group. I hope we continue to have this event.Fontaine: Agreed! The Run4One was great, and more people should come. It’s a great time even if you didn’t walk or run.


HEALTHCON 2015

NATIONAL CONFERENCE SNAPSHOT

HBM: Did you make any new friends or reconnect with a friend you haven’t seen in a while?

Kipreos: Oh my gosh, I always connect with old friends at confer-ence. We look forward to knowing we will see each other every year. Fontaine: Yes, several, including a former member of my chapter and a friend I knew from Arkansas before I even joined AAPC. Old friends are the best, but new friends are special, too. We have some wonderful new people on the AAPCCA board of directors.

HBM: What did you enjoy about the awards ceremony?

Fontaine: That I got to participate! I helped announce the 2014 Chapter of the Year, Albany, New York, and awarded the quilt and clock that were raffled to raise money for the scholarship fund. That was exciting! I also introduced the retired AAPCCA board mem-bers and the new ones, too.

HBM: Did you hear of anyone “striking it rich” or winning a hefty amount gambling?

Kipreos: YES! But it wasn’t me. Fontaine: Brenda Edwards said she won $158. Woo hoo!

HBM: Was there anything that inspired you at conference?

Kipreos: I’d have to say, watching the conference team work so hard to make everything run smoothly for the attendees inspired me.Fontaine: Talking to officers and members, and being given the chance to share experiences and ideas. From new members to the well-established members, this conference had something for every-one. I had a fantastic time!

Michelle A. Dick is executive editor at AAPC.


By Peter Davidyock, CPC, CPMA

There may come a time in your personal or professional life when you know you are ready, willing, and able to take on new op-portunities to either advance your career or positively influence someone else’s life, but none present themselves. As Milton Berle put it, “If opportunity doesn’t knock, build a door.”

AAPC Has the Tools You Need to SucceedThink of AAPC as your local DIY. Member-ship grants you access to all the tools you need to build doors that lead to new opportunities.

Door No. 1: Training If a first-time credential or a subsequent cre-dential is your current goal, you can build that door through specialized training. If you’re new to coding, you may need med-ical terminology and anatomy before pro-ceeding to a medical coding curriculum. If you are an experienced coder seeking an additional credential, you may only need a study guide or practicum prior to schedul-ing an exam. To get started, go to www.aapc.com/training/.

Door No. 2: Continuing EducationRegardless of your experience level, you can benefit from attending AAPC webinars and conferences. Local chapter workshops are also a great source for learning.

To find opportunities for learning, go to www.aapc.com/medical-coding-education/.

Door No. 3: NetworkingNetworking is another essential tool. Local chapter meetings provide opportunities to meet professionals who may be working in the area you want to work in. Asking chap-ter members for a job is not building a door, but is more like knocking on someone else’s door. To build your own door, demonstrate an interest in their areas of expertise, voice a desire to work in those fields, and ask how they came to those positions and what ed-ucation and experience is required. Follow-ing through on their advice and cultivating these professional relationships will not only help you build doors, but open them to new opportunities.Get started today by visiting https://www.aapc.com/networking/.Networking also happens in cyberspace. AAPC forums are one of the most effec-tive tools AAPC has to offer. The various fo-rums offer a wealth of information to help you build doors: Talk with like-minded indi-viduals who may have answers to your ques-tions; stay current on what is going on in the industry; and learn about educational re-sources your peers use to remain relevant in this changing landscape. You’ll find AAPC’s forums at www.aapc.com/memberarea/forums.

Door No. 4: CertificationIt should go without say-ing, but I’ll say it anyway: Certification not only helps you to build doors, but to open them all on your own accord. Did you know that more than 98,000 healthcare profes-sionals around the country hold one or more AAPC certifications? They work in physician practices, clinics, outpatient facili-ties, and hospitals. AAPC credentials represent the gold standard in medical coding, billing, auditing, compliance, and practice management.Learn about the many

AAPC credentials at https://www.aapc.com/certification/.

Keep Hammering AwayBuilding doors is not going through your entire community handing out resumes to anyone who will take one and waiting for the phone to ring. You’ll likely be waiting a long time. My experience says, you never know when opportunity will knock. For me, it came on my fifth resume trip through my community. A door I had been cultivating fi-nally opened. It wasn’t the door to my ulti-mate goal, but it was a door that led to another door, which led to yet another door. It has tak-en me seven years to get these doors built and opened, and I am still hammering away.

Peter Davidyock, CPC, CPMA, works for HCA Physi-cian Services. He has been coding for four years and has experience in anesthesia, ear, nose, and throat, family medicine, pain management, cardiothoracic surgery and electrophysiology. He is a regular presenter at the

Conway, South Carolina, local chapter. Davidyock is an AAPC Chapter As-sociation region 3 representative and has held several offices.

AAPC Chapter Association

If Opportunity Doesn’t Knock, Build a Door

Let skills, cultivated relationships, and perseverance be your carpenter.

AAPC forums are one of the most effective tools

AAPC has to offer.



Local Chapter News

Focusing on Our ChaptersMore than 500 local chapters make up the backbone of AAPC. Unique to the industry, our local chapters are places to learn, net-work, and have fun. And each chapter’s vitality is the product of its members. Here are a three perfect examples.

West Los Angeles, CaliforniaIt’s been an exciting year for the West Los Angeles, California, local chapter. They were honored to have AAPC CEO Jason VandenA-kker present on February 18 an overview of AAPC and answer mem-bers’ questions. On March 14, the chapter hosted its first Officer Training Work-shop, presented by 2013-2015 AAPC National Advisory Board Mem-ber Rhonda Zollars, CPC, COC. “In attendance were officers and members from many nearby chapters — Culver City, Long Beach, Orange, and Pasadena, to name a few,” said President Ruby Weiss-man, CPC. “A great time was had by attendees, learning and sharing ideas with one another.”

Jackson, MississippiThe officers from the Jackson, Mississippi, local chapter went to New Orleans, Louisiana, for 2015 officer training. During the luncheon, there was ample opportunity to converse with other officers and ask questions about the positions they hold. Betty Harris, CPC, said, “We gained more than just knowledge at the meeting. We also gained comrades in the field, and in the same officer position.”

Leesburg, VirginiaLeesburg, Virginia, local chapter had the privilege of spine surgeon Ali Moshirfar, MD, speak at their April 8 meeting. Moshirfar ex-plained spine procedures in a way that made learning easy and fun for coding professionals, said President Nathalie Ordanza, CPC.

Ali Moshirfar, MD, speaks to the Leesburg, Virgina, local chapter.

Leesburg, Virginia, officers: Risse Snelgrove, Christa Bilbow, Nathalie Ordanza, Judy Walters, and Alma Zarate

Jackson officers: Jermeika Burks, Betty Harris, Wendy Luckett, Sharon Ostrander, and Adonna Teague

Chapter officers from West Los Angeles, Woodland Hills, Carson, Loma Linda, Chino Hills, Chula Vista, Long Beach, Orange, Mission Hills, and Culver City, California

Angela Belt, Karen Layne, Jason VandenAkker, Ruby Weissman, Myrin Jayme, and Teri Hall (missing officers: Krystal Mays and Marie Garcia)

Healthcare Business Monthly is spotlighting local chapters with photos and stories. If your chapter would like to be featured, please contact your AAPC Chapter Association regional repre-sentative or send your information to [email protected]. In sharing what your chapter is doing, others will benefit.

We ask for your stories to be short and your photos to be high resolution and clear. Send us high-lights of what happened in your chapter recently. Spotlight your special events, coding training, special speakers, fundraising results, or honors bestowed on chapter members.


■ COVER

If the Albany, New York, local chapter looks familiar to you, it should. Last year, through its accomplishments in 2013, Albany

merited honorable mention for AAPC’s Chapter of the Year Award, second to Spartanburg, South Carolina. In 2014, when Healthcare Business Monthly interviewed Albany Chapter President Lynn M. Nobes, CPC, CPC-I, CEMC, about the honorable mention, she said, “I felt like we won a gold medal,” and she was beaming with pride. She also said, “We aren’t giving up!” because her motto is, “When you reach that star, then try reaching for the next one.”Albany set out to receive top billing for the 2014 award, and they got it. Now Nobes feels as if her chapter “won an Academy Award.” The officers who worked hard to bring their chapter to victory are:

• President: Lynn M. Nobes, CPC, CPC-I, CEMC• Vice President: Michelle M. Mesley-Netoskie, CPC• Secretary: Milissa M. Lessard, CPC• Education Officer: Kathryn M. Glasser, CPC• Treasurer: Linda L. Ambrose, CPC• Member Development Officer: Lisa A. Kain, CPC-A

The Big Surprise Comes at HEALTHCONIt was a good thing Nobes and Michelle M. Mesley-Netoskie, CPC, attended this year’s HEALTHCON in Las Vegas. Nobes said, “At the top of my bucket list were two items: attending a national convention and visiting Las Vegas.” She added, “I kept having strong feelings that I needed to be in Las Vegas; now I know why.” She went with her gut instinct, went to national conference, and recalls when she heard the news, “We noticed on the large screen that ‘Chapter of the Year’ was next, and then up popped, Albany, New York!”What a well-deserved surprise it was. Nobes said, “It was the most amazing moment of my career!” Their excitement was apparent from the second they received the award, and by the time Healthcare Busi-

ness Monthly called the chapter about an interview for the article, they had already picked out the location for photos. AAPC Local Chapter Officer Liaison Linda Litster said, “They are very excited and have the perfect place picked out for their picture!” That’s precisely why Al-bany won this award; they are always two steps ahead.

What Makes a Chapter Land at the Top?Mesley-Netoskie thinks Albany won because “members are the heart of our chapter and the officers serve at the will of the members, which is the key to a successful chapter.”The Albany chapter’s achievements in 2014 include:

• Holding 11 meetings (10 monthly meetings, plus an extra “Live Autopsy” video presentation)

• Holding 11 monthly exams, with a total of 203 examinees (seven more than the requirement)

• Continuing the “Denise Casso Scholarship.” Two winners were selected. One was presented with $300 and the other with $150 at the September 2014 New York State Coder’s Day celebration dinner and meeting.

• Winning the grand prize for May MAYnia. They held a bake sale and donation drive for the “Denise Casso Scholarship.”

• Participating in Project AAPC• Sending a $500 check to “Feeding America” • Uploading minutes every month• Submitting all reports to AAPC before deadlines• Participating in a “Rewards Points” system to reward active

chapter members• Hosting AAPC Chapter Department ICD-10 General Code

Set Boot Camps in March and May• Holding five extra meetings where CEUs were offered

By Michelle A. Dick

Back and Better than EverAlbany, New York, receives chapter recognition, again.



Chapter of the Year

Educational Officer Kathryn M. Glasser, CPC, notes other rea-sons why the chapter is so successful, “We are a very active chapter, offering frequent educational opportunities for our membership,” such as membership certification success recognition and engage-ment. She said, “The operations of the chapter are not owned by its board; all the members are encouraged and rewarded for ac-tively participating in planning and conducting chapter events.”The Albany chapter also makes information easily accessible to members through newsletters and a Facebook page. Member Development Officer Lisa A. Kain, CPC-A, said, “We want our members to become more interactive outside of our meet-ings by using our Facebook page to ask questions and share in-formation.”

One Word Sums It UpTreasurer Linda L. Ambrose, CPC, thought hard about why she feels Albany was successful enough to win this prestigious award, and she summed it up in one word: inclusiveness. “We welcome everyone,” Ambrose said. “We have payers, providers, educators, regulators, and students at our meet-ings. We all work together exchanging ideas, teaching each other, and networking. We have a variety of amazing speak-ers at each meeting, from doctors, pharmacists, and health-care auditors to our inspirational AAPC CEO Jason Van-denAkker. We also offer a variety of excellent education-al CEUs for our members. If a nightly monthly meeting doesn’t fit your schedule, how about a Saturday ‘Live Au-topsy’ video seminar with a continental breakfast, or a two-day ICD-10 boot camp? Or maybe fun and games at


The Albany chapter also makes

information easily accessible to

members through newsletters and a

Facebook page.

Photos by Christina Primero Photography www.primerophoto.com


Chapter of the Year

May MAYnia is more your style? We do our best to listen to our mem-bers and give them the support that fits their schedule and the pro-gramming they are asking for.”Secretary Milissa Lessard, CPC, also had one word to sum up their chapter: camaraderie. “The sharing of ideas, knowledge, and camara-derie brings everyone to the monthly meetings,” said Lessard.

Rewards Points Keep the Members InvolvedIn 2013, Albany established a rewards program. Nobes says that, since its implementation, their 600 members have become more in-volved. Chapter members are awarded for actively participating in events and for their efforts. They continued the rewards point sys-tem in 2014; members receive a raffle ticket stub for every five reward points they earn. Points are allotted as follows:

Volunteer to speak at a chapter meeting 50 points

Proctor an exam 30 points

Arrange for a speaker 25 points

Volunteer to serve on a committee (e.g., May MAYnia, Autopsy Video, Coder’s Day Celebration)

20 points

Assisting in the set-up/clean-up at a monthly meeting 10 points

Post on AAPC’s Albany, New York, chapter forum 10 points

Chapter meeting attendance (per meeting) 5 points

At the New York State Coder’s Day Celebration, members placed their ticket stubs in a raffle basket of choice. The more points a mem-ber earned for participation, the more chances he or she had at win-ning a prize.

Reaching for the Next StarIn 2015, the chapter continues to grow and reach out to fulfill mem-bers’ needs. Nobes said, “This year, we’ve implemented a quarter-ly chapter newsletter, connected our members on Facebook, hosted an AAPC officer training, completed an all-member survey, held a


From left to right: Front row: Darlene Buttner, Kathy Racette, Elizabeth AielloSecond row: Ashley Sforza, Linda AmbroseBack row: Michele Cusano, Jennifer Stabile, Paul Cotoia


Chapter of the Year

AAPC membership

spring seminar, are holding monthly exams, and continue to sup-port members as we make the journey together to ICD-10.”The chapter says it will continue to make a lasting impression on members. Mesley-Netoskie said, “The chapter is not just about earning continuing education units. It’s about always leaving with the feeling I learned something or made a connection with a fel-low coder.”Nobes said her “hope for the chapter is that it continues to strive and be successful.” Mesley-Netoskie agreed and added, “We’ll just continue to grow and run with what works.” Albany celebrated its 18th year as an AAPC local chapter in March.



“I always feel welcome. I feel it’s truly a professional organization with quality members and programs.”

- Michelle M. Mesley-Netoskie, CPC

2014 officers from left to right:Front row: Lynn Nobes, Lisa Kain, Kathryn Glasser

Back row: Michelle Mesley-Netoskie, Linda Ambrose, Milissa Lessard


■ CODING/BILLINGBy Faith C.M. McNicholas, RHIT, CPC, CPCD, PCS, CDC

■ Coding/Billing ■ Practice Management ■ Auditing/Compliance

Reporting an E/M Service on the Same Day as a ProcedureFollowing payer guidelines, using modifiers properly, and checking global packages are key to payment.

Over the past few years, payers have increased claims scrutiny to en-sure reimbursement matches the services documented in the pa-

tient record. As a result, many healthcare providers either have had a claim denied or have received a request for medical records review when an evaluation and management (E/M) service is performed on the same date of service (DOS) as a procedure.The Centers for Medicare & Medicaid Services (CMS) enhanced language in the Integumentary section of the National Correct Coding Initiative Policy Manual, version 19.3, which has affected the reporting of an E/M service on the same DOS as a procedure. The new the National Correct Coding Initiative (NCCI) narrative [text emphasized in the original] states:

If a procedure has a global period of 000 or 010 days, it is defined as a minor surgical procedure. E&M services on the

same date of service as the minor surgical procedure are included in the payment for the procedure. The decision to per-form a minor surgical procedure is in-cluded in the payment for the minor surgical procedure and should not be reported separately as an E/M service.

However, a significant and separate-ly identifiable E&M service unrelat-ed to the decision to perform the mi-nor surgical procedure is separate-ly reportable with modifier 25. The E&M service and minor surgical pro-cedure do not require different diag-noses. If a minor surgical procedure is performed on a new patient, the same rules for reporting E&M ser-vices apply.

The statement above indicates an E/M service is included in the minor procedure, but does not preclude you from reporting a separate, significant E/M service, when performed and accurately documented. Some Medicare carriers may rely on edits not

included in the NCCI. For example, the use of modifier 25 Signifi-cant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service varies among CMS carriers; some prefer providers to include modifier 25 when reporting a new patient E/M service with a procedure, while others don’t (e.g., Noridian Ad-ministrative Services). Healthcare providers and coders are encour-aged to clarify modifier 25 preferences with their regional Medicare and commercial carriers.

The fact that the patient is “new” to the provider is not sufficient alone to justify reporting an E/M service on the same DOS as a minor surgical procedure

– NCCI version 19.2


Same-day E/M

CODING/BILLING

Global Surgical PackageFor successful, stress-free reporting of E/M services and procedures on the same DOS, you must understand the global surgical pack-age. The CMS Internet Only Manual (IOM) (Claims Processing Manual, publication 100-04, chapter 12, section 40.1) defines all procedures with a global surgery indicator of 0 or 10 as minor sur-gical procedures. According to NCCI, modifier 25 may be appended to an E/M code when reported with minor surgical procedures or procedures not covered by global surgery rules to indicate the E/M service is sepa-rate and significantly identifiable from other services reported on the same DOS. Because all procedures include pre-, intra-, and post-procedural work that is a required part of the procedure, do not re-port an E/M code for this work. Payers will consider this to be “pro-cedure code unbundling.”For example, the work descriptor for CPT® 11100 Biopsy of skin, sub-cutaneous tissue and/or mucous membrane (including simple closure), unless otherwise listed; single lesion includes:

Pre-operative Work: Prior to biopsy of lesion, obtain pertinent history from patient to include: previous skin cancer, prior treat-ment history, sun protection history, etc. Discussion with patient will include: indication for biopsy procedure, risks, and bene-fits; description of biopsy procedure method, and expected result and/or scarring. In addition, patient agreement/informed con-sent is obtained and staff is advised for preparation of patient and necessary anesthetic, supplies, and instrument tray preparation.

Intra-service Work: Inspection and palpation of the lesion to assess depth and to select most representative site to obtain spec-imen. Cleanse biopsy site with suitable antiseptic; inject appro-priate local anesthetic; apply sterile drapes; obtain skin speci-men with scalpel, skin punch, or suitable instrument depend-ing on depth and amount of tissue needed. Collect specimen in labeled formalin container. Undermine wound edges as need-ed to facilitate repair. Suture to approximate wound edges, or achieve hemostasis with pressure, chemical, or electrocautery, or application of topical hemostatic agents. Apply antibiotic ointment and sterile dressing.

Post-operative Work: Instruction of patient and/or fami-ly on postoperative wound care, dressing changes, and follow-up. Patient advised how to recognize significant complications,

eg, bleeding, or allergic reaction to antibiotic ointment or ad-hesive dressings. Patient advised when results will be avail-able and how they will be communicated; completion of med-ical record; and communication of results to referring physi-cian as appropriate.

A procedure with a global period of 90 days is defined as a major surgical procedure. An E/M service performed on the same day as a major surgical procedure for the purpose of deciding whether to perform the surgical procedure is separately reportable with modi-fier 57 Decision for surgery. Other preoperative E/M services on the same DOS as a major surgical procedure are included in the global payment for the procedure and are not separately reportable. NCCI does not contain edits based on this rule because Medicare contrac-tors have separate edits; check with your local Medicare administra-tive contractor or commercial carrier for clarification.For major and minor surgical procedures, postoperative period E/M services related to recovery from the surgical procedure are included in the global surgical package, as are E/M services related to com-plications of the surgery that do not require additional trips to the operating room.

Major Procedure Global Days

Includes Minor Procedure Global Days

Includes

92 days Day prior to the procedure plus 90 days following the procedure

11 days Day of the procedure plus 10 days following the procedure

Postoperative visits unrelated to the diagnosis for which the surgical procedure was performed, unless related to a complication of sur-gery, may be reported separately on the same day as a surgical proce-dure with modifier 24 Unrelated evaluation and management service by the same physician or other qualified health care professional during a postoperative period.NCCI guidelines state:

… for major and minor surgical procedures, postoperative E&M services related to recovery from the surgical proce-dure during the postoperative period are included in the global surgical package as are E&M services related to com-plications of the surgery that do not require additional trips to the operating room. Postoperative visits unrelated to the diagnosis for which the surgical procedure was performed

For successful, stress-free reporting of E/M services and procedures on the same DOS, you must understand the global surgical package.


Same-day E/MTo discuss this article or topic, go to www.aapc.com

CODI

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unless related to a complication of surgery may be report-ed separately on the same day as a surgical procedure with modifier 24 (“Unrelated Evaluation and Management Ser-vice by the Same Physician or Other Qualified Health Care Professional During a Postoperative Period”).

Examples of Proper Modifier 25 ApplicationBelow are a few examples of appropriate and inappropriate use of modifier 25:Scenario: A patient presents for the first time with a lesion on the back that won’t heal. The doctor performs a biopsy after a problem-focused history and exam with straightforward medical decision-making.

Coding solution: According to the American Medical Association (AMA) Resource-based Relative Value Scale (RBRVS) Data Man-ager, CPT® 11100 includes effort to obtain pertinent history, and performing a limited/straightforward exam. NCCI further states, “The fact the patient is ‘new’ to the provider is not sufficient alone to justify reporting an E/M service on the same DOS as a minor surgi-cal procedure, nor is the decision to perform surgery — unless this was a major procedure (90 day global period)”In this case, an E/M service cannot be justified as distinct, significant, and separately identifiable from the procedure. Report only 11100.

The safest, practical thing to remember is that the E/M documentation must indicate the E/M service was above and beyond what is included in the procedure and, upon review, must stand on its own to support the level of service reported.

Scenario: A patient presents for followup of a clinically premalig-nant lesion or nodule of the face previously treated with Efudex with exacerbation. The patient also requires a refill of a topical steroid to treat lichen planus. The premalignant lesion was previously addressed with no improve-ment. The provider reviews the medical history form completed by the patient and vital signs are obtained by clinical staff. She ob-tains an expanded problem-focused history and examination and formulates and develops a treatment plan for the lichen planus. She discusses diagnosis and treatment options with the patient. A deci-sion is made to treat the lesion with LN2. The provider reconciles medication(s) and writes prescription(s). She completes the medical record documentation. She provides necessary care coordination, telephonic or electronic communication assistance, and other nec-essary management related to this office visit. She handles (with the help of clinical staff) any treatment failures or adverse reactions to

medications that may occur after the visit.Coding solution: Due to the significant, separately identifiable nature of the E/M service provided, as well as the supporting doc-umentation, it is appropriate to report an E/M service at the same time as the procedure. Scenario: A patient presents for the first time with a clinically be-nign lesion or nodule of the lower leg that has been present for many years. The provider reviews the medical history form completed by the patient, and vital signs are obtained by clinical staff. She obtains a problem-focused history and examination, formulates a diagno-sis, and develops a treatment plan (diagnostic skin biopsy). Biopsy is performed. The provider completes the medical record documenta-tion, provides necessary care coordination, telephonic or electronic communication assistance, and other necessary management relat-ed to this office visit, and receives and responds to any interval test-ing results or correspondence. Coding solution: All the services described are a standard part of the biopsy procedure. Reporting a separate E/M service is not ap-propriate.

ResourcesNational Correct Coding Initiative:www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/index.html

Global Surgery Fact Sheet: www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/GloballSurgery-ICN907166.pdf

Medicare Claims Processing Manual, Chapter 12, Physicians/Nonphysician Practitioners: www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c12.pdf AMA RBRVS Data Manager:www.ama-assn.org/ama/no-index/physician-resources/ruc-rbrvs-data-manager.page

Faith C.M. McNicholas, RHIT, CPC, CPCD, PCS, CDC, specializes in dermatology coding. A national speaker on coding and regulatory issues, she presents at American Academy of Dermatology annual and summer meetings, AAPC regional conferences, and several other venues. McNicholas has a wide range of experience in various medical specialties, both solo and group practice settings ranging from cardiology to endocrinology to dermatology. Other

qualifications include certification in medical billing and coding, and management of medical office and healthcare practice with a degree in Health Information and Management Technology. McNicholas is a certified and approved ICD-10-CM/PCS Expert and Trainer. She is a member of the AAPC Chapter Association, and has served office for the Des Plaines, Illinois, local chapter.


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By Nancy G. Higgins, CPC, CPC-I, CIRCC, CPMA, CEMC


Get to Know Telemedicine Payment CriteriaTelemedicine is a rapidly expanding component of healthcare in

the United States. According to statistics provided by the Ameri-can Telemedicine Association (ATA), over half of all hospitals in this country use some form of telemedi-cine. It’s viewed as a cost-effective al-ternative to traditional face-to-face en-counters. The ATA broadly defines telemedicine as “the use of medical information ex-changed from one site to another via electronic communications to improve a patient’s clinical health status.” They also indicate the term “telemedicine” is synonymous with the term “tele-health.” The Centers for Medicare & Medicaid Services (CMS) have set Medicare pay-ment criteria for these services. Some commercial and managed care payers have also set payment guide-lines for telemedicine services.CMS has established the following criteria for Medicare patients.

Patient Must Be at a Qualifying LocationThe patient must be present at a qualified originating site. A site is considered “qualified” if it meets two criteria. First, the originating site must be physically located in either:

• A rural health professional shortage area (HPSA) located either outside of a metropolitan statistical area (MSA) or in a rural census tract, or

• A county outside of an MSA.Second, the patient must be at one of the following places of service:

• The office of a physician or practitioner• Hospital• Critical access hospital (CAH)

• Rural health clinic• Federally qualified health center• Hospital-based or CAH-based renal dialysis center, including

satellites• Skilled nursing facility• Community mental health center

Check if a Location QualifiesTo determine for sure if a particular location is considered a qualified originating site, go to the U.S. Department of Health & Human Services’ Health Resources and Services Administration website at http://datawarehouse.hrsa.gov/telehealthAdvisor/telehealthEligibility.aspx and enter the location’s address. This website will confirm whether the site you are considering is in an approved location.

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Telemedicine

CODING/BILLINGTo discuss this article or topic, go to www.aapc.com

Practitioner Must be Qualified to Receive PaymentPractitioners at the distant site who may provide telehealth services and receive payment for them are:

• Physicians• Nurse practitioners• Physician assistants• Nurse midwives• Clinical nurse specialists• Certified registered nurse

anesthetists

• Clinical psychologists and clinical social workers (excluding CPT® codes 90792, 90833, 90836, and 90838)

• Registered dietitians or nutrition professionals

Use Modifiers GT and GY, as AppropriateWhen billing for telehealth services provided from an eligible origi-nating site, append modifier GT Via interactive audio and video tele-communications system to the CPT® or HCPCS Level II code that de-scribes the provided telehealth service. If a telehealth service is provided for a Medicare patient located at an ineligible originating site, consider appending both modifier GT and modifier GY Item or service statutorily excluded, does not meet the defi-nition of any Medicare benefit or for non-Medicare insurers, is not a con-tract benefit. Appending both modifiers will allow tracking of tele-health services provided while indicating the payer’s reimbursement criteria have not been met.

Check for Medicare Accepted Telehealth CodesMedicare provides a list of CPT® and HCPCS Level II codes eligible for reimbursement when provided via telehealth on its website (www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes.html). Individuals can submit a request to CMS for an addition to the approved list, but their submission must meet the CMS criteria to be considered (see www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Criteria.html). Not all payers cover telehealth services.

Fulfill Documentation RequirementsProviders should be aware that documentation requirements for a telehealth service are the same as that required for any face-to-face patient encounter, with the addition of the following:

• A statement that the service was provided using telemedicine;• The location of the patient;

• The location of the provider; and• The names of all persons participating in the telemedicine

service and their role in the encounter.Example: Mrs. Smith, a Medicare patient, was seen by her fami-ly practice doctor, Dr. Jones, with complaints of palpitations, short-ness of breath, and fatigue. During his examination of Mrs. Smith, Dr. Jones discovered a new heart murmur not identified previously. Because the practice was located in a remote area, far from any car-diology practices, Dr. Jones contacted Dr. Black, a cardiologist, and asked him to evaluate Mrs. Smith via an interactive telecommuni-cations system, and to provide recommendations regarding Mrs. Smith’s care. Mrs. Smith was taken to a special room at Dr. Jones’s practice that was fully equipped for providing services via telemedicine. Dr. Jones’s nurse used the equipment to contact Dr. Black, and he conducted an eval-uation of Mrs. Smith. Dr. Black gathered and documented a detailed patient history. Using a specialized stethoscope, he examined Mrs. Smith’s heart and lungs. Dr. Black performed and documented a de-tailed exam. Dr. Black ordered an echocardiogram and scheduled an in-person follow-up encounter with Mrs. Smith. His documentation supported moderate complexity decision-making.Dr. Jones’s practice is located in a qualified rural HSPA outside of an MSA. Because this was his first encounter with this patient, Dr. Black billed the service provided for Mrs. Smith as 99203-GT Office or oth-er outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A detailed history; A detailed ex-amination; Medical decision making of low complexity-via interactive audio and video telecommunications system.The American Medical Association (AMA) believes appropriate use of telemedicine could improve access to services and quality of care. In June 2014, the AMA voted to approve a list of guiding principles to en-sure appropriate coverage of and payment for telemedicine services. As telemedicine becomes increasingly popular, and CPT® codes are add-ed to the list of approved services, you will need to continually update your understanding of the billing and documentation requirements as-sociated with this innovative type of service.

Nancy G. Higgins, CPC, CPC-I, CIRCC, CPMA, CEMC, is a manager in the Carolinas Health-Care System Medical Group Coding and Charge Capture department. She was the 2009 AAPC Coder of the Year and is a past-president of the Charlotte, North Carolina, local chapter.

If a telehealth service is provided for a Medicare patient located at an ineligible originating site, consider

appending both modifier GT and modifier GY.


■ CODING/BILLINGBy Lynn Garrity, CPC, COC

Endoscopic ultrasound (EUS) combines endoscopy and ultrasound to obtain images of the digestive tract and the surrounding tissue

and organs. The endoscopy involves inserting a long, flexible tube via the mouth to visualize the digestive tract, with or without a bi-opsy at the esophagus or other level. The ultrasound uses high-fre-quency sound waves, with or without fine needle aspiration (FNA), to produce images of the organs and structures inside the body (such as the liver, gallbladder, pancreas, and aorta). CPT® Assistant (March 2009) explains EUS “provides an advantage in the ability to image the wall of the GI tract as a series of definable layers corre-sponding to histology, rather than imaging the wall of the GI tract as a single entity.”EUS allows screening for pancreatic, esophageal, and gastric can-cers, and can define benign tumors of the upper gastrointestinal (GI) tract. It can also identify malformations and masses in the bile and pancreatic ducts. The gastrointestinal wall also may be imaged to see if it’s abnormally thick (which would suggest inflammation or malignancy). Payer requirements may vary, but generally EUS is considered medically necessary for:

• Staging and/or diagnosis of cancer of the esophagus, pancreas, colon, and rectum

• Evaluating anal incontinence• Evaluating abnormalities of the gastrointestinal tract wall or

adjacent structures

• Tissue sampling of lesions• Evaluating abnormalities of the pancreas and/or biliary tree• Providing endoscopic therapy under ultrasonographic

guidance• Evaluating adenopathy and masses of the posterior

mediastinum (EUS with FNA)• Staging of lung cancer (EUS with FNA)

CPT® codes for reporting EUS are:

43231 Esophagoscopy, flexible, transoral; with endoscopic ultrasound examination

43232 Esophagoscopy, flexible, transoral; with transendoscopic ultrasound-guided intramural or trans-mural fine needle aspiration/biopsy(s)

43237 Esophagogastroduodenoscopy, flexible, transoral; with endoscopic ultrasound examination lim-ited to the esophagus, stomach or duodenum, and adjacent structures

43238 Esophagogastroduodenoscopy, flexible, transoral; with transendoscopic ultrasound-guided in-tramural or transmural fine needle aspiration/biopsy(s), (includes endoscopic ultrasound exam-ination limited to the esophagus, stomach or duodenum, and adjacent structures)

43242 Esophagogastroduodenoscopy, flexible, transoral; with transendoscopic ultrasound-guided in-tramural or transmural fine needle aspiration/biopsy(s) (includes endoscopic ultrasound exami-nation of the esophagus, stomach, and either the duodenum or a surgically altered stomach where the jejunum is examined distal to the anastomosis)

No Stress EUSCoding endoscopic ultrasound services is easy to digest if you understand the procedures and use a decision grid.


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43259 Esophagogastroduodenoscopy, flexible, transoral; with endoscopic ultrasound examination, in-cluding the esophagus, stomach, and either the duodenum or a surgically altered stomach where the jejunum is examined distal to the anastomosis

CPT® Assistant (March 2009) explains, “For upper GI EUS, there are three basic components of the procedure: the endoscopic ex-amination, the high frequency ultrasound examination, and the performance of an FNA biopsy when indicated.” To select the ap-propriate code, consider the individual service components docu-mented in the patient record, and enter them into the EUS Cod-ing Decision Grid.

To select the appropriate code, consider the individual service components documented in the patient record …

EUS Coding Decision Grid

Code Esophagogastroduodenoscopy (EGD) Component Ultrasound Component FNA/Biopsy

43231 Esophagus only Esophagus only None

43232 Esophagus only Esophagus only Esophagus only

43237 Esophagus, stomach, other organs Esophagus only None

43238 Esophagus, stomach, other organs Esophagus only Esophagus only

43242 Esophagus, stomach, other organs Esophagus, stomach, other organs Esophagus, stomach, other organs

43259 Esophagus, stomach, other organs Esophagus, stomach, other organs None

Report only a single unit of any of the above EUS codes per session. Do not report separately radiologic supervision and interpretation (e.g., 76975 Gastrointestinal endoscopic ultrasound, supervision and interpretation) or ultrasonic guidance for needle placement (e.g., 76942 Ultrasonic guidance for needle placement (eg, biopsy, aspira-tion, injection, localization device), imaging supervision and interpre-tation), as they are inclusive of EUS procedures. Example 1: A 39-year-old with metastatic colon cancer has a mass on the head of the pancreas, suspicious for metastatic carcinoma. EUS is performed for evaluation and placement of fiducial mark-ers in the head of the pancreas. No biopsy is performed. Proper cod-ing is 43259.Example 2: EUS is performed to evaluate lymph nodes and exclude neoplasms for a 72-year-old with abdominal discomfort and mul-

tiple retroperitoneal lymph nodes. An FNA is done initially into a celiac lymph node and a biopsy is taken. Proper coding is 43242.Example 3: A 61-year-old with cancer of the esophagus is referred for EUS. There is a stricture in the esophagus and the provider di-lates the esophagus less than 15 mm in diameter. EUS FNA of a ce-liac lymph node is then performed. Proper coding is 43249 Esopha-gogastroduodenoscopy, flexible, transoral; with transendoscopic balloon dilation of esophagus (less than 30 mm diameter) for the EGD with balloon dilation and 43242 for the EUS FNA.

Lynn Garrity, CPC, COC, is a coder for Crozer Keystone Health Systems. She has 10 years’ ex-perience with Independence Blue Cross claims adjustments, six years’ experience with HAN Billing and Promise System, and eight years’ experience in coding hospital outpatient/ancil-lary claims. Garrity is a member of the Upland Pennsylvania Chapter, for which she has served as CEU coordinator, treasurer, and vice president.

Esophagus

Diaphragm

Liver

Stomach

OropharynxTongue

JejunumDuodenum

The esophagus isexamined by ultrasound.

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■ CODING/BILLINGBy Lori Carlin, CPCO, CPC, COC, ACS-E/M


Critical Thinking for Coding Critical Care ServicesThree criteria determine what may be billed as critical care time.

Simply because a patient is in an intensive care unit (ICU) doesn’t qualify him or her for critical care services. Critical care is usually

(but not always) given in a critical care area, such as a coronary care unit, ICU, respiratory care unit, or the emergency department (ED); however, payment may be made for critical care services provided in any location, as long as the services meet the definition of critical care.

Define Critical CareCPT® and the Centers for Medicare & Medicaid Services (CMS) de-fine critical care as the direct delivery of medical care by a physician(s) or other qualified healthcare professional for a critically ill or critically injured patient. A critical illness or injury acutely impairs one or more vital organ systems, where there is a high probability of imminent or life threatening deterioration in the patient’s condition. Critical care involves high complexity medical decision-making (MDM) to assess, manipulate, and support vital organ system function(s) to treat single or multiple vital organ system failure, and/or to prevent further life threatening deterioration of a patient’s condition.

Examples of vital organ system failure may include:• Central nervous system

failure• Shock • Renal failure

• Hepatic failure• Metabolic failure• Respiratory failure

Critical Care CriteriaCritical care services must meet three criteria. Proper coding re-lies on:1. Critical Care Time: Only one physician may bill for a given time of critical care, even if multiple providers simultaneously care for a critically ill or injured patient.Time that can be reported as critical care is the time spent engaged in work directly related to the individual patient’s care — whether that time was spent at the immediate bedside, or elsewhere on the floor or unit. In all cases, the physician must be immediately avail-able for the patient.For instance, reviewing test results or imaging studies, discussing the critically ill patient’s care with other medical staff, or document-ing critical care services in the medical record count as critical care time. As long as this time represents the provider’s full attention to the management of the critically ill or injured patient, it counts, even if services do not occur at the bedside.Time involved performing procedures that are not bundled into critical care (i.e., billed and paid separately) may not be includ-ed and counted toward critical care time. The physician’s progress note(s) in the medical record should document that the time in-volved in the performance of separately billable procedures was not counted toward critical care time. For example: “Total critical care time spent was 45 minutes, which excludes time spent performing intubation.”If the patient is unable or clinically incompetent to participate in discussions, time spent on the floor or unit with family members or surrogate decision makers obtaining a medical history, review-ing the patient’s condition or prognosis, or discussing treatment or limitation(s) of treatment may be reported as critical care, provided the conversation bears directly on the MDM. The physician’s prog-ress note must link the family discussion to a specific treatment is-sue and explain why the discussion was necessary that day.

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Critical Care

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For example: “The patient is unable or incompetent to participate in giving history and/or making treatment decisions,” or “Because the patient was deteriorating so rapidly, I needed to immediately discuss treatment options with the family.”You may not report time spent in activities that occur outside of the unit or off the floor as critical care because the physician is not im-mediately available to the patient. Because critical care is a time-based code, the physician’s progress note must contain documentation of the total time involved provid-ing critical care services. Review the time-based coding chart for re-porting critical care (Table A).2. Critical Care Treatment Requirements: Critical care means the qualified provider is performing life and organ supporting in-terventions that require frequent, personal assessment, and manip-ulation. Withdrawal of or failure to initiate these interventions on an urgent basis would likely result in sudden, clinically significant, or life threatening deterioration in the patient’s condition. The phy-sician should document all organ sustaining interventions that re-quire physician assessment and interventions.Examples of critical care treatment may include:

• Thrombolytics• Anti-arrhythmics • Epinephrine, atropine,

sodium bicarbonate• Cardioversion for atrial

fibrillation or atrial flutter• Defibrillation

• Fluid and blood administration for shock or impending shock

• Narcan • Nitroglycerin drip• Mechanical ventilation

(continuous positive airway pressure, bilevel positive airway pressure, or endotracheal tube)

Services bundled into critical care, and not separately reported, in-clude:

• Interpretation of cardiac output measurements (CPT® 93561, 93562),

• Chest X-rays (CPT® 71010, 71015, 71020),• Pulse oximetry (CPT® 94760, 94761, 94762)• Blood gases, and information data stored in computers

(e.g., electrocardiograms, blood pressures, hematologic data (CPT® 99090)

• Gastric intubation (CPT® 43752, 43753)• Transcutaneous pacing (CPT® 92953)• Ventilator management (CPT® 94002-94004, 94660,

94662)• Vascular access procedures (CPT® 36000, 36410, 36415,

36591, 36600)3. Critical Care Illness/Injury Criteria: Critical care may be de-livered in a moment of crisis, at the patient’s bedside emergently, or for post-operative patients who come out of surgery stable, but lat-er deteriorate. In all circumstances, the patient’s condition is life threatening or of imminent deterioration (i.e., the patient is criti-cally ill or injured at the time of the physician’s visit). CMS offers these examples of patients whose medical condition may warrant critical care services:

• An 81-year-old male patient is admitted to the ICU following abdominal aortic aneurysm resection. Two days after surgery, he requires fluids and vasopressors to maintain adequate perfusion and arterial pressures. He remains ventilator dependent.

Only one physician may bill for a given time of critical care, even if multiple providers simultaneously care for a critically ill or injured patient.

Table A: Time-based Coding Chart

Total Duration of Critical Care Codes Code(s)

Less than 30 minutes Appropriate evaluation and management (E/M) code(s)

30 - 74 minutes 99291 Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes x 1

75 - 104 minutes 99291 x 1 and +99292 Critical care, evaluation and management of the critically ill or critically injured patient; each additional 30 minutes (List separately in addition to code for primary service) x 1

105 - 134 minutes 99291 x1 and +99292 x 2

135 - 164 minutes 99291 x 1 and +99292 x 3

165 - 194 minutes 99291 x 1 and +99292 x 4

194 minutes or longer 99291 x 1 and +99292 per unit “each additional 30 minutes”


To discuss this article or topic, go to www.aapc.comCritical Care

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• A 67-year-old female patient is three days status post mitral valve repair. She develops petechiae, hypotension, and hypoxia requiring respiratory and circulatory support.

• A 70-year-old admitted for right lower lobe pneumococcal pneumonia with a history of chronic obstructive pulmonary disease becomes hypoxic and hypotensive two days after admission.

Examples of patients whose medical condition may not warrant critical care services:

• Daily management of a patient on chronic ventilator therapy does not meet the criteria for critical care unless the critical care is separately identifiable from the chronic long term management of the ventilator dependence.

• A dermatologist evaluates and treats a rash on an ICU patient who is maintained on a ventilator and nitro infusion, managed by an intensivist. The dermatologist should not report critical care. Just because the patient is in the intensive care or other specialized care unit does not mean that critical care services have been performed, or that the patient meets the definition of critically ill or injured.

• A surgery post-op patient is admitted to the ICU for monitoring. The patient is stable and does not require critical

care treatment, only monitoring and pain medication. This service is part of routine post-op care.

Services not meeting the definition of critical care, or services pro-vided for a patient who is not critically ill or injured in accordance with the above definitions and criteria, but who happens to be in a critical care, intensive care, or other specialized care unit, should be reported using an appropriate E/M code (e.g., subsequent hospital care, 99231-99233).

ResourcesCMS Manual System, Pub 100-04, Medicare Claims Processing Manual, ch 12 www.cms.hhs.gov/Transmittals/Downloads/R1548CP.pdf

www.cms.hhs.gov/MLNMattersArticles/downloads/MM5993.pdf

Lori Carlin, CPCO, CPC, COC, ACS-E/M, is director, Professional Coding Services, for Reimbursement & Advisory Services at Altegra Health, Inc. She has more than 15 years’ experience in revenue cycle management, coding and auditing, quality assurance, training, and litigation support. Carlin has extensive experience in coding outpatient and inpatient E/M services. She specializes in coding and compliance with responsibility for large-scale clients including academic centers. Carlin is a member of the Seattle First Hill, Washington, local chapter.

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Scleroderma, or systemic sclerosis, is a chronic autoimmune rheumatic disease that affects the skin and other organs of the body. Scleroderma causes the skin to become thick and hard (scle-rotic); a build up of scar tissue; and damage to internal organs such as the heart and blood vessels, lungs, stomach, and kid-neys. The effects of scleroderma vary widely and range from minor to life-threatening, depending on how widespread the disease is and which body parts are affected.There are two main types of scleroderma:Localized scleroderma usually affects only the skin, al-though it can spread to the muscles, joints, and bones. It does not affect other organs. Symptoms include:

• Discolored patches on the skin (called morphea)• Streaks or bands of thick, hard skin on the arms and

legs (linear scleroderma). Linear scleroderma on the face and forehead is called en coup de sabre.

Systemic scleroderma, also called generalized scleroderma, can involve many body parts or systems. This form of the dis-ease is further broken down into two subcategories:Limited scleroderma: It comes on slowly and affects the skin of the face, hands, and feet. It can also damage the lungs, in-testines, or esophagus (sometimes referred to as CREST syn-drome). With limited scleroderma, the outlook is good but the disease tends to get worse over time. It can affect the heart and raise blood pressure in the lungs.Diffuse scleroderma: This comes on quickly. Skin on the mid-dle part of the body, thighs, upper arms, hands, and feet can become thick. It also affects internal organs, like the heart, lungs, kidneys, and gastrointestinal tract.ICD-10-CM coding for scleroderma is dependent on the type, as well as the involvement: for example, M34.2 System-ic sclerosis induced by drug and chemical.

Rhonda Buckholtz, CPC, CPMA, CPC-I, CENTC, CGSC, COBGC, CPEDC, is vice president of ICD-10 Training and Education at AAPC.

By Rhonda Buckholtz, CPC, CPMA, CPC-I, CENTC, CGSC, COBGC, CPEDC

Scleroderma

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■ CODING/BILLINGBy G.J. Verhovshek, MA, CPC

Get a Clear Picture of Myelography ReportingThree factors weigh into choosing proper codes.

Myelography or myelogram is an imaging procedure of the spine (myelo = spine, graphy = imaging) used to diagnose and locate spinal cord injuries, spinal stenosis, and other abnormali-ties of the spinal canal. Proper coding for myelography requires you to know: (1) the number of providers involved in perform-ing the complete procedure; (2) the region of the spine imaged; and (3) whether any follow-up imaging was performed.

Complete Includes Both Injection and Radiological S&IA complete myelography is a two-step procedure: A provid-er injects a contrast medium (step one), typically in the area of the lumbar spine. The contrast medium is a dye that dispers-es throughout the intrathecal space (the area surrounding the spinal cord), improving the visual contrast among structures viewed under the X-ray examination that follows (step two).According to CPT® Assistant (September 2014), “An X-ray my-elogram provides imaging of the entire region of the spine on a single image.” CPT® includes four codes to describe the com-plete procedure when performed by a single provider:

62302 Myelography via lumbar injection, including radiological supervision and interpretation; cervical

62303 Myelography via lumbar injection, including radiological supervision and interpretation; thoracic

62304 Myelography via lumbar injection, including radiological supervision and interpretation; lumbosacral

62305 Myelography via lumbar injection, including radiological supervision and interpretation; 2 or more regions (eg, lumbar/thoracic, cervical/thoracic, lumbar/cervical, lumbar/thoracic/cer-vical)

Code selection is based on the spinal region(s) targeted for vi-sualization. For example, for myelogram of the thoracic spine, report 62303. For myelogram of the thoracic and lumbosa-cral regions during the same session, report 62305 (not 62303, 62304).

Injection or S&I Call for Different CodingCodes 62302-62305 describe the bundled services of perform-ing the contrast injection and radiological supervision and illu

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interpretation (RS&I) of myelography. When reporting these codes, you may not separately report any of the following:

62284 Injection procedure for myelography and/or computed tomography, lumbar (other than C1-C2 and posterior fossa)

72240 Myelography, cervical, radiological supervision and interpretation

72255 Myelography, thoracic, radiological supervision and interpretation

72265 Myelography, lumbosacral, radiological supervision and interpretation

72270 Myelography, 2 or more regions (eg, lumbar/thoracic, cervical/thoracic, lumbar/cervical, lumbar/thoracic/cervical), radiological supervision and interpretation

These codes describe the individual components of myelogra-phy, including contrast injection (62284) and the radiological S&I (72240, 72255, 72265, 72270). As explained in CPT® Assis-tant (September 2014):

In the CPT® 2015 code set, the lumbar injection code and the X-ray myelogram RS&I code will be bundled if the same physician or other qualified health care profes-sional does both [e.g., 62302-62305]. When the lumbar injection is administered by one physician or other qual-ified health care professional and the myelogram is in-terpreted by another, code 62284 should be used by the first physician or other qualified health care profession-al, and the appropriate X-ray myelogram code [72240, 7255, 7265, 72270] by the subsequent physician or oth-er qualified health care professional.

For example, if Provider A performs a lumber injection of con-trast medium, and Provider B performs the RS&I for cervical myelogram, coding is:

• Provider A: 62284• Provider B: 72240

If Provider A performs a lumber injection of contrast medium, and Provider B performs the RS&I for cervical and thoracic my-elogram, coding is:

• Provider A: 62284• Provider B: 72270 (not 72240, 72255)

Note: You should report a single unit of 62284, per session, re-gardless of the number of spinal areas addressed (see CPT® Assis-tant, September 2004).

For injection at C1-C2, see 61055 Cisternal or lateral cervical (C1-C2) puncture; with injection of medication or other substance for diagnosis or treatment (e.g., C1-C2), rather than 62284.

Separately Report Follow-up CT, when PerformedThe provider may perform computed tomography (CT) follow-ing X-ray myelography. CPT® Assistant (September 2014) advises that you may report the CT separately by appending modifier 59 Distinct procedural service to the appropriate CT procedure code.

72126 Computed tomography, cervical spine; with contrast material

72129 Computed tomography, thoracic spine; with contrast material

72132 Computed tomography, lumbar spine; with contrast material

For example, a single provider performs the bundled service of contrast injection and cervical myelogram, followed by CT of the same spinal region. Coding is 62302 and 72126-59.In a second example, Provider A introduces contrast via lum-bar puncture. Provider B performs RS&I for cervical and lum-bar myelogram, followed by CT of the same regions. Coding is:

• Physician A: 62284• Physician B: 72240, 72126-59, 72132-59

If CT under contrast occurs without myelography, report the contrast injection (62284) and the appropriate CT code (72126-72132) without a modifier.

G.J. Verhovshek, MA, CPC, is managing editor at AAPC and a member of the Ashville-Hendersonville, North Carolina, local chapter.

Codes 62302-62305 describe the bundled services of performing the contrast injection and radiological supervision and interpretation (RS&I) of a myelography.


■ ROADMAP TO ICD-10By Rhonda Buckholtz, CPC, CPMA, CPC-I, CENTC, CGSC, COBGC, CPEDC

ICD-10 Supports All Types of HerniasProper documentation should reveal the type, location, and complications for precise diagnosis coding.

Hernias occur when the contents of a body cavity bulge out of the area where they are normally contained. These contents, usual-

ly portions of intestine or abdominal fatty tissue, are enclosed in the thin membrane that naturally lines the inside of the cavity. Hernias may not produce symptoms, or they may cause slight to severe pain. Nearly all have the potential of becoming strangulated. Strangulation occurs when the contents of the hernia bulge out and ap-ply enough pressure that blood vessels in the hernia are constricted, cut-ting off blood supply. If the blood supply is cut off at the hernia opening in the abdominal wall, it becomes a medical and surgical emergency.

Identify Hernia TypeThere are several different types of hernias. The ability to identify the various types of hernias is critical to appropriate diagnosis cod-ing in ICD-10-CM.

InguinalInguinal (groin) hernias make up approximately 75 percent of all ab-dominal wall hernias, and occur up to 25 times more often in men than in women. There are two different types of inguinal hernias: di-rect and indirect.Both types occur in the groin area where the skin of the thigh joins the torso (the inguinal crease), but they have slightly different origins.

• Indirect inguinal hernia (indirect hernia): à Follows the pathway that the testicles made during fetal

development, descending from the abdomen into the scrotum; and

à May occur at any age.• Direct inguinal hernia:

à Occurs slightly to the inside of the site of the indirect hernia, in an area where the abdominal wall is naturally slightly thinner;

à Rarely protrudes into the scrotum; and à Tends to occur in the middle-aged and elderly because

abdominal walls weaken with age.ICD-10-CM coding example:James has been diagnosed with a unilateral inguinal hernia with ob-struction and gangrene that has been recurrent.

K40.41 Unilateral inguinal hernia, with gangrene, recurrent

FemoralFemoral hernias are normally confined to a tight space, and some-times they become large enough to allow abdominal contents (usu-ally intestine) to protrude into the canal. They cause a bulge just be-low the inguinal crease in roughly the mid-thigh area, and usually occur in women.ICD-10-CM coding example:A 78-year-old woman presented with a two day history of a painful mass in her right groin. Abdominal examination disclosed mild ten-derness in the right lower quadrant. A 6 cm right inguinal mass was palpated that was non-reducible and exquisitely tender to palpation. At laparotomy, a large, edematous, inflamed femoral mass, medial to the femoral vein, was identified. The anterior surface was opened, and purulent fluid was drained. The femoral hernia was repaired by suturing the iliopubic tract to Cooper’s ligament.

K41.90 Unilateral femoral hernia, without obstruction or gangrene, not specified as recurrent

UmbilicalUmbilical hernias are common and make up approximately 10 to 30 percent of hernia cases. They are often noted at birth as a protrusion at the belly. ICD-10-CM coding example:A 42-year-old female patient presents with a gangrenous Meckel’s di-verticulum in a strangulated umbilical hernia sac. She was treated by dissection of diverticulomesenteric bands and diverticulectomy.

K42.0 Umbilical hernia with obstruction, without gangrene

Q43.0 Meckel’s diverticulum

Hiatal hernia

DiaphragmEpigastric hernia

Incisional hernia

Umbilical hernia

Inguinal hernia

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Hernias


IncisionalAn incisional hernia can occur:

• When abdominal surgery causes a flaw in the abdominal wall, creating an area of weakness through which a hernia may develop

• Following 2-10 percent of all abdominal surgeriesICD-10-CM coding example:Tim noticed a bulge in his abdominal wall following abdominal surgery this past year. He indicates the bulge appears to expand under increased abdominal pressure, such as when he coughs or lifts a heavy object. The physician diagnoses him with an incision-al hernia.

K43.2 Incisional hernia without obstruction, without gangrene

Spigelian Spigelian hernias are rare and occur along the edge of the rectus ab-dominus muscle through the spigelian fascia. In ICD-10-CM, spi-glian hernias are coded to K43.6 Other and unspecified ventral her-nia with obstruction, without gangrene or K43.7 Other and unspeci-fied ventral hernia with gangrene, depending on whether gangrene is present.

ObturatorObturator hernia is an extremely rare abdominal hernia, which de-velops mostly in women. This type of hernia protrudes from the pelvic cavity through an opening in the pelvic bone. Due to the lack of visible bulging, this hernia is very difficult to diagnose.

EpigastricEpigastric hernia occurs between the navel and the lower part of the rib cage in the midline of the abdomen. It’s composed usually of fatty tissue and rarely contains intestine. In ICD-10-CM, epi-gastric hernias are coded to K43.6, K43.7, or K43.9 Ventral hernia without obstruction or gangrene, depending on the presence of ob-struction or gangrene.

Diaphragmatic A diaphragmatic hernia is a rare birth defect in which there is an abnormal opening in the diaphragm. This type of hernia occurs while the baby is developing in the womb, and prevents the lungs from growing normally.

ICD-10-CM coding example:A 17-year-old female presents with congenital diaphragmatic hernia. She originally presented with vague abdominal pain and was thought to have urinary tract infection, ruptured ovarian cyst, and appendici-tis by different medical teams in the first few days. Recently, she un-derwent a diagnostic laparoscopy with no significant findings. In the early postoperative recovery period, she suffered from severe cardio-respiratory distress and a large intestinal left diaphragmatic hernia was diagnosed subsequently. Today, during surgery, a strangulated loop of large bowel herniating through a left antero-lateral congeni-tal diaphragmatic hernia was discovered, which was reduced and re-paired with a Prolene mesh through thoracotomy.

K44.0 Diaphragmatic hernia with obstruction without gangrene

Proper Documentation Allows Seamless CodingEducating physicians on documenting hernias is fairly simple. Work with them on concepts such as:

• Type• Laterality• Location• Complications/Manifestations

Combining your knowledge of the clinical condition with the phy-sician’s documentation allows for seamless selection of the most specific ICD-10-CM code.

Rhonda Buckholtz, CPC, CPMA, CPC-I, CENTC, CGSC, COBGC, CPEDC, is vice president of ICD-10 Training and Education at AAPC.

The ability to identify the various types of hernias is critical to appropriate diagnosis coding in ICD-10-CM.

Esophagus

Diaphragm

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ParaesophagealHiatal Hernia

Gastroesophagealjunction (remains

in place)

Gastroesophagealjunction (slidesup and down)

Anatomical Illustrations 2014, Optuminsights, Inc.


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■ CODING/BILLINGBy G.J. Verhovshek, MA, CPC

58: The “Goes Beyond” ModifierUsing it correctly requires knowing when to use modifier 78 instead.Modifier 58 Staged or related procedure or service by the same physi-cian or other qualified health care professional during the postopera-tive period is applied only during the postoperative period of a prior procedure to indicate the current procedure is either:

a. Planned prospectively or at the time of the prior procedure;

For example, skin grafts may be performed in stages to allow ad-equate healing time between procedures. Subsequent skin grafts are expected following the initial procedure.

Tip: Do not append modifier 58 for staged procedures when the code description indicates “one or more visits” or “one or more sessions” (e.g., 65855 Trabeculoplasty by laser surgery, 1 or more sessions (defined treatment series))

b. More extensive than the prior procedure; or

The physician performed a dilation and curettage (D&C) on April 1, followed by a hysterectomy on April 10. In this case, the D&C (e.g., 58120 Dilation and curettage, diagnostic and/or ther-apeutic (nonobstetrical)) is the initial procedure. The hysterecto-my (e.g., 58260 Vaginal hysterectomy, for uterus 250 g or less) is a more extensive procedure during the global period of the initial, related procedure, to which you append modifier 58.

c. For therapy following a diagnostic surgical procedure.

The National Correct Coding Initiative Policy Manual for Medi-care Services, chapter 1, General Correct Coding Policies, ex-plains:

If a diagnostic endoscopy is the basis for and precedes an open procedure, the diagnostic endoscopy is separately reportable with modifier 58. However, the medical re-cord must document the medical reasonableness and ne-cessity for the diagnostic endoscopy.

In this case, the open procedure is a therapeutic procedure fol-lowing a diagnostic endoscopy. The follow-up procedure does not have to be planned ahead of time; however, in all cases, the related follow-up procedure is per-

formed to treat an underlying condition, rather than as a result of the prior procedure. Stated another way, the follow-up procedure will “go beyond” the initial procedure, but is not due to a compli-cation of the prior procedure.

Modifier 78 Is for Complications of SurgeryIn another example, a return to the operating room to control bleeding is more extensive than the original procedure, but occurs due to an initial procedure complication, not to further treat the underlying condition. The National Correct Coding Initiative Pol-icy Manual for Medicare Services, chapter 1, elaborates:

Control of postoperative hemorrhage is … not separately reportable unless the patient must be returned to the oper-ating room for treatment. In the latter case, the control of hemorrhage may be separately reportable with modifier 78.

When treatment for complications requires a return to the operat-ing or procedure room, append modifier 78 Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related pro-cedure during the postoperative period to the subsequent procedure code, rather than modifier 58. Lastly, unlike modifier 58:

• When applying modifier 78, the diagnosis is usually different for each procedure.

• Modifier 78 does not reset the global period from the previous procedure.

• Modifier 78 usually results in slightly discounted payment (i.e., only the inter-operative portion of the fee schedule amount is paid).

G.J. Verhovshek, MA, CPC, is managing editor at AAPC and a member of the Asheville-Hendersonville, North Carolina, local chapter.

Unlike modifier 58, modifier 78 does not reset the global period from the previous procedure.



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Think You Know ICD-10? Let’s See …

ICD-10 QuizBy Rhonda Buckholtz, CPC, CPMA, CPC-I, CENTC, CGSC, COBGC, CPEDC

Based on the code descriptor for M34.2 Systemic sclerosis induced by drug and chemical, which of the following would be most important for physicians to doc-ument for the correct code to be assigned?

A. Type

B. Temporal factors

C. Caused by/contributing factors

D. Both a and c

E. All

Check your answer on page 65.

Rhonda Buckholtz, CPC, CPMA, CPC-I, CENTC, CGSC, COBGC, CPEDC, is vice president of ICD-10 Training and Education at AAPC. IC

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■ PRACTICE MANAGEMENTBy Debra Cascardo, MA, MPA, CFP

Informed Consent: A Process, Not Just a SignatureSet treatment expectations, limit your liability, and improve patient satisfaction.

Informed consent has two purposes:1. To educate the patient about the proposed treatment. Because

patients often forget what the doctor tells them, providing some-thing written in plain, non-technical language is the most effec-tive way to educate them.

2. To protect the doctor from liability. Regardless of how doctors educate their patients, they aren’t protected from liability without properly documenting consent before treatment begins.

It’s crucial for coders, billers, and managers to fully document the informed consent process in an automated, efficient manner. Fail-ure to obtain informed consent may be a liability for physician neg-ligence, battery, or malpractice.

The ProcessThe informed consent process includes:

• Delivering patient education, with confirmation the patient understood it;

• Presenting the informed consent/refusal form;• Patient acknowledgment via signature; and• Documenting consent in medical records.

Technologies exist to support each step in the process; the most widely available technology covers obtaining, tracking, and verify-ing patient signatures.

Patient Acknowledgement via Electronic SignatureElectronic signatures can be images of handwritten signatures, voiceprints, signing by mouse-click, or tracing signatures onto elec-tronic documents with finger, mouse, or stylus. These types of sig-natures present a number of legal verification problems, however, including:

• No proof of whether the document was signed before or after the procedure

• Possibility of the signature being copied from one document to another

• Possibility of manipulating the document after signingDigital signatures offer a more secure, legally enforceable elec-tronic signature. Digital signatures link the document to the sign-er’s identity, permanently embedding a time and date stamp of the signer’s information into the document. The evidence of the signa-ture’s validity, along with a facsimile of the signature, may be viewed by opening the PDF file. Altering the document after it’s digitally signed invalidates the digital signature. If informed consent is to protect physicians legally, they should look for the highest signature verification level to withstand rigorous le-gal scrutiny.


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Informed ConsentTo discuss this article or topic, go to www.aapc.com

Signature Technology SolutionsSeveral vendors offer HIPAA-compliant solutions for obtaining digital signatures. Some cloud-based solutions allow the consent document to be sent via email and signed online through a Web browser, while others allow only onsite signing with an electronic signature pad. Some also allow data entry fields with buttons, check boxes, fill-in responses, and multiple signatures. A few even allow consent form data to be integrated into specific electronic health re-cord (EHR) fields.

Cloud-based ServicesDocuSign, e-SignLive, Adobe EchoSign, RightSignature, Co-sign, and SIGNiX are popular non-healthcare-specific systems that make the e-signing process affordably simple and secure. The practice sends the patient an encrypted email with a link to the in-formed consent form. The patient views the form online, fills in the required fields, initials and signs where requested, and submits the completed form. Copies are then emailed to the patient and doc-tor, and the practice can import the document into its EHR. These systems also maintain a cloud-hosted dashboard of all signed doc-uments.Pricing varies according to the number of users and number of doc-uments. Expect to budget approximately $20 per user, per month for unlimited documents. For most small, single-location practices, one user account usually is enough.For in-office patients, emailing to obtain an online signature may not be the best way to obtain consent. Accordingly, SIGNiX also lets office staff specify if the document is signed “in person.” The form may then be viewed and signed on an iPad or a Windows 8 touch screen.

In-office Signature Pad SolutionsBasic digital signature pad solutions for obtaining patient signatures in-office can be purchased on Amazon for $100 to $250. These con-sist of a signature capture pad, stylus, and software to download. The patient views the consent form on paper or a computer moni-tor and then uses the stylus to sign his or her consent on the signa-ture pad. The signature is embedded digitally in the PDF or Word document, which the office staff saves, naming it as that patient’s informed consent form. The form then may be imported into the patient’s EHR.

Tip: Meaningful use requires providing patients with educational materials about their specific medical conditions. Many of these systems can be set up to provide patients with medical education.

Other Areas Where Consent Is NecessaryMedical practices use consent forms for purposes other than pro-posed courses of treatment. For example:Consent for use of the patient portal: Stage 2 of meaningful use re-quires that at least 5 percent of patients view, download, and transmit their health information, and send a secure electronic message to their provider. To comply with this requirement, physicians can grant pa-tients access to their personal health records through a patient portal module provided by the EHR system. The portal permits patients to view clinical treatment information, request appointments, and se-curely communicate with the physician or the medical office staff.Have patients read the policies and procedures for portal use, and sign an informed consent document acknowledging they under-stand the security risks of using the portal, and agree to use the por-tal for its intended use only.Consent for health information exchange: Meaningful use Stage 2 requires doctors to electronically share a summary of care infor-mation when referring a patient to another provider. Generally, this electronic sharing is through a health information exchange (HIE). Ask patients to sign a consent form letting their healthcare provid-ers view their shared health information via the HIE.Based on state e-laws and HIE requirements, consent must be ob-tained before a physician can share or view a patient’s informa-tion via an HIE. The U.S. Department of Health & Human Ser-vices launched its HealthIT.gov website in September 2013 to ad-dress “laws, policies, and issues related to the electronic exchange of health information.” This site provides abundant resources for ed-ucating both healthcare professionals and patients about sharing medical information via an HIE.

Improve Patient ExperienceInformed consent benefits the provider by limiting liability and ben-efits the patient by setting expectations and improving satisfaction. Automating the consent process can reduce the risk of malpractice claim litigation arising from the discrepancy between the patient’s ex-pectations and the treatment outcome. Technology can enable med-ical practices to implement an educational consent process to ensure patients are indeed informed and to create indisputable evidence of consent in an automated, efficient manner. Be sure everyone in the office is educated in this process — especially billers and coders.

Debra Cascardo, MA, MPA, CFP, is a Fellow of the New York Academy of Medicine and a healthcare journalist.

Digital signatures link the document to the signer’s identity, permanently

embedding a time and date stamp of the signer’s information into the document.


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■ PRACTICE MANAGEMENTBy Michelle A. Dick

Initially, Phyzit, Inc. co-founders Stephen Canon, MD, and Mike Canon, JD, launched a software tool aimed at improving patient-

physician communication via telemedicine and mobile messaging. It turned out to be an opportunity to streamline transitional care man-agement (TCM) and chronic care management (CCM), as well.After evaluating the market and interviewing customers, they pivot-ed their strategy to streamline billing workflow and improve TCM reporting.When creating this app, Stephen Canon consulted Pam Brooks, CPC, COC, coding manager at Wentworth-Douglass Hospital in Dover, New Hampshire, about TCM and CCM services in regards to how they are coded and reimbursed. Brooks said:

“I see the value in such an application … as [practices and facilities] try to navigate the complexities of CCM billing, improve revenue, and decrease patient admissions/re-admissions. Tracking these services along with unplanned admissions, time, bundling issues and payer and CPT® guidelines is a full-time job. And frankly, our organization had to develop this technology within our own EHR system, which was both costly and time consuming. I can see this application being a very cost-effective alternative for providers who don’t have the deep pockets of corporate medicine.”

Here’s How It WorksThe TCM process has an interface that saves time for office staff, re-duces workflow demands on primary care physicians, and increases revenue. Patients have direct communication with their doctors and can add family members or other caregivers to their health manage-ment plan.The application, Phyzit TCM, “incorporates secure electronic mes-saging, phone calls, telemedicine video sessions, and SMS text mes-

saging into a cloud-based platform designed to increase patient en-gagement and aid physicians in keeping patients healthy after hospi-tal discharge,” according to Arkansas Small Business and Technolo-gy Development Center.

Takes Clunks Out of TCM BillingThe process of billing TCM services can be clunky, according to Brooks, with areas that can use improvement. “Although CMS is headed in the right direction by reimbursing for TCM to help prevent costly readmissions, the logistics in regards to proper billing and cod-ing is sometimes confusing and time-consuming,” Brooks said. “A tool such as this will go a long way towards simplifying the process.”When the smartphone app was beta tested last fall, Brad Bibb, MD, a family practice physician in Ash Flat, Arkansas, made an additional $1,400 per month using the app, and his hospital readmissions were cut by 50 percent. Zana Johnson, care manager for Family Clinic of Ashley County in Crossett, Arkansas, also uses the app. “In today’s healthcare, we must utilize all the tools available to be efficient and still maintain the level of care our patients deserve,” Johnson said. “That’s what Phyzit does — it makes my job easier without all the stress, so I can concentrate on patients and their needs.”CCM is another area that would benefit from this approach to pa-tient management workflow and greater coding and billing efficien-cy. Phyzit CCM is in the planning stages, and Stephen Canon assures us it will streamline the CCM practice opportunity.

Sources:http://phyzit.com/http://asbtdc.org/arkansas-company-phyzit-tackles-transitional-care-management-nationally/


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Coder Assists Physician in Developing a TCM Tool

Coder Assists Physician in Developing a TCM Tool


■ ASK THE LEGAL ADVISORY BOARDBy Michael D. Miscoe, JD, CPC, CASCC, CUC, CCPC, CPCO, CPMA

Don’t Let Incident-to Turn into “Incident-4” BillingWhen a registered nurse bills under the nurse practitioner, you are liable for overpayments.

QI am reaching out in the hopes of receiving guidance to a ques-tion posed by one of my physicians. This particular physician works offsite from the office, usually in the hospital located on the same campus. This physician employs a staff member who is a certified urologic registered nurse (CURN). The CURN performs scheduled urodynamic studies in the office while the

physician is working at the hospital. This same physician also employs a nurse practitioner (NP) who remains in the office while the doctor is off-site at the hospital.Can the urodynamic studies performed by the CURN, bill incident-to (I2) under the NP? If the urodynamic studies are billable as incident-to under the NP, can the physician expect a 15 percent reduction in re-imbursement?I appreciate any direction or resources I can check that may assist in this area.

AThis is jokingly called “incident-4” billing. Jokes aside, it is not permissible.There is no authority for billing a service performed un-der the direction of a nurse practitioner or other non-physician practitioner (NPP) such as a physician assis-tant (PA). NPs/PAs have no delegation authority under

Medicare/Medicaid. It’s also important to understand that the I2 rule applies only with respect to services that are incidental/inte-gral to a physician’s plan of care and which are performed under the direct on-premise supervision of a licensed and credentialed physi-cian. It’s presumed from your question that the CURN cannot be credentialed by Medicare/Medicaid, which would permit her or him to bill the urodynamic studies under her or his own Nation-al Provider Identifier (NPI). Assuming this to be the case, the only way the urodynamic studies performed by the CURN could be billed legitimately is under the physician, provided the studies were performed in compliance with all elements of the I2 rule, as follows:

1. The physician performed the initial evaluation of the patient (not the NP) and ordered the test (thereby making the test an incidental, although integral, part of the physi-cian’s service).

2. The physician remained actively involved in the care.

3. Both physician and CURN are employed by the same en-tity, or if they are not in a group, the physician employs the CURN.

4. The CURN qualifies as auxiliary personnel under state li-censure rules, which must permit the physician to dele-gate physical performance of the urodynamic study to the CURN.

5. The physician provides direct on-premise supervision (i.e., in the office suite) during the performance of the test.

The primary issue based on your question is that the physician is not on premise when the study is performed. I also cannot tell whether the initial visit and order requirements of the I2 rule are satisfied. The I2 rule, again, does not permit the NP to supervise the performance of any service, even if permissible under their state licensure rules. Additionally, under the facts provided, be-cause ALL of the above elements are not satisfied, and because the CURN performed the service, the service is not compensable. It would not be correctly reportable under either the NP or the physi-cian. Remember: I2 does not apply to services ordered/supervised by a NPP, such as an NP or PA. Bottom Line: Assuming the service was billed under the NP but not performed by the NP, it is not compensable and money paid for the service is an overpayment. Any overpayments should be refund-ed voluntarily to avoid potential False Claim Act liability for failure to refund an overpayment. The act provides 60 days from the date that specific overpayments are identified by anyone in the organi-zation. The clock starts right now. If you need legal assistance with the overpayment disclosure, please don’t hesitate to contact me.

Michael D. Miscoe, JD, CPC, CASCC, CUC, CCPC, CPCO, CPMA is president elect of AAPC’s National Advisory Board, serves on the AAPC Legal Advisory Board, and is the AAPC Ethics Committee chair. He has over 20 years of experience in healthcare coding and over 16 years as a compliance expert, forensic coding expert, and consultant. He has provided expert analysis and testimony on coding and compliance issues in civil and criminal cases and his

law practice concentrates on representing healthcare providers in post-payment audits and with responding to HIPAA OCR issues. He speaks on a national level, and is published in national publications on a variety of cod-ing, compliance, and health law topics. He is a member and president of the Johnstown, Pa., local chapter.



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■ AUDITING/COMPLIANCEBy Joette Derricks, MPA, CMPE, CPC, CHC, CSSGB


Prior to the HIPAA Security Rule, a generally accepted set of se-curity standards to govern electronic protected health informa-

tion (ePHI) didn’t exist. Today, all covered entities, including small health plans, are required to comply with the Security Rule. To en-sure compliance with HIPAA security standards, start by assessing how ePHI is handled in your practice.

HIPAA Security Rule Risk AssessmentOne major difference between the HIPAA Privacy Rule and the Se-curity Rule is that the Security Rule applies only to ePHI, which in-cludes information that is created, received, maintained, transmit-ted (e.g., over the Internet), or stored electronically on a computer hard drive or removable disk. The Security Rule does not cover PHI stored on paper or communicated verbally. The Security Rule requires covered entities (including physician practices) to have in place appropriate administrative, technical, and physical safeguards to protect ePHI against intentional or un-intentional use or disclosure.

Meaningful Use Security AssessmentPhysician practices are also faced with ensuring ePHI security if participating in either the Medicare or Medicaid Electronic Health

Conduct a Security

Analysis for Your Practice

The first step to ensuring your patients’ ePHI is secure is assessing your office’s HIPAA compliance.

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Table 1: Administrative Safeguard Standards

ADMINISTRATIVE SAFEGUARDS

Standards Sections Implementation Specifications (R)= Required, (A)=Addressable

Security Management Process § 164.308(a)(1) Risk AnalysisRisk ManagementSanction PolicyInformation System Activity Review

(R)(R)(R)(R)

Assigned Security Responsibility § 164.308(a)(2)

Workforce Security § 164.308(a)(3) Authorization and/or SupervisionWorkforce Clearance ProcedureTermination Procedures

(A)(A)(A)

Information Access Management § 164.308(a)(4) Isolating Health Care Clearinghouse FunctionsAccess AuthorizationAccess Establishment and Modification

(R)(A)(A)

Security Awareness and Training § 164.308(a)(5) Security RemindersProtection from Malicious SoftwareLog-in MonitoringPassword Management

(A)(A)(A)(A)

Security Incident Procedures § 164.308(a)(6) Response and Reporting (R)

Contingency Plan § 164.308(a)(7) Data Backup PlanDisaster Recovery PlanEmergency Mode Operation PlanTesting and Revision ProceduresApplications and Data Criticality Analysis

(R)(R)(R)(A)(A)

Evaluation § 164.308(a)(8)

Business Associate Contracts and Other Arrangements

§ 164.308(b)(1) Written Contract or Other Arrangement (R)

Source: http://www.hhs.gov/ocr/privacy/hipaa/administrative/securityrule/adminsafeguards.pdf

Records (EHR) Incentive Program. The meaningful use core objective to which I refer requires participating practices to secure ePHI created or maintained by cer-tified EHR technology through the implementation of appropriate technical capabilities. As part of its risk management process, an organization must conduct or review a security risk analysis in accordance with the requirements under 45 CFR 164.308(a)(1), implement security updates, as necessary, and correct any identi-fied security deficiencies.The meaningful use requirements are not intended to supersede or substitute compliance required un-der HIPAA. As a covered entity, you’re still required to comply with the HIPAA Privacy and Security Rules. The section of the Code of Federal Regulations cited in the meaningful use core objective refers back to the HIPAA regulations.The question then becomes: What action is required to adequately comply with both the HIPAA Security Rule and the meaningful use requirements associated with EHR incentive payments?In a nutshell: If you are in compliance with the HIPAA Security Rule, you should be able to attest to meeting the meaningful use core objective for security of ePHI.

Risk Assessment RequirementsThe Security Rule has detailed instructions for imple-menting safeguard standards. Each standard may be ei-ther required or addressable. (Table 1 shows some of the administrative safeguards standard, with the imple-mentation specifications noted as either (R) Required or (A) Addressable).

Set aside an hour or two each week to go through the administrative, technical, and physical standards and

implementation specifications. Before you know it, the risk assessment will be completed.


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When a standard is addressable, your practice must assess wheth-er it’s a reasonable and appropriate safeguard in your environment. This involves analyzing the specification in regards to the likeli-hood of protecting your ePHI from reasonably anticipated threats and hazards. If your practice chooses not to implement an address-able specification based on its assessment, it must document the rea-son and, if reasonable and appropriate, implement an equivalent al-ternative measure.Two required standards in the administrative safeguard section are: (1) conduct a risk analysis; and (2) implement a risk management plan. Together, these two standards form the foundation upon which you build necessary security protections.A risk assessment helps organizations ensure they are compliant with HIPAA’s administrative, physical, and technical safeguards. The required risk analysis and risk management implementation specifications serve as the foundation for your practice’s overall HIPAA compliance program.

• Risk Analysis: Conduct an accurate and thorough assessment of the potential risks and vulnerabilities to the confidentiality, integrity, and availability of ePHI held by the organization.

• Risk Management: Implement security measures sufficient to reduce risks and vulnerabilities to a reasonable and appropriate level to comply.

The Office of Civil Rights (OCR) has published extensive reports, guides, and tools to help organizations of all sizes comply with the HIPAA Security Rule. They are available on the U.S. Department of Health & Human Services website.In addition, the Health IT website provides an interactive tool any organization may use to complete a security risk assessment. Al-though the tool allows the information to be entered online, you may find it easier to download the requirements.While on the Health IT website, be sure to download a copy of Guide to Privacy and Security of Health Information (www.healthit.gov/sites/default/files/pdf/privacy/privacy-and-security-guide.pdf). This guide pro-vides an excellent overview of what is required for both the Privacy and Security Rules.

The Cost of NoncomplianceNeither the Security Rule nor meaningful use mandates for physi-cian practices to use a particular tool. The HIPAA Security Rule is clear that the standards are scalable and flexible; however, the pen-alties for noncompliance are substantial. Under HIPAA, penalties start at $100, per violation, and can grow to an annual maximum fine of $1.5 million, contingent on the type of the violation and whether the violator acted unknowingly or de-liberately. Another factor in the penalty calculation is whether the violator became aware of the violation and implemented corrective action in a timely manner. The penalty under meaningful use is a total payback of any incentive funds received through the program.

Take That First Step to ComplianceYour practice is ultimately responsible for conducting a risk assess-ment. Although the task may appear overwhelming, it’s obtainable. To tackle it, appoint a team that includes your practice administra-tor, a physician representative, and one or two staff members (per-haps the billing manager or front desk person). Set aside an hour or two each week to go through the administrative, technical, and physical standards and implementation specifications. Before you know it, the risk assessment will be completed. Unfortunately, this task is not a “once and done” requirement. Pro-visions in both meaningful use and the Security Rule require you to perform reviews at least annually, and whenever there has been a change in your practice. Changes that may affect the security assess-ment and require an update include implementing new technology that accesses PHI, entering into a joint venture or merger with an-other practice, and moving to a new facility.

Joette Derricks, MPA, CMPE, CPC, CHC, CSSGB, has 35 years of healthcare finance, op-erations, and compliance experience. A national speaker and author, her unique style is to bridge the regulatory requirements with the practical realities of day-to-day operations. Derricks has provided numerous expert reports and testimony regarding Medicare, Medic-aid, and third-party payer regulations with an emphasis on coding, billing, and reimburse-

ment rules. She serves as the vice president, regulatory affairs at Anesthesia Business Consultants, and is a member of the Ann Arbor, Michigan, local chapter.

Another factor in the penalty calculation is whether the violator became aware of the violation and implemented corrective action in a timely manner.


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■ AUDITING/COMPLIANCEBy Marcia L. Brauchler, MPH, FACMPE, CPC, COC, CPC-I, CPHQ


Risk Assessment High PrioritiesPart 2: Five human resources policies every practice should implement and maintain.

Five significant human resources policies your practice should adopt are: non-discrimination, sexual harassment, Family Med-

ical Leave Act, the Fair Labor Standards Act, and non-retaliation. These policies ensure your practice complies with important federal and state laws implemented to protect individuals in the workplace.

Non-discriminationAdopt a strict policy that your practice will not discriminate against any provider, staff member, patient, family member, or any other person, based on the following regulations:

• Title VII of the Civil Rights Act of 1964 (Title VII), which prohibits employment discrimination based on race, color, religion, sex, or national origin;

• The Equal Pay Act of 1963 (EPA), which protects men and women who perform substantially equal work in the same establishment from sex-based wage discrimination;

• The Age Discrimination in Employment Act of 1967, which protects individuals who are 40 years of age or older;

• Title I and Title V of the Americans with Disabilities Act of 1990, as amended, which prohibits employment discrimination against qualified individuals with disabilities in the private sector, and in state and local governments;

• Sections 501 and 505 of the Rehabilitation Act of 1973, which prohibit discrimination against qualified individuals with disabilities who work in the federal government;

• Title II of the Genetic Information Nondiscrimination Act of 2008, which prohibits employment discrimination based on genetic information about an applicant, employee, or former employee; and

• The Civil Rights Act of 1991, which among other things, provides monetary damages in cases of intentional employment discrimination.

DisclaimerThe information provided in this article is a summary of human resources policies and procedures. Consult with your lawyers or other professional advisors for definitive information about how to implement human resources policies tailored to your practice.

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Sexual HarassmentSexual harassment includes unwelcome sexual advances, requests for sexual favors, and other verbal or physical conduct of a sexually harassing nature when:

• Submission to the harassment is made (either explicitly or implicitly) a term or condition of employment;

• Submission to or rejection of the harassment is used as the basis for employment decisions affecting the individual; or

• The harassment has the purpose or effect of unreasonably interfering with an individual’s work performance or creating an intimidating, hostile, or offensive work environment.

If you receive a complaint of sexual harassment by anyone, includ-ing supervisors, co-workers, or visitors, immediately tell the harass-er that his or her behavior is offensive or unwelcome and request that the behavior stop. Bring the matter to the attention of your compli-ance officer or practice manager (unless the compliance officer or practice manager is involved — if that’s the case, inform other man-agement or your practice’s owner(s)). If alleged harassment involves any type of threats of physical harm, suspend the alleged harasser with pay, and conduct an investiga-

tion. If the investigation supports charges of sexual harassment, discipline the harasser, up to and including termination. If the investigation reveals the charges were brought falsely and with malicious intent, discipline the accuser, up to and including ter-mination.

The Family Medical Leave Act (FMLA)The FMLA applies if your practice employs 50 or more employ-ees. Employees and the Department of Labor can file claims for violations of the FMLA. The FMLA allows employees to take medical or family leave for their own health reasons or to care for other family members. The employee must have been employed at least 12 months and have worked at least 1,250 hours during the previous 12 months to be eligible for leave.An employee is allowed 12 workweeks of leave in a 12 month pe-riod for the birth and care of a newborn within the first year, af-

ter adoption or foster care placement, or if he or she, or a spouse, par-ent, or child has a serious health condition. Longer leaves may be al-lowed if the person who is seriously ill is in the military.The FMLA leave includes any other paid time off the employee has, including during short- or long-term disability. For example, em-ployees may take intermittent medical leaves for periodic treatments of a serious health condition. Require a written explanation for a requested FMLA leave and make sure that, during the leave, the employee keeps you updated on any changes. You can require an employee to get a second or third med-ical opinion — although you must do so at your cost.Establish a policy that any employee who can reasonably anticipate a medical leave inform you in advance. If a request for leave is fore-seeable and the employee fails to provide adequate notice, you can delay or deny the leave.If the leave lasts 12 weeks or less, you must guarantee that the em-ployee can return to his or her previous position or an equivalent po-sition with equivalent pay, benefits, and other terms and conditions. If the leave is longer than 12 weeks, you can fill the employee’s po-sition and attempt to place the employee at the end of the leave. You

In Part 1 of this series (Healthcare Business Monthly, May, pages 51-54), I gave you several pointers on how to guard against False Claims Act violations, and I introduced the Compliance Heat Map, created by my firm to help physician practices identify where they should focus their resources (time, money, manpower, and the attention of management, providers, and staff).

The upper right quadrant on the Compliance Heat Map contains the highest severity categories — those representing the greatest probability you will be audited, and with the most severe penalties for non-compliance.

Note: HIPAA compliance is being addressed in the seven-part series “Building a HIPAA Toolbox” (pages 52-53 in this issue).

If alleged harassment involves any type of threats

of physical harm, suspend the alleged harasser

with pay, and conduct an investigation.


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To discuss this article or topic, go to www.aapc.com

can terminate an employee that does not return from their autho-rized leave.If an employee takes intermittent leave, you can require the em-ployee to transfer temporarily to an alternative, available position for which the employee is qualified, or you can modify the employ-ee’s existing job, as long as the temporary position has equivalent pay and benefits and better accommodates the employee’s recur-ring periods of leave.Employees on leave will continue to receive insurance benefits and remain responsible for his or her portion of premiums. You may recapture premiums you pay during an employee leave if the em-ployee fails to return to work because of his or her (or family mem-ber’s) health condition, or other circumstances beyond the employ-ee’s control.

Fair Labor Standards Act (FLSA)The FLSA prescribes standards for basic minimum wage and over-time pay, and affects most private and public employment. It re-quires employers to pay covered employees at least the federal min-imum wage, and overtime pay of 1.5 times the regular rate of pay. The FLSA is administered by a division of the Department of Labor.You are required to post wage and hour information for your em-ployees in a conspicuous place. These posters can be obtained for free from the Department of Labor and your state agency that ad-ministers wage and hour laws.

Non-retaliation PolicyThe U.S. Sentencing Commission’s organizations guidelines and the Office of Inspector General’s compliance guidance requires you to implement and maintain a policy of non-retaliation/non-retribu-tion for employees who report violations of laws, or your practice’s policies and procedures or code of conduct. Adopt a policy and im-plement procedures that encourage your employees to communi-cate problems, concerns, and opinions on any issue without fear of retaliation or reprisal. Post the policy prominently, and clearly state:

• All employees have a duty to promptly report actual or potential wrongdoing and violations of laws, policies and procedures, and your code of conduct;

• Your practice will act upon all reports of actual or potential violations, problems, or concerns in an appropriate manner;

• Employees who in good faith report wrongdoing or violations will not be subjected to retaliation, retribution, or harassment; and

• While employees cannot escape the consequences of their own wrongdoing, you will consider self-reporting when determining what disciplinary action will be taken.

Physician practices often focus on risks associated with noncompli-ant billing and lose sight of the most elemental risk associated with doing business: employees. Solid, up-to-date human resources pol-icies will prevent costly misunderstandings.

Marcia L. Brauchler, MPH, CMPE, CPC, COC, CPC-I, CPHQ, is president and founder of Physicians’ Ally, Inc. Brauchler and a uniquely qualified staff provide advice and counsel to physicians and practice administrators, as well as education and assistance on how best to negotiate managed care contracts, increase reimbursements, and stay in compliance with healthcare laws. Brauchler’s firm sells updated HIPAA policies and procedures at

www.physicians-ally.com. She is a member of the South Denver, Colorado, local chapter.

ResourcesHere is a list of resources where you can find more information about the policies discussed in this article.

Anti-DiscriminationEqual Employment Opportunity Commission (EEOC): www.eeoc.gov

Sexual HarassmentTitle VII of the Civil Rights Act of 1964: www.eeoc.gov/laws/statutes/titlevii.cfm EEOC: www.eeoc.gov/laws/types/sexual_harassment.cfm

Guidelines: www.gpo.gov/fdsys/pkg/CFR-2011-title29-vol4/sml/CFR-2011-title28-vol4-part1604.xml

FMLAwww.dol.gov/whd/regs/statutes/fmla.htm

Fair Labor Standards Actwww.dol.gov/compliance/laws/comp-flsa.htm

www.dol.gov/whd

www.dol.gov/whd/regs/compliance/posters/flsa.html

www.dol.gov/whd/regs/compliance/posters/fmlaen.pdf

Non-retaliationU.S. Sentencing Commission, Guidelines Manual, Federal Sentencing Guidelines for Organizations, chapter 8: www.ussc.gov/Guidelines/Organization_Guidelines/index.cfm

OIG Compliance Guidancewww.oig.hhs.gov/compliance

Establish a policy that any employee who can reasonably anticipate a medical leave inform you in advance.


MGMA

Medical Group Management Association®

• Code of conduct

• Compliance officer position description

• Antitrust laws

• DEA certification

• Food and Drug Administration

• Sunshine Act

• Professional courtesy

• Dismissing a patient

• Non-retaliation

• Nondiscrimination

• Sexual harassment

• Use of nonphysician providers

• And dozens more

With the MGMA Compliance Plan Toolkit, a web-based “wizard,” and a few simple pieces of your practice’s information, you can create a customized compliance plan in minutes.

This compliance toolkit covers the seven elements of a small group or third-party billing company’s voluntary compliance plan, as outlined by the U.S. Department of Health and Human Services Office of the Inspector General in 2000.

Authors:Marcia Brauchler, MPH, FACMPE, CPC, CPC-H, CPC-I, CPHQErika Riethmiller Bol, CHC, CIPP/US, CPHRMAmy Powers, JDChristopher Varani, MSF, MBA, CPCDaryl T. Smith, FACMPE

Build your compliance plan in minutes

Policies in the toolkit include:

Purchase your toolkit today. mgma.org/store-compliance

Invest in your current peace of mind and your practice’s long-term future


■ AUDITING/COMPLIANCEBy Julie Roth


With the adoption of the Medicare and Medicaid Electronic Health Records (EHR) Incentive Programs, collectively known

as meaningful use, there has been a steady increase of providers who have transitioned from a paper-based medical record to an EHR. Re-gardless of which format your office uses, the government expects your medical record documentation to be timely, accurate and com-plete, properly authenticated, and safeguarded from unauthorized ac-cess or disclosure. If you’re considering making (or have already made) the switch from paper records to an EHR, you should be aware of the unique compliance issues this newer technology creates for providers.

Risky BusinessGovernment enforcement efforts have been primarily focused on providers who failed to properly implement HIPAA security stan-dards in their EHR, which resulted in electronic protected health information (ePHI) breaches. The government’s attention is turn-ing to other vulnerabilities in EHR systems, however — particular-ly fraudulent or abusive documentation practices.Although the government has recognized that EHRs, when used appropriately, have the potential to reduce healthcare system costs and improve patient care, there is increasing concern that certain EHR documentation features may result in healthcare fraud and poor data quality. Activities of particular concern to the government are: Copying and Pasting: In September 2012, the U.S. Department of Health & Human Services and the U.S. attorney general wrote an open record to the nation’s hospitals warning of “troubling indica-

tions that some providers are using [EHR] technology to game the system, possibly to obtain payments to which they are not entitled.” The letter specifically addressed the “cloning” of medical records to inflate the amount providers are paid, and states, “A patient’s care information must be verified individually to ensure accuracy: it can-not be cut and pasted from a different record of the patient, which risks medical errors as well as overpayments.” This concern was echoed in a January 2014 Office of Inspector Gen-eral (OIG) report entitled CMS and Its Contractors Have Adopted Few Program Integrity Practices to Address Vulnerabilities in EHRs:

When doctors, nurses, or other clinicians copy-paste in-formation but fail to update it or ensure accuracy, inaccu-rate information may enter the patient’s medical record and inappropriate charges may be billed to patients and third-party health care payers. Furthermore, inappropriate copy-pasting could facilitate attempts to inflate claims and du-plicate or create fraudulent claims.

User Identity and Overdocumenting: The OIG also expressed concern that EHR technology may be used to mask true author-ship of medical records. “For example,” the OIG wrote, “clues with-in the progress notes, handwriting styles, and other attributes that help corroborate the authenticity of paper medical records are large-ly absent in EHRs.”According to the OIG, tracing authorship and documentation in an EHR is not as straightforward as tracing in a paper record; EHRs allow providers to use software features that may mask true author-

Building a HIPAA ToolboxPart 7: EHR vulnerabilities can lead to overpayments.

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AUDITING/COMPLIANCE

EHR VulnerabilitiesTo discuss this article or topic, go to www.aapc.com

ship of the medical record and distort information in the record to inflate health care claims.The OIG also cited concern about systems that permit “overdoc-umenting” to occur, such as EHR technologies that auto-popu-late fields when using templates built into the system, and systems that generate extensive documentation based on a single click of a check box.

Best PracticesHealthcare providers can reduce the risks associated with inappro-priate EHR documentation and authentication by implementing policies that integrate both billing compliance and HIPAA Securi-ty Rule standards.

Avoid Cloned DocumentationAlthough a copy-paste feature may enhance the efficiency of data en-try, healthcare providers should be aware that documentation indi-cating a patient had the exact problem and symptoms, and required the exact same treatment as another patient (or the same patient had the same problem/situation on every encounter), will raise a red flag for impermissible cloned documentation in a medical record audit.From a HIPAA security standpoint, providers should assess the ex-tent to which their EHR technology allows for importing and ex-porting copied data from one patient encounter to another, and de-termine what controls are available to limit or track the use of this function.From a billing compliance standpoint, train providers to under-stand that cloned documentation will not support medical necessity requirements for coverage of services, and may lead to recoupment or an assertion that the provider has knowingly submitted false claims. Medical record documentation policies may advise users to avoid indiscriminately copying and pasting and, in cases where data has been copied, to cite the original source of the copied-pasted data.

Avoid Masked Users and OverdocumentationThe HIPAA Security Rule requires providers to determine which individuals will be granted access to patients’ EHRs, and to assign a unique name and/or number identifying and tracking the identity

of every individual who has been granted such access.To deter documentation by a “masked” user, a provider’s HIPAA se-curity policies should clearly prohibit any individual from logging in under another individual’s login information and prohibit individ-uals from sharing password information for this purpose. Providers also should ensure audit logs are enabled. Ideally, audit logs should track changes in a record by capturing data elements such as date, time, and users stamps for each update to an EHR.Providers should consider carefully the implications of using any product that auto-creates medical record documentation. In any case where text is automatically created or pulled forward from pre-vious entries, providers should be required to specifically review, edit, and update the information to assure it accurately reflects the services performed during the encounter. Although the implementation of EHRs often is seen as a way to in-crease the efficiency and quality of the healthcare system, there is growing concern about the potential for EHR technology misuse and abuse leading to overpayments and fraudulent claims. Provid-ers should assess the risks unique to their organizations, and explore the methods through which they can best demonstrate the accura-cy of their medical record documentation.

Julie Roth is a partner in Lathrop & Gage, LLP, and represents healthcare providers on regu-latory compliance, Medicare & Medicaid reimbursement issues, self-disclosure matters, gov-ernment investigations, HIPAA privacy and security standards, the Stark law, the Anti-kick-back Statute, the False Claims Act, and a variety of federal and state laws.

… there is increasing concern that certain EHR documentation features may result in

healthcare fraud and poor data quality.

DisclaimerThis is an advisory publication of Lathrop & Gage, LLP. It is not intended, nor should it be used, as a substitute for specific legal advice, as legal counsel may only be given in response to inquiries regarding particular situations.


■ ADDED EDGEBy Angela Clements, CPC, CEMC, COSC, CCS

Grow as a ProPrepare yourself for a professional future of opportunity and success.

There are many ways to grow as a professional. All areas of growth start with an internal evaluation of where you are and where you

want to be. A common phrase used in our society is “dress for the job you want, not the job you have.” In other words: Prepare yourself for a future opportunity so you’re ready when the opportunity presents itself. All it takes is a little initiative on your part.

Take InitiativeA person who takes initiative is proactive. She does not wait for an opportunity to fall into her lap. She prepares for it, and then goes and gets it. Those who excel as a professional are willing to work hard and perform any task that is asked of them, or take the initia-tive by asking for additional tasks — even if it means starting at the bottom and working up.For example, before I was a manager, I started out reading only ma-terial that pertained to my current role. One day, the light bulb went off, and I realized I would not grow beyond the status quo if I didn’t read about topics and specialties I did not completely understand. I started asking my supervisor for additional tasks. I became eager

to learn and to grow in areas unknown or out of my comfort zone. When I changed my perspective, opportunities became limitless.

See Things in a New PerspectiveI have watched Coder A get angry at a co-worker, Coder B, who re-ceived a promotion that Coder A wanted. In Coder A’s mind, Cod-er B should not have gotten the position. In reality, the promotion was probably earned and deserved because Coder B did what was asked and went beyond the normal job responsibilities, meeting ev-ery challenge and assisting others. Coder B had a positive attitude. In contrast, Coder A commonly asked, “Why do I have to do that?” or “How much more money am I going to get for adding that to my responsibilities?”Have you ever been passed over for a promotion and you didn’t know why? Look at how you handled it (or how you think you would handle it). It’s OK to be disappointed, but it’s not OK to be angry at the co-worker who got the promotion.Instead, congratulate your co-worker, and then do something that will ensure you don’t get passed over again.

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Remember: Working in the medical field requires keeping up with constant changes. To succeed in this field, you must adapt. New reg-ulations, new technologies, annual coding changes (not to mention the temporary codes Medicare may add mid-year), and new meth-odologies are some areas you must update every year, every quarter, or even every month. Changes in responsibilities don’t always reflect pay grade changes. It’s your responsibility to stay current with pol-icies and regulations.

Sharpen Your SkillsEvery so often, perform a self-assessment. Look at yourself and de-termine what areas need refinement. It could be functional skills such as improving your computer proficiency or social skills to help bridge a generation gap. There are many skills needed in the work-place that we fail to develop because we don’t focus on attitude and the social aspect as much as the functional aspect of work. Each of us likes to believe we are a model employee; however, no one is per-fect. Everyone has at least one skill that needs sharpening and an honest self-assessment will illuminate the area(s) you need to hone. You might even be proactive by seeking a mentor who can help you sharpen skills that lack luster.

Worry About YourselfMany employees fail to grow as a professional because they are too worried about what their co-workers are doing (or not doing). Do not focus on others. The time you spend worrying about others is valuable time you could be spending on yourself.

Overcome BarriersAttitude is probably one of the biggest barriers to overcome. A change in attitude, or a change in how you react to a situation, may be your first step to growing as a professional. This is a change that needs to come from within. Have you ever noticed how some people (maybe even you) hate Mondays? Of course Monday is likely to be a miserable day if you don’t look forward to going to work. Choose your attitude when you

wake up, and make it positive by saying out loud, “Today is going to be a great day!” or “I love my job!”Time can also be a barrier. If you feel like you need a 36-hour day to complete your work, perhaps you need to improve your time man-agement skills. Think about how you can reorganize your work for maximum time efficiency.Your priorities may shift daily, but knowing what they are will help you with time management. Prioritize your work. Determine what needs to be completed today and set a timeline. If you spend most of the day working on one task that is due the next day, and leave an hour for a task that has a 5 p.m. deadline, you are setting your-self up for failure. Don’t get comfortable in your “safe zone.” Challenges are good. Fac-ing challenges enables you to grow as a person and a professional. Failure just proves you’re trying. It’s OK if you don’t succeed right away. As William Edward Hickson wrote, ‘Tis a lesson you should heed, Try, try again. If at first you don’t succeed, Try, try again.” A successful day is a day you learn at least one thing!

Angela Clements, CPC, CEMC, COSC, CCS, is the physician coding auditor/educator con-sultant at Medkoder. She has over 16 years of experience in the healthcare industry. Clements serves on the National Advisory Board as member relations officer, and is president of the Cov-ington, Louisiana, local chapter.

Think PositivelyPart of growing as a professional is developing a positive attitude. Give it a try!

The Old You The New You

“I can’t do that.” “Yes, I can!”

“I’ve never done that before.” “I’ll try anything at least once!”

“That’s not my job.” “I would love to take on new responsibilities!”

“How much more money will I get for adding this to my responsibilities?”

“I appreciate the opportunity!”

“I’ve never had to do that before.” “I might learn something new!”

“Why doesn’t she have to do it?” “I must be special!”

It’s hard to grow and sharpen your skills if you are

worrying about someone else’s actions or comparing

yourself to your co-workers.


Carlos Carioca-Gomes, COC-A, has been working as a medical cod-er for over a year. His story has become increasingly unique in the cod-ing world: He was hired as an entry-level coder. As some coders with ap-

prentice designation struggle to land a coding position, you may wonder how that comes about. What challenges did Carioca-Gomes face in transi-tioning into the coding field? What kind of help did he receive? Where will he go from here?I sat down with Carioca-Gomes to dig a little deeper into his experience as a newly-certified coding professional.

Denis Rodriguez (DR): What setting do you work in? I work in a remote setting, from home, for a large, national surgical solutions provider. I code several different surgical specialties.

DR: How long have you been a coder?I have been a coder since January 2014. I passed the Certified Outpatient Coding (COC™) exam (formerly CPC-H®) in May 2014.

DR: What did you do before you became a coder?I used to work as front desk clerk/manager on duty at a hotel. I worked in that field for years. Finally, I decided to make a career switch to medical coding. It was quite a transition from one field to another, especially because I had no experience in the medical field.

DR: What made you decide coding is something you wanted to do?I have a good friend who has been a coder for years. My wife suggested I speak with him to see if I could get into that field. When I spoke to my friend, he actually said that he had thought about me becoming a medical coder before! From that moment, I decided I wanted to become a medical coder.

DR: How did you get your start in coding?That friend gave me direction on how to get started. He told me that I would need to know medical terminology and anatomy. He discovered on the AAPC website that there was a coding package that would help to train me. This package included online courses for medical terminology, anato-my, and COC™. The package also had a voucher that allowed me to take the COC™ exam. I purchased the package and got started. My friend also ex-plained some different things about medical coding, like how to use coding books, National Correct Coding Initiative (NCCI) edits, etc.When I was ready to sit for the exam, I let my friend know. He said that he would speak to management of the company he worked for, Surgical Care

Interview

CODER’S VOICEBy Denis Rodriguez, COC, CASCC

A coder is guided to becoming a coding professional and explains his challenges and what lies ahead.

WITH A CODER


Affiliates (SCA), to see if they would hire me. Management decid-ed to give me a chance, and even to develop a training program for entry-level coders.

DR: What has helped you the most as a coder?Definitely having good knowledge of medical terminology and anatomy. Sometimes, you may find a case in which you are not fa-miliar with the terms or the anatomy involved. It’s key to educate yourself in such cases.You want to follow American Medical Association (AMA) and NCCI guidelines very closely, depending on the payer. This helps ensure accurate coding. Also, ask assistance from experienced cod-ers. They provide great guidance on how to code accurately.

DR: What skill sets have you been able to translate from your previous work experience into coding?My previous occupation involved ensuring customer service satis-faction. Working at SCA, I have to code for different facilities. As in my previous role, I work very hard to ensure excellent customer service to the teammates from each facility I work with and the en-tire company.When I worked as a front desk agent, I had to be extremely profes-sional towards workmates and customers. I do the same working with SCA in that I make sure emails and phone conversations are handled in a very professional manner.

DR: What has been the most challenging thing for you as a coder?I think the most challenging aspect — and I suspect many cod-ers will agree with me — is knowing if codes bundle into each oth-er. Sometimes, you may know all the codes to use for a specific en-counter, but find out that some procedures are bundled into other procedures. To overcome this challenge, it’s mandatory for a coder to know AMA/CPT® or NCCI guidelines, depending on the pay-er. CPT® Assistant articles have helped me make these decisions, and experienced coders have guided me, as well.

DR: In what directions are you thinking of taking your coding career?I plan on possibly getting specialty certification — ambulatory sur-gery center (ASC) or certain surgical specialties like orthopedics — for other coding specialties or settings. SCA has a Performance Im-

provement department that develops education for their coders, au-dits coding, and researches coding issues. I would love to develop enough as a coder to do something like that. But as of now, I am con-centrating on acquiring accurate medical coding knowledge.

DR: What advice would you give to someone who was thinking of transitioning into a career in coding?This is a very rewarding career to get into. It’s rewarding in the sense that you are involved in a unique aspect of the medical field. You will also gain extensive knowledge of medical terminology and anatomy. Expect to do a lot of research in the beginning, and ask for assistance from experienced coders. Your personal research will never end; the medical field is rich with information that is always being updated. It will require a lot of work on your part, but you will see with time that it is well worth the investment!

Denis Rodriguez, COC, CASCC, works as a performance improvement analyst for SCA, a large, national surgical solutions provider. In his 15 year coding career, he has worked as a cod-er, auditor, educator, and speaker in both the professional and facility settings. As an educa-tor, Rodriguez has overseen and implemented the development of weekly, monthly, and yearly educational programs, publications, and assessments. As an auditor, he has performed

hundreds of audits for surgery centers throughout the country, identifying compliance issues and areas of missed revenue. Rodriguez has spoken at several national ASC conferences and has published articles in sever-al medical industry magazines. He is a member of the Orlando, Florida, local chapter.

Interview with a Coder

Management decided to give me a chance, and even to develop a training

program for entry-level coders.

Why Do You Do What You Do?

Healthcare Business Monthly wants to know why you chose to be a healthcare business professional. Explain in less than 400 words why you’re a coder/biller, auditor/compliance officer, practice manager, or consultant; how you got to where you are; and your future career plans. Send your success stories and a high resolution digital photo of yourself to Michelle Dick ([email protected]).


NEWLY CREDENTIALED MEMBERS

Magna Cum LaudeMagna Cum LaudeMagna Cum Laude

Amy Corkins, CPC-A Angela Sue Trively, CPC-A Anne-Corinne Kell, CPC-A Arun Jebastin Gnanaiah, CPC, CPC-P, CPMA Bob Lathrop, CPC, CASCC Christina Gulden, CPC-A Christopher Anrig, CPC-A Crizagne Armin De Guzman, CPC-A Deana R Osborne, CPC, CPB Dustin Johnson, CPC-A Elisabeth Wilder, CPC-A Essie G Ordonez, CPC, CIRCC Francesca Marie Pamintuan, CPC-A Gina Gibson, CPC Jay Prakash Kuliyal, CPC-A Jeremy Dale Clark, CPC, CIRCC Justine Moomaw, CPC Kelly Langschultz, CPC Kristin Lynn Carnahan, CPC-A Leena Evelyn S, CPC Lielanie Cura, CPC-A Lizelle Guilas, CPC-A Lori Sobral, CPC MA.Purita Castro Pingol, CPC-A Mark Lester Dela Cruz, CPC-A Mark Rovin Malit, CPC-A Michele M Riordan, CPC-A Nandkishor Sharma, CPC-A Nino Mayuyu, CPC-A Norma Ann Panther, CPC, CIRCC, CPMA, CPC-I, CEMC

Patricia Merdian, COC, CPC, CPB, CPMA, CEMC

Patricia Wieczorek, CIRCC Reizsha Reyes, CPC-A Tarun Sharma, CPC-A Terri Brown, CPC, CPC-P, CPMA, CRCTricia A Thomas, COC-AYarina Diaz, CPC-A

CPC®CPCCPCAbigaiel Dalke, CPC Abinaya Ponpandian, CPC Adair Rispoli-Chesley PhD, CPC Adrianne Crawford, CPC Agnes Elizabeth Marek, CPC Aisha Ali, CPC Alesia Irby, COC Alexa Albert, CPC Alicia Reedy, CPC Allison Brinkman-Henneke, CPC Alyssa Aschbrenner, CPC Amanda Anderton, CPC Amanda J Hernandez, COC, CPCAmanda McFarland, CPC Amanda Poole, CPC Amanda Williams, CPC Amber Danielle Roberts, CPC Amber Lee Blankenship, CPC Amber Leigh Neeley, CPC Amber Seymour, CPC Ami Edmonds, CPC Amit Nagpal, COC, CPC, CPC-P Amutha Murugeasan, CPC Amy Abbott, CPC Amy Campbell, CPC, CPPMAmy Hulker, COC, CPCAmy Mizell, CPC Amy Reeger, CPC Amy StGeorge, CPC Amy Walker, COC, CPC, CEDCAna Laura Bacallao, CPC Anand Babu M, COC, CPCAnantharaj Ramakrishnan, COC, CPCAndrea R Swales, CPC Andrea Ryken, CPC Andy Markel, COC, CPCAngela Buchanan, CPC Angela K Barnett, COC, CPCAngela Marie Eplin, CPC Angela R Theriault, COC, CPCAngela Thompson, CPC

Angeline Wright, COC Angie Knight, CPC Anita Hairston, CPC Anita M Bennett, COC, CPC, CPCO, CFPCAnn Sczygelski, CPC Anna Huffman, CPC Annamarie E Trent, CPC Anne Arenstein, CPC Arun Kumar Duraisamy, CPC Ashleigh Grooms, CPC Ashley D’Amore Ellis, CPC Ashley Gore, CPC Ashok Mani, CPC Ayesha R. C. Hampton, COC, CPCBarbara Allen, CPC Barbara Ashdown, CPC Barbara Cullen, CPC Barbara Montemayor, CPC, CEMCBarbara Vaughn, COC Becky Johnston, CPC Beverly Sides, CPC Bhagyashree Bharambe, CPC Bhavin Kumar Vadodaria, CPC Bill Woerner, CPC Billie Jo Swink, CPC Bipin Bhosale, CPC Blair M Ortega, CPC Blessing Sivaraj, CPC Brandi Gleason, CPC Brandi McGee, CPC Brandy Shaw, CPC Brenda Knapp, CPC Brenda Ritchie, CPC Brian Smith, CPC Briana Primavera, COC, CPCBrianna Rivera, CPC Brittany Dewey, CPC Brittany L Williard, CPC Brittany Meza, CPC Brittany Nicole Goulart, CPC Brittany Wilson, CPC Cailin Spencer, CPC, CPBCamille Chargois, CPC Candace J Frohlich, CPC Carla Tierney, CPC, CPC-P Carla Tierney, CPC, CPC-PCarly Arroyo, CPC Carmen Sanchez, CPC Carol Caravelli, CPC Carol Chestnut Buonadonna, CPC Carol Drake, COC Carol Marcoux, CPC Carol Motley, CPC Carrie K Hubbard, CPC Caryn Daane, CPC Catherine A Cline, CPC Catherine Jean Steburg, CPC Cathleen A Rutschow, CPC Cawandra Jallow, COC, CPCCeleste R Williams, CPC Chance Unterseher, CPC Charity Green, CPC Charmion Cosse, CPC, CIRCCCharnley McCrorey, CPC Chassidy Morgan, CPC Cherie Chenel, CPC Cherie Fieri, COC, CPCCheryl Wanat, CPC Chezka Milan Pandez, CPC Christian Morris, CPC Christina N Harshman, CPC Christine Ciprian, COC Christine Clingman, COC, CPCChristine Poe, CPC Christine Staples, CPC Christy Wills, CPC Cindy Helton, CPC Cindy Kennedy, COC, CPC, CPMACindy M Sanchez, CPC Claire Herrera Melhorn, COC, CPC Clara Olachea, CPC Clarissa Phillips, CPC, CPMAClaudia N Uribe, CPC Cody Creekmore, COC Colleen Gifford, CPC Colleen Olsen, CPC Connie Akins, CPC Connie Waddell, CPC Coumba Sam Diallo, CPC

Courtney Thrift, CPC Craig Bard, CPC Crystal Gallegos, CPC Crystal McCarter, CPC Crysten Watkins, CPC Cynthia Anne Elliott, CPC Cynthia Brennan, CPC Cynthia M Larson, CPC, CPC-P Daniele DeGrandis-Kneer, CPC Danielle Holt, CPC Darcie Gessner, CPC Darlene Nunez, COC, CPCDarlene Patterson, CPC Darryll Ruben Martinez de Castro, CPC David Vidal, CPC Dawn Hamman, CPC Dawn Kurelko, CPC Dawn M Sparks, CPC Dawn Mary Hauptmann, CPC Dawn Moreno, CPC Dawn Villare, CPC Dawn Wittke CCS-P, CPC, CPMADayna Anderson, CPC Deanna Ann Heath, CPC Deanna Barber, CPC Deanna Jo Chandler, CPC Deanna Kay Christopherson, CPC Debbie Crouch, CPC Debbie Greene, CPC Debbie McDonald, CPC Debbie Novak, CPC Debbie Snyder, CPC Deborah Carbery, CPC Deborah Critzer, CPC Deborah Vierra, CPC-P Deborah Wilmoth, CPC Debra A Taylor, CPC Debra Jahnke, CPC Dedra King, COC, CPCDeepa Kangalamoorthy, COC, CPCDeepa Sukumar, CPC Deidre Walker, CPC Delaine Fast, CPC Della Lloyd, CPC Delores Miles, CPC Demir Rai Smith, CPC Denice Johnson, CPC Denise Cobourn, CPC Denise Grabowski, CPC Denise Lynn Brown, CPC Denise T Patrick, CPC Derek Martin, CPC Dhanya Purushothaman, CPC Dheeraj Sonawane, CPC Dian Ford, CPC Diana Hogaboom, CPC Diana Mary Kipp, COC, CPCDiana Santana, CPC Diana Sickles, CPC Diana Wenrich, CPC Diane Ringling, CPC Dipti Deshmukh, CPC Dominika Sadej, COC, CPC, COBGCDonielle D Davis, CPC Donna Fedrowitz, CPC Donna Felder, CPC Donna Ferris, CPC Dorri McPherson, CPC Dr MadhuSudhanRao Kotha, COC, CPC, CPC-P, CEDC

Dr. Pallavi Yenpure, CPC Dr. Vaishali Dhore, CPC Dusty Groff, CPC-P Edith Clark, CPC Elaine DiLoreto, CPC Elaine E. Schaedel, CPC Elaine Poynter, CPC Elizabeth Ann Angelastro, CPC Elizabeth Anne Lindsay, CPC Elizabeth Hamilton, CPC Elizabeth Luhr, CPC Emily A. Albert, CPC Emily Chighizola, CPC Emily Dorcey, CPC Eric Hoang Lam, CPC Erika Hurley, CPC Eugene Kwak, CPC-P Eva Barranco, CPC Eva Clark, CPC

Farrah Dray, CPC Frances Michael Lynch, CPC Frieda T Cromley, CPC Gary Clifton Dennis, CPC George Jared Jeppson, CPC Gerry Yang, CPC Ghia Chantelle Esponja Larios, CPC Gina L Clark, CPC Glenda Mattonen, CPC Gloria Garcia, CPC Gloria Jemery, CPC Gowri T, CPC Gowthami Kammari, CPC Gregory Collins, CPC Gretchen Hill, CPC Haley Sutton, COC, CPCHannah Collings, CPC Harriet Denise Wright, CPC Heather Beasley, COC Heather Blakeman, CPC Heather Hughes, CPC Heather Lynn Cooper, CPC Heather Morrison, COC Heather Oliveira, CPC Heather Pravorne, CPC Herb Bruss, CPC Isaiyas Arulappan, CPC Ivy Miller, CPC Jackie Vasquez, CPC Jaclyn Jones, CPC Jacqueline Willett, COC Jade Nichole Peterson, CPC Jaime McCoy, CPC James A Steele, CPC Jamie Caron, CPC Jamie D. Bowles, CPC Jamie Languedoc, CPC Jamie Lorraine Harrison, CPC Janice B Steele, COC Jaya Sudha, CPC Jeannie Korb, CPC Jenna Medalen, CPC Jennie E Moody, COC, CPCJennifer Wilkie, CPC Jennifer Bolds, CPC Jennifer Connolly, CPC Jennifer D Thomason, COC Jennifer Helminiak, CPC Jennifer Lea Smith, CPC Jennifer Nelson, CPC Jennifer Prater, CPC Jennifer Sechrist, CPC Jennifer Wright-Davis, CPC Jeremy Stacey, CPC Jerri Hampton, COC, CPCJerry Joseph, CPC Jessica Anderson, CPC Jessica Fleischman, CPC Jessica Harless, CPC Jessica Louise Hamilton, CPC Jessica Michele Rose, CPC Jessica Tavorn, CPC Jintu Susan Alex, CPC Joanie Howard, CPC Joanne Newton, CPC Jodi Pendergast, CPC Jody Armstrong, CPC Joe Morton, COC Joleen R Splichal, COC, CPCJonel Querrer, CPC Josephine Destine, CPC Joy Jones, CPC Joyce Amidio, CPC Judith A Wells, CPC Judith Powell, CPC Judy Roaden, CPC Julfic Jubairali, CPC Julia Keenen, CPC Julianne C George, COC, CPC, CEMCJulianne Foley, CPC Julie Kaiser, CPC June Witt, CPC Juveria Kareem, CPC Jyothi U B, CPC Kalicia M Hopson, CPC Kanika A. Hodges, CPC Kanimozhi Parimalan, CPC Kara Moran, CPC Karen Davis, COC, CPC

Karen Fitzgerald, CPC Karen Knotts, CPC Karen Krause, COC Karen Liu, CPC Karen Lubeck, CPC Karen Schiltz, CPC Karen Seibert, CPC Karla Samaniego, CPC Karri Thompson, CPC Karrina Felder, COC, CPCKarye Jean Hutton, COC, CPCKate Herrema, CPC Katherine Gobenciong Barnes Sa, CPC Kathleen M Skolnick, COC, CPC, CPCO, CPB, CPMA, CPPM, CPC-I

Kathleen Shapiro, COC, CPCKathryn Kuklish, CPC Kathryn Lee Sheppeard, CPC Kathryn Siedel, CPC Kathy A Wolfgang, CPC Kathy Sherrill, CPC Kathy Son, COC, CPC, CPC-P Kathy Stapleton, CPC Kathy Streuber, CPC Katie Pinkerton, COC Katy Cardwell, CPC Kay L Carroll, COC, CPCKeertika Krishnamurthy, CPC Keiren Gillum, CPC Kelleyne Stigsell, CPC Kellie J Syfert, CPC Kenneth Lin, COC Keri Flournoy, CPC Kerry Peterson, CPC Kervin Daniel, CPC Ketki Kailas Ambavale, CPC Kevin Timp, COC Kharen L LaTorre, COC, CPC, CIRCCKim Turner, CPC Kim V Rachow, COC, CPCKimberly Crystal Lique, CPC Kimberly L Orwig, CPC Kina Carlisle, CPC Kirk Stein, CPC Kirsten Jaime, CPC Kristen Mascera, CPC Kristen Rogers Kozay, CPC Kristi Boren, CPC Kristine Derdowski, CPC Kristine Joy Borja, CPC Kristine Taylor, COC Kristy Newell, CPC Krystal Francesco, CPC Kwannisha Colton, CPC Kyle Schmuker, CPC Laida I Solá Suárez, CPC Lakisha Lassiter, CPC LaRae Garrigan, CPC Laura C Greubel, CPC Laura Crawford, CPC Laura Fish, CPC Laura Kaminski, CPC Laura Skarzynski, CPC Laurel Wilcox, CPC Laurin Grubbs, CPC Lee Cox, CPC Leilani Edwards, CPC Lena Marie Roberts, CPC Lenore Reed, CPC Leona Bolling, CPC Lesa F Anderson, CPC Leslie Michelle Pickens, CPC Leslie Reddy, COC Linda Butler, CPC Linda L Oakes, CPC Linda Pica, CPC Linda Smith, CPC Linda Swett, CPC Linda Westermann, CPC Lindsey Holladay, CPC Lindsy Worley, CPC Liria Rangel, CPC Lisa Azevedo, COC, CPCLisa Cumming, CPC Lisa Forlin, CPC Lisa Henry, CPC Lisa Hornick, CPC Lisa R Cannady, CPC Lise A Thoma, CPC


NEWLY CREDENTIALED MEMBERSLizzett Lesmes, CPC Loretta Rockel, CPC Lori Cunningham, CPC Lori Niebaum, CPC Lori Petrozza, CPC, CPBLori Potter, CPC Lorrie Ann Burnett, CPC Lucianne Van Vonderen, CPC Luz Casas, CPC Lyndsay Anderson, CPC Lynette Stachowski, CPC MacKenzie Brown, CPC Madhu Nalamotu, COC Mahesh Pattem, CPC Malana Skolnick, COC, CPC, CPCO, CPMAMamatha Konam, CPC Manga Telidevara, COC, CPC Manga Telidevara, COC, CPCMargarita Guerrero, CPC Margie Juergens, CPC Maria Michelle Unger, COC, CPCMaria Morales, CPC Maria Sowmya Paul, CPC Maribeth Irish, COC Marie T Wheaton, CPC Marissa Reyes, CPC Maritza Rivera, CPC Mark Crowley, CPC Mark Gilbert, CPC Marla Brown, CPC Martha Blanton, CPC Martha Swem Brady, CPC Marty Lauridsen, CPC Marveric Ortiz, COC Mary A Suja, CPC Mary Anderson, CPC Mary B Bonkoski, CPC Mary E Doris, CPC Mary Ellen Hawf, CPC Mary Gilbreath, CPC Mary Kulig, CPC Mary McCreary, CPC Mary Rose Orje Daquiz, CPC Marymay Anderson, CPC Maureen Gorman, CPC Maureen Peart, CPC May Lamour, CPC Meaghan Wyatt, CPC Mechelle Baldridge, CPC Megan Paredes, CPC Meghan Vincent, CPC Meily Nodal, CPC Melanie Abwajee, CPC Melanie E Cash, CPC Melanie Garcia, CPC Melanie Romans, CPC Melanie Vannoy, CPC Melinda Jones, CPC Melisa Sallad, CPC Melissa Carter, CPC Melissa Nelson, CPC Melissa Burdick, CPC Melissa J Patro, CPC Melissa Marquez, CPC Melissa Pizor, COC, CPC, CPCO, CPMA, CPRCMelissa Sweeney, CPC Melissa Torres, CPC Melody Ward, CPC Mendie E. Cleveland, COC, CPCMercenita Morales, CPC Merlin Mathew, COC Mhildred dela Vega Molina, CPC Michelle Arteca, CPC Michelle Bassett, CPC Michelle Feuge, COC Michelle L Boone, CPC Michelle Quattrociocchi, CPC Michelle Ramey, CPC Michelle Renee Woodruff, CPC Mohamed Sajjad Hussain, CPC Molly F Edgington, CPC Molly Harrison, CPC Molly Harrison, CPC Monica Maurice, CPC Monique A Milhomens, CPC Morgan Woodley, CPC Muhil Azhagi Magesh, CPC Muthu Kumaran, COC Nadine Grubb, CPC-P

Namrata Bajaj, CPC Nancy Bradburn, CPC Nancy E Newbold, CPC Nancy Harder, CPC Nancy Thayer, CPC Natalie Richardson, CPC Neha Kulkarni, CPC Nettie Cebada, CPC Nicole Srutowski, CPC Nirai Pandiyan Aathimoola Narayanasamy, CPC

Noraidys Galendez, CPC Norma Rodriguez, CPC Nuzhat Malik, CPC Nykia L Whitsey, CPC Olga Lachi, CPC Oxana Pokoyeva, CPC, CPCO, CPC-P, CPMA, CUC

P Darlene Payton, COC, CPCPaige Segovia, COC, CPCPam Vorass, CPC Pamela Ann Cook, CPC Pamela Crose, CPC Pamela Ediger, CPC Pamela L Lutze, CPC Patricia Ezzell, CPC Patricia Faulks, CPC Patti Haines, CPC Paula Davis, CPC Paula Warren, CPC Paula Renee Driggers Ausaf, CPC, CPMAPaulette D Simmons, COC, CPCPeggie L Dey, CPC Peggy Gilligan, CPC Peggy Sue Thomas-Wiegard, COC, CPC Penny Owens, CPC Phyllis Griffin, COC Pola L Wendt, COC, CPCPrakash Salimath, CPC Praveenkumari Ravipaul, CPC Prince Ezeokafor, COC, CPCPriya Yangoubam, COC, CPCPuja Karalia, CPC Rachael Boone, CPC Rachel Footen, CPC Rachel Foster, CPC Rachel Grimm, CPC Raisa Chudnovskaya, CPC Rajesh P Ravikanth, COC Rajeshwari Rajendran, COC, CPCRajko Anic, CPC Rakesh Nandala, CPC Ramesh N C, COC Randy Tito, CPC Raven Hart, CPC RaviChandra Verma Vallabhuni, CPC Rebecca Horton, CPC Rebecca Lynn Herman, COC Regina M Pearson, CPC Reiko Wolf, CPC Renee George, CPC Renee Kinsey, CPC Reneih Aziz, COC, CPCRenuka Purnima Toppo, COC Revathy Vellaiyappan, COC Rhonda Climes, CPC Richard Glen Wendorf, COC, CPCRichard Joseph Higley, COC, CPCRita Antonelli, CPC Rita Mauldin, CPC Rizwan Ali, CPC Robyn Greenberg, CPC Ronda Simmons, CPC Roopa Govande, CPC Rosalia Bautista, CPC Rosalind Ryan, COC Rosario Sierra, CPC Rosemary Coffey, CPC Rudolph D’Mello John, COC, CPC, CPC-P Sabina Causey, CPC Safal Chariyampadath, CPC Sally Class, CPC Samantha Bartkiewicz, COC Samantha Haakinson, CPC Sandhya Dhandapani, CPC Sandra Chamberlin, CPC, CPC-ISandra Jahr, CPC Sandra Jean Adkins, CPC Sandra Shong, CPC

Sandra West, CPC Sandy Heffron, CPC Sandy L Palmer, COC, CPCSara Oakley, CPC Sarah E Pross, CPC Sarah Findley, CPC Sarah Gonzalez, CPC Sarah Hagen, CPC Sarah Renn, CPC Sarah Schweers, CPC Saravanan Vasudevan, COC Sarrah Jane Generoso, COC Scotisha Beckford, CPC Senobia Y Veney, CPC Sepideh Farrokh-Spain, COC Shajan Vp, CPC Shalana Nunnally, CPC Shameen Tillman, CPC Shanna Faith Somes Torreres, CPC Shannon Barker, CPC Shannon Garza, CPC Shannon Kathleen Dykhouse, CPC Shantana Minter, CPC Shantel Robinson, CPC Sharath Chandra, COC, CPCSharon Boggs, CPC Sharon Diane Blevins, COC, CPC, CIMCSharon Gillentine, CPC Sharon Gott, CPC Sharron Lawson, CPC Shauna Bair, CPC Shauna Stephens, CPC Sheena Brooke Whitworth, CPC Sheila Devellis, CPC Shekila Lashell Nelson, CPC Sheri Yau, CPC Sheria Smith, COC, CPC, CPMASherry Lou Coggins, CPC Sherry Pennington, CPC Shirley Bailey, CPC Shirley DeHardt, CPC, CPMAShiva Darshan Kota, COC, CPCShrikant Patil, CPC Simone D Finn, COC Sirisha Bommireddipali, COC, CPCSithu Anirudhan, COC Sonal Patel, CPC, CPMASoniya Kasirajan, CPC Sonja Taylor Emmett, CPC Sophia Dixon, CPC Sophia Lynn Wagner, CPC Sreelekha J, CPC Stacy Lizotte, CPC Stacy Loftis, CPC Stacy Sparks, CPC Stephanie Garst, COC, CPCStephanie Geary, CPC Stephanie Killea, CPC Stephanie Kires, CPC Stephanie Norris, CPC Stephanie Shanks, COC, CPC Steven Paul Browne, CPC Subaja J Malar, CPC Sujata Mital, CPC Sujatha Bandaru, COC Sujaya Ghosh, CPC Sunil Kharade, CPC Susan A. Brown, CPC Susan Belgardmarquis, COC Susan Honig, COC, CPCSusan Hubbard, CPC Susan L McAbee, COC, CPC, CPMASusan Lea Stovall, COC, CPCSusan Mercer, CPC Susan Sheedy, CPC Susan Sifrit, CPC Sushilkumar Govande, CPC Susie Moniot, CPC Suzanne Elaine Huyck, CPC Suzzette Flores, COC, CPCSwapna P N, COC Tabitha Lynn Barone, CPC Tammi Schneider, CPC Tammi Williams, CPC Tammy Jackson, CPC Tammy Nelson, CPC Tanya E Perales, CPC Tara Gowens, CPC Terence Cummings, CPC

Teresa Lynn Helsper, COC, CPCTeresa Teaster, CPC Terese M. Chanda, COC Terie Bowers, CPC Terri Chambers, CPC Terri Lynn Lutz, CPC Terrill Thurman, CPC Theresa Callari, CPC Theresa Foushee, CPC Theresa Gordon, CPC-P Theresa M Smith, CPC Thulasi Dharani, CPC Tina F Smith, COC, CPCTina Hudson, CPC Tina Lewis, CPC Tobi Gannon, CPC Tonya Harrison, CPC, CPC-PTonya Morgan, COC, CPCTracey Jones, CPC Traci Jurgensen, CPC, CICTracy A Collins, R.N., CPC Tracy Nord, CPC Tracy Pritchard, CPC Tracy Rink, CPC Travia Patterson, CPC Tricia Hart, CPC Trilby Lorayne Foster, CPC Tristan Johann Roxas Salazar, RN, CMT, CPC Trudy Martin, CPC Tuhina Sharma, CPC Tyyana Riley, COC Umamaheswari Jaiganesh, CPC Ummer Sheriff, COC, CPCUrania (Nia) D Frye, CPC Valerie Carr, COC, CPCValerie Wentz, CPC Vandana Sharma, CPC Vanessa Joy Templeman, CPC Velda Rivard, CPC Veronica James, CPC Vibisha Vikraman, CPC Vicki L Devine, CPC Vijaya Babu, CPC Vimal Kumar Narasimman, CPC Vrushali Dhananjay Mokal, CPC Wendy May, CPC Yaimara Seijas, CPC Yandi Garcia, CPC Ying Zhao, CPC Yolanda Marie Williams, CPC Yolanda Thomas, CPC Yudelky Almonte, CPC Yvette Kennedy, CPC

ApprenticeApprenticeApprenticeAakanksha Biradar, CPC-A Aaron Keen, CPC-A Abby Fowler, CPC-A, CPBAbdul Khalid Raza, CPC-A Abhijit Padihari, CPC-A Abhishek Allenki, COC-A Abhishek Shukla, CPC-A Abrielle Kia Uritz, CPC-A Aby Thankachan, CPC-A Adina Heller, COC-A, CPC-AAditi Sharma, CPC-A Adriane Rosenberg, CPC-A Adrienne Floyd, CPC-A Agatha Jeremiah Orjaleza, CPC-A Ahmed Ubaidullah, CPC-A Aileen Del Rosario, COC-A Aimee Alexander, CPC-A Aizel Jade Aspecto Gonzales, CPC-A Aju Varghese, CPC-A Akash Ramrao Hankare, CPC-A Akhil Ponnappan, COC-A Akhil Sasi, CPC-A Aleena K S, COC-A Alejandro Cervantez, CPC-P-A Alena Stevenson, CPC-A Alene Beth Goodstein, CPC-A Alexandra White, CPC-A Alfred Rascon, CPC-A Alice Mai Eggleston, CPC-A Alicia Chavis, CPC-A Alicia Fry, CPC-A

Alicia Johnson, CPC-A Alijah Apostol, CPC-A Alison Mitchell, CPC-A Alka Tiwari, CPC-A Alli Arizmendez, CPC-A Allison Caine, CPC-A Allison King, COC-A Allison Malone, CPC-A Alyssa Erin Campbell, CPC-A Aman Pannu, CPC-A Amanda Bedeaux, CPC-A Amanda Brewer, CPC-A Amanda Clevenz, CPC-A Amanda Colby Czysz, CPC-A Amanda deHoog, CPC-A Amanda Dues, CPC-A Amanda Dunbar, CPC-A Amanda Fearon, CPC-A Amanda Herr, CPC-A Amanda Jurgens, CPC-A Amanda Lynn Martin, CPC-A Amanda Lynn Whetzel, CPC-A Amanda Mcelrath, CPC-A Amanda Painter, CPC-A Amanda Peacock, COC-A Amanda Ryden, CPC-A Amanda Sabilla, CPC-A Amanda Sisco, CPC-A Amar Goudo, CPC-A Amber Mandella, CPC-A Amber Pietrzykowski, CPC-A Amber Trotter, CPC-A Amie Walsh, CPC-A Amit Kumar Singh, CPC-A Amit Malik, COC-A Amrita Chaurasiya, CPC-A Amruta Joshi, CPC-A Amy Adams, CPC-A Amy Armknecht, CPC-A Amy Clemons, COC-A Amy Desserich, CPC-A Amy Fenker, CPC-A Amy Gleason, CPC-A Amy Jo Kline, CPC-A Amy Nicolajsen, CPC-A Amy Riley, CPC-A Amy Sly, CPC-A Amy Tucker, CPC-A Amy West, COC-A Ana Joy Velante Dela Cruz, CPC-A Ana Vazquez, CPC-A Anagha S R, COC-A Anand Annasaheb Ingale, CPC-A Anand K, CPC-A Anandhi Bhavani, CPC-A Anantha Jothi Adaikalam, CPC-A AnanthaKumar Elumalai, CPC-A Andrea Deegan-Smith, COC-A Andrea Larkin, CPC-A Andrea Ward, CPC-A Andrew Lutton, CPC-A Andrew Struse, CPC-A Angel Cano, CPC-A Angel Skoglund, COC-A, CPC-AAngel Smith, CPC-A Angela Cantwell, CPC-A Angela Cochrane, CPC-A Angela Cromwell, COC-A, CPC-A Angela Floyd, CPC-A Angela K Wik, CPC-A Angela Mattice, CPC-A Angela Phillips, CPC-A Angela Pritt, CPC-A Angela S Moore, COC-A Angela V Percival, CPC-A Angelic Oliveras, CPC-A Angelica Bautista Pascua, CPC-A Angelica Castro, CPC-A Angelica Oaks, CPC-A Angelina Duran, CPC-A Angelique Acosta, CPC-A Angelo Gonzales Mariano, CPC-A Anija Krishnakumar, CPC-A Anil Babu Culmi, CPC-A Anil Barapati, COC-A Anil Bhandari, CPC-A Anil Patiyal, CPC-A Animesh Kumar, CPC-A Anisha VS, COC-A


NEWLY CREDENTIALED MEMBERSAnita Benson, CPC-A Anita Mangalore, CPC-A Anitha John, CPC-A Anjana Girija, CPC-A Anjana Susan, COC-A Ankita Dixit, CPC-A Ankita Sanjay Palande, CPC-A Ann Aker, CPC-A Ann Bray, CPC-A Ann Keiko Johiro, CPC-A Anna Grace Adiova, COC-A Anna K Jett, CPC-A Anna Marie Terez Gepte, CPC-A Anna Milewski, CPC-A Anna S Hyden, CPC-A Annabelle Kimberly Santos, CPC-A Annamaneni Sridhar Rao, CPC-A Anne Katrize Velasco Carlon, CPC-A Anne Loraine Sanogal Sibonga, CPC-A Anne Vila, CPC-A Annette Thompson, CPC-A Annie Barrera, CPC-A AnnMarie Maher, COC-A Anoop Kumar, CPC-A Anshita Sharma, CPC-A Anshu Bali, CPC-A Anshu Sharma, CPC-A Anthony L Gonzalz, CPC-A Antoinette Tokunaga, COC-A Antony Praveen Kumar, COC-A Anu Koshy, COC-A Anu Vijayan, CPC-A Anugu Sandhya, CPC-A Anuja Shetkar, CPC-A Anuradha Sahyogi, CPC-A Anurekha S. Rajendran, CPC-A Anusha Mummareddy, CPC-A Anvesh Patel, CPC-A Anwar Salik, CPC-A Aparna Casukhela, CPC-A April Campbell, CPC-A April Fields, CPC-A April Poole, CPC-A April Rose Dolores, CPC-A April Varble, CPC-A April Wu, CPC-A Arby Deluao, COC-A Archana S Biradar, CPC-A Archana Subramanyam, COC-A Arfat Shaikh, CPC-A Arlen Falcon, CPC-A Arlene Ballesteros Inosanto, CPC-A Arnel Pacleb Ganeb, CPC-A Arpita Katiyar, CPC-A Artemio B Castillejos Jr, CPC-A Arulselvi Selvan, CPC-A Arun Kumar Jayabalan, CPC-A Arun Parthiban, CPC-A Arun Rajan Arumugam, CPC-A Arunachalam Annamalai, CPC-A Arya Nair Maheswari, CPC-A Ashi HUssain, CPC-A Ashish Kumar, CPC-A Ashish Sinha, CPC-A Ashley Coleman, CPC-A Ashley DeVaughn, CPC-A Ashley Evenson, CPC-A Ashley Hummer, CPC-A Ashley Kelley, CPC-A Ashley Lee, CPC-A Ashley Nuxoll, CPC-A Ashley Rad, CPC-A Ashley Singleton, CPC-A Ashok Garg, COC-A Ashok Kumar, CPC-A Ashok Reddy, COC-A Ashwini More, CPC-A Aswani Sreekala, COC-A Aswathi Mohanraj, CPC-A Aswini Arumugam, CPC-A Athena Parker, CPC-A Atif Hussain Junaidi, CPC-A Audrianna Copeland, CPC-A Avniben Padalia, CPC-A Ayehu Berhan Gizaw, COC-A Balaji Kumarasamy, CPC-A Balamurugan Asirvatham, CPC-A Balannagari Siva Prasad, COC-A Balkrishna Shivaji Survase, CPC-A

Bama Ganesan, COC-A Bambi Winter, CPC-A Banupriya Manickam, CPC-A Barbara Beierlein, CPC-A Barbara Braunfeld, CPC-A Barbara Brock, CPC-A Barbara Butler, CPC-A Barbara Kao, CPC-A Barbara Kineavy, CPC-A Barbara Sucha, CPC-A Beatriz Escalante, CPC-A Becky Hajjar, CPC-A Beegum Safna.S.M, COC-A Bency Baby Yesu Annathurai, CPC-A Bernadette Pousardien, COC-A Bethany Sibert, CPC-A Betrice Dela Cruz, COC-A Betsy Matthews, CPC-A Betty Gould, COC-A Betty Gray, COC-A Betty Kuan, COC-A Beverly Abelow, CPC-A Beverly Miller, CPC-A Bhagish B, CPC-A Bhagyalakshmi Bommalata, CPC-A Bhagyalakshmi Guthi, COC-A Bhanu Bisht, CPC-A Bhanu Charan Purama, CPC-A Bhanuprakash Gummadi, CPC-A Bharanikumar Dhanasekar, CPC-A Bharathi Raksha, CPC-A Bhargav Lanka, COC-A Bhavani Reddy, CPC-A Bhawna Mishra, COC-A Bhoopal Patoori, COC-A Bhuvaneshwaran Poopathi, CPC-A Bhuvaneshwari C, CPC-A Bianca Brown, CPC-A Bianca Maria Ferguson-Brown, CPC-A Bill Gander, CPC-A Bill Johnson, CPC-A Blanca M Vasquez, CPC-A Bohree Kim, CPC-A Bollikonda Sudhakar, CPC-A Bowrna Nagarajan, CPC-A Bradley Bruce Harper, CPC-A Bradley Meyers, COC-A Brandi Martin, CPC-A Brandi Meyer, CPC-A Brandyn Dee, CPC-A Brenda Elizabeth Hanegraaf, COC-A Brenda Hartman, CPC-A Brenda Joy Noullet, CPC-A Brenda L Coleman, CPC-A Brenda Thompson, CPC-A Brian Parsons, CPC-A Briana Ickowicz, CPC-A Bridget McCarthy, CPC-A Bridget Reiver, CPC-A Bridgette Bailey, CPC-A Britney Chasteen, CPC-A Brittanie Smiddy, CPC-A Brittany Daniels, CPC-A Brittney Danna, CPC-A Brooks Burt, CPC-A Bruce Everrett Elliott, CPC-A Bryan Kelly, CPC-A Bryce Wangen, CPC-A C Raga Pallavi, COC-A C.S Prathyusha, CPC-A C.V. Ramakrishna Prasad, CPC-A Caitlin Capaldi, CPC-A Cameron Turner, CPC-A Camie Andrews, CPC-A Camille Goodrich, CPC-A Camille Libut, CPC-A Candice Tate, CPC-A Candy Falcao, CPC-A Candy R Pate, CPC-A Cara Wills, CPC-A Caren Goss, CPC-A Carissa Lavine Aposacas Garduque, CPC-A Carla Effron, CPC-A Carla Nowack, CPC-A Carla Ross, CPC-A Carlie Aaron Blevins, CPC-A Carmen Santana, CPC-A Carol A Mitchell, CPC-A Carol Barbarino, CPC-A

Carol DeForest, CPC-A Carol Fricano, CPC-A Carol Jean Rafail, COC-A Carol Kenyon, CPC-A Carol Viger, CPC-A Carole Knack, CPC-A Caroline Alfieri, COC-A Caroline R Kennedy, CPC-A Carol-Lynn Knight, CPC-A Carolyn Esham, COC-A Carolyn Weil, CPC-P-A Carrie Atkinson, CPC-A Carrie Page, CPC-A Casandra Maya Pollack, CPC-A Casey Roe, CPC-A Casiano P Estibeiro, CPC-A Cassandra Conner, COC-A Cassandra Ortiz, CPC-A Cassie Jones, CPC-A Catherine Lerpido Obana, CPC-A Catherine Randall, COC-A Catherine Rose, CPC-A Catherine Suganya, CPC-A Cathy Ferguson, CPC-A Catrina Hammond, CPC-A Celica Ogad Salen, COC-A Celine Bouchard, CPC-A Cesar Esguerra Zagado Jr., CPC-A Chaitanya Madam, COC-A Challa Lavanya, CPC-A Chandra Prakash Akula, CPC-A Chandrea Nez, CPC-A Charanjeet Kaur, CPC-A Charina Tiongco, CPC-A Charlene Boswell, COC-A Charli Engle, CPC-A Charmaigne Tapar, COC-A Chasity Elliott, CPC-A Chassity Lee, CPC-A Chauncey R. Williams, CPC-A Chendra Sekhar Reddy Avuduri, CPC-A Cherrice Smith, CPC-A Cherry Edwards, CPC-A Cheryl Anne Ramirez Mendoza, CPC-A Cheryl Benally Murphy, CPC-A Cheryl Irene Young, COC-A, CPC-ACheryl Kohagen, COC-A Cheryl Metzger, CPC-A Cheryl Witte, CPC-A Chetan Dhadge, CPC-A Chetan Parmar, CPC-A Chithra Rangaswamy, COC-A Chris Fassinger, CPC-A Chris Lopez ICD-10, COC-A Christian Aguirre, CPC-A Christian Sales Mendoza, CPC-A Christie Montagne, CPC-A Christin A Chappell, CPC-A Christina Civil, CPC-A Christina Elizabeth Bessette, CPC-A Christina Gilliam, CPC-A Christina Marie Crawford, COC-A Christina Nomura, CPC-A Christina Pulliam, COC-A Christinal Shobana Priya F, CPC-A Christine Bitz, CPC-A Christine Burns, CPC-A Christine Carter, CPC-A Christine Coppock, CPC-A Christine Dianne Gordon, CPC-A Christine Kokinda, CPC-A Christine Kurta, CPC-A Christine Mitchell, CPC-A Christine Prescott, CPC-A Christine Register, CPC-A Christine Rush, CPC-A Christine Wolff, CPC-A Christy Chandler, CPC-A Christy Mosier, CPC-A Christy Watts, CPC-A Ciera Richardson, CPC-A Cindi Stevens, CPC-A Cindy Contos, CPC-A Cindy Larson, CPC-A Claire Biggs, CPC-A Clairissa Gillespie, CPC-A Clara Faye Kalb-Deemie, CPC-A Clarissa Corcoran, CPC-A Clarissa Marie Masangkay De Guzman,

CPC-A Clariza Ramos Escueta, CPC-A Cole Stevens, CPC-A Colette M Flynn, CPC-A Colleen Ann Murphy, CPC-A Connie Pendley, CPC-A Connie Krosch, CPC-A Cora Charina Gloria, CPC-A Cori Devers, COC-A Corrina Rice, CPC-A Courtney Irwin, CPC-A Courtney Lynn Wesolowski, CPC-A Cristy Ann Paugh, COC-A, CPC-ACrystal Ruiz, COC-A Cynthia Klingelhoets, CPC-A Cynthia Lima, COC-A, CPC-ACynthia Lyon, CPC-A Cynthia Welch, CPC-A Cyril Buenvenida, CPC-A D. Salome, CPC-A D.V.L. Phani Sonam, CPC-A Daisy Evanjalin A, CPC-A Daisy Sharma, CPC-A Damian Suarez, CPC-A Damyantee Meher, CPC-A Dana C Hammett, CPC-A Dana Sterling, CPC-A Daniel Sixkiller, CPC-A Daniel Stephen Rodriguez, CPC-A Danielle DaSilva, COC-A Danielle Foss, CPC-P-A D’Arci Johnson, CPC-A Darcie Pike, CPC-A Darcy Leite, COC-A Darlene Magdaraog, COC-A Darwin Gingco, COC-A Davetta Peterson, CPC-A David Benton, CPC-A David Gibson, CPC-A David Wolf, CPC-A Dawn M Hall, CPC-A Dawne Graf, CPC-A Dawnya Hostetler, CPC-A Dayna Kakes, CPC-A De Ann Griepentrog, CPC-A Dean Noel Tongol, CPC-A Deavyn Crenshaw, CPC-A Debbie Andersen, CPC-A Debbie Brandenburg, CPC-A Debbie Jones, CPC-A Debbie McGraw, CPC-A Deborah Burris, CPC-A Deborah Conlee, CPC-A Deborah Mason, CPC-A Deborah Wilson, CPC-A Debra Gross, CPC-A Debra Hurley, CPC-A Debra Knight, CPC-A Debra Lynne Curry, CPC-A Debra Segedy, CPC-A DeeAnn Robinson, CPC-A Deepa Padmonkar, CPC-A Deepa Shenoy, CPC-A Deepak Dhone, CPC-A Deepak Sharma, CPC-A Deepali Chavan, COC-A Deepthy Rajkumar, CPC-A Deidre Trombley, CPC-A Delbert Lambert Jr, CPC-A Delores A Rodriguez, CPC-A Delores Thrower, CPC-A Dena Harte, CPC-A Denise Fralick, CPC-A Denise Greer, CPC-A Denise Little, CPC-A Deniz Soyer, CPC-P-A Dennis Sohn, CPC-A Deon N Tenzie, CPC-A Desiree Buckman, CPC-A Desteracy Wright, CPC-A Devi Arunya, CPC-A Devi Solai, CPC-A Devika Kattamuri, CPC-A Dhanya Kamalan, COC-A Dharavath Shivapavani, CPC-A Dhinesh Nacha Goundan, CPC-A Dhivyabharathi Manoharan, CPC-A Diana D’Arrigo, CPC-A Diana Francis, CPC-A

Diana Ocampo Marinas, CPC-A Diana Sitts, CPC-A Diane Cheverie, CPC-A Diane Milbrand, CPC-A Dianna Dorman, CPC-A Dileep Sunkari, CPC-A Dina Yavny, CPC-A Dinesh Singh, CPC-A Dipika Mahadev Jagtap, CPC-A Divesh Khatwani, CPC-A Divya Devaraj, COC-A Divya Haridas, COC-A Divya Nair, CPC-A Divya Periyasamy, CPC-A Divyesh Jaiswal, COC-A Domingo Nunez, CPC-A Dominic Cedeno, CPC-A Donald E Tulloss, CPC-A, CPBDonald W. Harrison, CPC-A Donna Cavaretta, CPC-A Donna D Robinson, CPC-A Donna Lynne Wydra, CPC-A Donna Plencner, CPC-A Donna Youngblood, CPC-A Donna-Faye Nator Mainit, CPC-A Doraswamy Chandrakala, CPC-A Dorith Brown, COC-A Dorothy Beth Goodell, CPC-A Doug Lackey, CPC-A Douglas Hood, CPC-A Douglas Palmer, CPC-A, CRCDr. Bazegha Taseen Lubna, CPC-A Dr. Nandini Shashidhar Kesha, CPC-A Dr.Maheshwari Tipirishetty, CPC-A Dulce Armas, CPC-A Dundra Praveen Kumar, COC-A Dupinder Kumar, CPC-A Durga P, COC-A Dylan Freeman, CPC-A Ebony Gibbons, CPC-A Edel Quinn Catarata Cotaco, CPC-A Edward Weisman, CPC-A Eileen Viloria, CPC-A Elaine Regan, CPC-A Elakkia Durairaj, CPC-A Elena Letterman, CPC-A Elena Rios, CPC-A Elgin Balilo, CPC-A Eliana Euceda, CPC-A Elisabeth Louise Henry, CPC-A Elisabeth Stafford, CPC-A Elisha Hunt, CPC-A Elisha Melcher Lazenby, CPC-A Elisha Troup, CPC-A Elizabeth Anne Wilmot, CPC-A Elizabeth Burns, CPC-A Elizabeth Curbow, CPC-A Elizabeth Garriques, CPC-A Elizabeth Haight, CPC-A Elizabeth Kerr, CPC-A Elizabeth Miller, CPC-A Elizabeth P Locascio, CPC-A Ellen Curtice, CPC-A Ellen Daly, COC-A Elma Rose Alfaro, CPC-A Elsa Lee, CPC-A Elvira Sanchez, CPC-A Emilibeth Labrador Pantig, CPC-A Emily Adkins, CPC-A Emily Osta, CPC-A Emily Sandoval, CPC-A Emmie Yee Leopoldo, CPC-A Eradys Santos, CPC-A Eric Heros, CPC-A Eric Tinkle, CPC-A Erica Jones, COC-A Erica Kristoff, CPC-A Erica Manzanares, CPC-A Erica Segura, CPC-A Erica Thoele, COC-A Erik Chang, CPC-A Erika Forsythe, CPC-A Erika Frances Cahilog Ronquillo, CPC-A Erika Guzman, CPC-A Erin Cadden, CPC-A Erin Kirby, CPC-A Erin L Gatlin, CPC-A Ernesto Velazquez Perez, CPC-A Esther Chiu Yee, CPC-A


NEWLY CREDENTIALED MEMBERSEstrellita Hurtado, CPC-A Ethel Mae Echon Rabino, CPC-A Eugene Kim, CPC-A Evangelina B Steinbrenner, CPC-A Evelyn Guerra, CPC-A F. Queen Helen Pramila, CPC-A Famatta DeShield, CPC-A Fania Rosario, CPC-A Farahnaz K Shahid, CPC-A Farida Bhanu Noorbash, CPC-A Fatima Dorcas Labausa, COC-A Faustine Ramos Salas, CPC-A Fazilath Sultana, CPC-A Firoz Khalife, CPC-A Florence Staten, CPC-A Fouzia Jabeen, CPC-A Francis Valeriano Lacandola Quejano, CPC-A

Franco Faranda, CPC-A Frank Pierovich, CPC-A Freida Buck, CPC-A G. Vikas Rao, CPC-A G.V. Naga Tarun, CPC-A Gail Baird, CPC-A Gajula Divya, CPC-A Gale Ann Tobin, CPC-A Ganesh Burra, COC-A Ganesh Chennoju, COC-A Gauri Potdar, CPC-A Gayathri Nachimuthu, CPC-A Gayathri Neruguttu, CPC-A Gayathri S, CPC-A Gayatri Annaldas, CPC-A Gayatri Ramesh Suryawanshi, CPC-A Gayatri Sheth, CPC-A Geetanjali Pawar, CPC-A Geetha T, CPC-A Gema Morera, CPC-A Gemma King, CPC-A George J Donati, CPC-A Georgene Davis, CPC-A Georgia Marcum, CPC-A Gerry Grigsby, CPC-A Ginette Samad, CPC-A Ginger Leonard, CPC-A Giridhar Shetty, CPC-A Glenn Larsen, CPC-A Gloria Wagner, CPC-A Gnanamoorthy Settu, CPC-A Gohar Ali Khan, CPC-A Gomathi Murugan, CPC-A Gopal Rao Kollikonda, COC-A Gopinath Selvarasu, CPC-A Gordon Cameron, CPC-A Grace Irons, CPC-A Gracielle Irene Guerrero Alejandro, CPC-A Gregory Nenninger, CPC-A Groseilo Jade Recide, CPC-A Gulnar Akhtar, COC-A Gurujala Sai Chand Goud, CPC-A Gurumoorthy Soundrrajan, COC-A Gwenda Knight, CPC-A Haidee Litz Concepcion Baccay, CPC-A Hal McDonough, CPC-A Haleigh Hanssen, CPC-A Hannah Danielle Dieterich, CPC-A Haribabu Kanipakam, COC-A Harikishan Reddy, CPC-A Hariprasad Pulicherla, CPC-A Haripriya Sakthivel, CPC-A Hayley Sutton, CPC-A Heather Cook, CPC-A Heather Garrison, COC-A Heather Goldberg, CPC-A Heather L Maruschak, CPC-A Heather Mansell Ostermiller, CPC-A Heather Maxwell, CPC-A Heather McCoy, CPC-A Heather N Lewis, CPC-A Heather Norton, CPC-A Heather Schaefer, CPC-A Heather Steel, CPC-A Heather Sweat, CPC-A Heidi Frigon, CPC-A Heidi Gunter, CPC-A Heidi Hartman, CPC-A Helen Selenal Selva Kumar, CPC-A Helen T Cox, CPC-A Hemamalini Ananthakrishnan, CPC-A

Hemant Keval Khairnar, CPC-A Hemonthi Malakapalli, CPC-A Hilary McIntire, CPC-A Hillary Moore, CPC-A Himanshi Sharma, CPC-A Himanshu Shekhar Rout, CPC-A Holly Davis, CPC-A Holly Hoefer, COC-A Holly Martin, CPC-A Hrushikesh Jagannath Surdi, COC-A Ibis Garces, CPC-A Ignacio Garcia, CPC-A Ilam Bharathi, CPC-A Ina Kreps, CPC-A India Foster, CPC-A Indira G, COC-A Indu Saraswat, CPC-A Inez Guillen, CPC-A Inga Cebotari, CPC-A Irene San Juan Alarde, CPC-A Iryna Kesel, CPC-A Itesha Trisvan, CPC-A J Angelica Hernandez, CPC-A Jacinta Hernandez, CPC-P-A Jackie Horner, CPC-A Jackie Lynn Banks, CPC-A Jackie McCafferty, CPC-A Jacqueline Rogers, CPC-A Jacqueline Sabella, COC-A Jacqueline Wallace, CPC-A Jacqueline Walthall, CPC-A Jagadish Chandra Kagitha, COC-A Jagadish Kumar Anam, COC-A Jagan Balasubramaniyam, CPC-A Jaganmohana Rao, CPC-A Jagruti Yadav, CPC-A Jaime Hastings, CPC-A Jaipal Reddy Vanga, COC-A Jalene Denise Turner, CPC-A James Brewer, CPC-A James deJonge, CPC-A James Erwin Leones, CPC-A James Murphy, COC-A James Solomon, CPC-A James White Kulandai Raj, COC-A Jamie Bodnar, CPC-A Jamie Oestreich, CPC-A Jamie Wismer, CPC-A Jane Kathleen Carag Go, CPC-A Jane M West, CPC-A Jane MacMurray, CPC-A Janelle Dominguez Vargas, CPC-A Janelle Hallett, CPC-A Janelle Howard, CPC-A Janet Fearer, COC-A, CPC-AJanet Kiefer, CPC-A Janet Stevens, CPC-A Janhavi Rupesh Patil, CPC-A Janice Nelson, CPC-A Janice Riemersma, CPC-A Janis Snyder, CPC-A Janna Vice, CPC-A Jari White, COC-A Jasmere Anne Tanate, CPC-A Jasmine Jordan, CPC-A Jayabharathy Mayakrishnan, CPC-A Jayachandran Beena Jothish, COC-A Jayakumar Rengarajan, CPC-A Jayalekshmi Leela, COC-A Jayaprasad G Krishnaiah, CPC-A Jayaramsuri Tirunagari, CPC-A Jayaseeli Thangavelu, CPC-A Jay-jay Payoc Papina, COC-A Jayme Lopez, CPC-A Jayne Chagnon, CPC-A Jayson Pedro, COC-A Jean May, CPC-A Jeanette Lindquist, CPC-A Jeanie Unger, CPC-A Jeanne Dickson, CPC-A Jeevitha Nehru, CPC-A Jeff Weiss, CPC-A Jeffrey L Clark, CPC-A Jehan Saeed Siguiente Al-marboui, CPC-A Jena Rader, CPC-A Jenae K Hart, CPC-A Jene’a Wilson, CPC-A Jenna Scheich, CPC-A Jennie Reaume, CPC-A

Jennifer Alberti, CPC-A Jennifer Ashley, CPC-A Jennifer Bakkum, CPC-A Jennifer Bracco, CPC-A Jennifer Chronaberry, CPC-A Jennifer Critchlow, CPC-A Jennifer Dompier, CPC-A Jennifer Everett, CPC-A Jennifer Fish, CPC-A Jennifer Foo, CPC-A Jennifer Hagan, CPC-A Jennifer Harley, CPC-A Jennifer Johnson, CPC-A Jennifer Kurtz, CPC-A Jennifer L David, CPC-A Jennifer Leah Baker, CPC-A Jennifer Lent, CPC-A Jennifer Lynn Rux, CPC-A Jennifer Phillips, CPC-A Jennifer Pryer, CPC-A Jennifer Rosal Retzlaff Pinero, CPC-A Jennifer Rose Wake, COC-A Jennifer Springer, CPC-A Jennifer Stuart, COC-A Jennifer Tran, CPC-A Jennifer Whittier, CPC-A Jennifer Wietecha, CPC-A Jenny Gopurathingal, CPC-A Jenny Joy Dixon, CPC-A Jenny Spann, CPC-A Jerico Abaya, CPC-A Jerin Zachariah, CPC-A Jeronima Corea, CPC-A Jervine Ramos, COC-A Jessica Benjamin, CPC-A Jessica Brooks, CPC-A Jessica Carlisle Peurifoy, CPC-A Jessica Gielow, CPC-A Jessica Greene, CPC-A Jessica L Penny, CPC-A Jessica Lynn Arrigo, CPC-A Jessica Madson, CPC-A Jessica Michelle Smith, CPC-A Jessica R Clay, CPC-A Jessica Raney, CPC-A Jessica Siena, CPC-A Jessica Vione Johnson, CPC-A Jessica Yaeger-Bluma, CPC-A Jessin Kishor, CPC-A Jezzraelle Cubita, CPC-A JhansiRani R, CPC-A Jhoanna Marie Epong, CPC-A Jill Renee Reynolds, CPC-A Jill Stain, CPC-A Jillian Jeffers, CPC-A Jils Jose, COC-A Jim Rose Wijangco Digo, CPC-A Jini Johny, CPC-A Jitendra Eknath Ghude, CPC-A Jitendra Kumar, COC-A Jo Annette Short, CPC-A Joan E Morris, CPC-A Joan Wood, CPC-A JoAnn Gregg, CPC-A Joanna Birnbaum, CPC-A Joanna Cuesta, CPC-A Joanne Bumanglag, CPC-A Jocelyn Budzynski, CPC-A Jodi Rose, CPC-A Jody E Nadeau, CPC-A Jody Rocks, CPC-A Joelene Boiano, CPC-A Johanna Medina Caballes, CPC-A John Edward Brejente, CPC-A John Jayson Malapote, CPC-A John Lorenz Bautista, COC-A John Martin, CPC-A John Methgen, CPC-A John Pascual, CPC-A John Rockwell, CPC-A Jojo Dingal Garcia, CPC-A JoLyn Morris, CPC-A Jonalyn Efericto Madera, CPC-A Jonique Dietzen, CPC-A Jordan Karlie Wilson, CPC-A Joseph Zornick, CPC-A Josephine Pascale, CPC-A Josha Krista Ventura Hilahan, CPC-A Jothi Prakash R, CPC-A

Jothy A, CPC-A Joyce Jackson, CPC-A Joyce Mallare Marasigan, CPC-A Joyce Miller, CPC-A Judi Groenendyk, CPC-A Judith Nguyen, CPC-A Judy Clarke, CPC-A Judy Ward-Carter, CPC-A Juli Hedrich, CPC-A Julia Pepe, COC-A, CPC-AJuliana Khubeis, CPC-A Julie Brake, CPC-A Julie Bramlage, CPC-A Julie Kerstner, CPC-A Julie Saenz, CPC-A Julie Sewell, COC-A Julie Williams, CPC-A Junfeng Huang, CPC-A Justin Villar Yabut, CPC-A Juyoung Kim, CPC-A Jyotsna Ugale, CPC-A Kaajal Mistry-Patel, COC-A Kahkashan Siddiqui, CPC-A Kailey Blasingame, CPC-A Kaitlyn Weaver, CPC-A Kalaiarasi S, CPC-A Kalaiselvi Periasamy, COC-A Kalaivani Dilli, CPC-A Kamalahasan Baskaran Mr, COC-A Kamalam Arunachalam, CPC-A Kambalayappa Gari Sarada, CPC-A Kanchan Pawar, CPC-A Kanchana Bakthakumar Ms, COC-A Kanimozhi Arunachalam, CPC-A Kara Jo Spence Dean, CPC-A Kara Schwab, CPC-A Karanam Sridhar Goud, CPC-A Karasala Pratyusha, CPC-A Karen Ann Williams, CPC-A Karen Gerlitz, CPC-A Karen Heacox, CPC-A Karen King, COC-A Karen Mercer, CPC-A Karen R Valines, CPC-A Karen Schoby, COC-A Karen Shell, CPC-A Karen Skoda, CPC-A Karie Jarvis-Slayton, CPC-A Karin Freese, CPC-A Karishma Sreejith, CPC-A Karla Carker, CPC-A Karla Gehrke, CPC-A Karlyn Lewis, CPC-A Karra Russell, CPC-A Karthiga Kumari, CPC-A Karthikeyan Kumaravel, COC-A Karunakar Dasari, CPC-A Kassie Hefty, CPC-A Kate Lewis, CPC-A Kate Sekeroglu, CPC-A Katerina María Rivera, CPC-A Katherine Chesley, CPC-A Katherine Faulkner, CPC-A Katherine Jane Villete Beso, CPC-A Katherine Sheena Manuntag Sabillo, CPC-A Kathie R Orvis, CPC-A Kathleen Craven, CPC-A Kathleen Harris, CPC-A Kathleen Hill, CPC-A Kathleen Wilcox, CPC-A Kathryn A Loose, CPC-A Kathryn Devlin, CPC-A Kathryn Harless, COC-A Kathryne Mary Smith, CPC-A Kathy Haugh, CPC-A Kathy Kannenberg, CPC-A Kathy Pearson, CPC-A Katie Foster, CPC-A Katie Morris-Buch, CPC-A Katii Sawyer, CPC-A Kaushikrajan Manickavasagam, COC-A Kavita Chavan, CPC-A Kayla Johnson, COC-A Kealia Huntley, CPC-A Keasha Vergamini, CPC-A Keith Haas, CPC-A Kelley Mcandrews, CPC-A Kelli Krumwiede, CPC-A Kelli Mckeown, CPC-A

Kelli Ochoa, CPC-A Kelli Ricks, CPC-A Kelly Norris, CPC-A Kelly Bassin, CPC-A Kelly Blaker, CPC-A Kelly Collins, CPC-A Kelly D’Amour, CPC-A Kelly Dockery, CPC-A Kelly Escobar, CPC-A Kelly Harrison, CPC-A Kelly Kane, CPC-A Kelly King, CPC-A Kelly Mann, CPC-A Kelly Meier, CPC-A Kelly Miller, CPC-A Kelly Wolanski, CPC-A Kelsey Millette, CPC-A Kelsey Parkin, CPC-A Kenda Chandler, CPC-A Kendall Brancheau, CPC-A Kendall Church, CPC-A Kenneth Gorrell, COC-A Kerry Raab, CPC-A Ketan Mohadikar, CPC-A Kevin Ashdown, CPC-A Kevin Asutilla, COC-A Khanh Thuy Vu, CPC-A Khariza Hilario Mahilom, CPC-A Khemchand Sure, CPC-A Khushboo Rai, CPC-A Kiamarie Wolfe, CPC-A Kilona Kara, CPC-A Kim A Mulvey, CPC-A Kim Holt, CPC-A Kim Rice, COC-A Kim Taitt, CPC-A Kim Visushil, CPC-A Kimberlee Talaga, CPC-A Kimberly A Braun, CPC-A Kimberly A Gallagher, CPC-A Kimberly Ann Stevens, CPC-A Kimberly Beatty, CPC-A Kimberly Cooper, CPC-A Kimberly Martin, CPC-A Kimberly McNamee, COC-A Kimberly Nicole Carter, CPC-A Kimberly Patten, CPC-A Kimberly Penland, CPC-A Kimberly Riley, CPC-A Kimberly Yates, CPC-A Kira Amanda Snider, CPC-A Kiran Kumar Reddy Samsani, COC-A Kiran Milkuri, COC-A Kiran Pavale, CPC-A Kirthiha Ganesan, COC-A Kishan Akoju, COC-A Kodanda Rajesh Jarugu, CPC-A Kolleen Herlong, CPC-A Komal Patil, COC-A Koshy Mathew Tharakan, CPC-A Kourtney Bowden, CPC-A Kranthi Ranadev Naspuri, COC-A Kreizelle Hilario Madrid, CPC-A Krischelle Ann Gargallo, CPC-A Krishna G Vprm, COC-A Krisler Lugayan, CPC-A Krisselle Ann Tan, CPC-A Krista Schroering, CPC-A Kristen Bowers, CPC-A Kristen Dixon, CPC-A Kristen Kostacopoulos, CPC-A Kristen Roeser, CPC-A Kristerson Reyes, COC-A Kristi Smith, CPC-A Kristie Cherry, CPC-A Kristie Newcomb, CPC-A Kristina Witts, CPC-A Kristine Ann Bury, CPC-A Kristine Graves, CPC-A Kristine Mary Lawler, CPC-A Kristy Lynn Taylor, CPC-A Kristyna Gibson, CPC-A Krunalkumar Patel, CPC-A Krysten Dinsmore, CPC-A Kuldeep Keshav Gaikwad, CPC-A Kumar Sagar Beasam, COC-A Kuntumalla Revathi, CPC-A Kylie Tantuco, COC-A Kzer Aron Gumabon, CPC-A


NEWLY CREDENTIALED MEMBERSLacey Flanagan, CPC-A Lakhvinder Singh, CPC-A Lakshmi Prasanna Bunadri, CPC-A Lana Lovett Clark, CPC-A Lanae Edna Brooks, CPC-A Latoya Benton, CPC-A LaTrece Vines, CPC-A Laura Ann Southard, CPC-A Laura Beaston, CPC-A Laura Boggs, CPC-A Laura Elizabeth Rogalsky, CPC-A Laura Fowlkes Young, CPC-A Laura J Doyle, CPC-A Laura Langlois, CPC-A Laura Rood, CPC-A Laura Strange, CPC-A Laura Wilkerson, CPC-A Laura Wilson, COC-A Laurel Savage, COC-A, CPC-ALauren Adams, CPC-A Lauren Hughes, CPC-A Lauren Lyerla, CPC-A Lauren Park, CPC-A Lauri Cribben, CPC-A Lavanya Jonnadula, CPC-A Laveena Arrabelli, COC-A Lea Allison Froze, CPC-A Leandro Quiros, CPC-A Lee Garrett, CPC-A LeeAnn Roberge, CPC-A Leeanne Schwartz, CPC-A LeeEllen Minson, CPC-A Leigh Anne Prouty, CPC-A Leodigard III Potang Carlos, CPC-A Leslie Gould, CPC-A Leslie Joy Manlangit, CPC-A Leslie Tackett, CPC-A Leyiset Crespo, CPC-A Lida Harutyunyan, CPC-A Lillian Martinez, CPC-A Lily H Cheng, CPC-A Linda Brown, CPC-A Linda Kleinschmidt, COC-A Linda Langdon, CPC-A Linda Peterson, CPC-A Linda Robinson, CPC-A Linda Seibert, CPC-A Linda Sue Erdmann, CPC-A Lindsay Boyer, CPC-A Lindsay J Cooke, CPC-A Lindsay Windsbrooke Haines, CPC-A Lindsey Renee Ackerman, CPC-A Lisa Berry, CPC-A Lisa Boyer, CPC-A Lisa Depriest, CPC-A Lisa Hochberg, CPC-A Lisa Hopkins, CPC-A Lisa Jamison, CPC-A Lisa Kollar, CPC-A Lisa M McLean, CPC-A Lisa Pickens, CPC-A Lisa Selby, CPC-A, CPBLisa Streich, CPC-A Lois K Hammer, CPC-A Lolia Deal, CPC-A Lorelie Caparida Pardillo, CPC-A Loretta Bivens, CPC-A Lori Bacani, CPC-A Lori Barger, CPC-A Lori Elizabeth Jones, CPC-A Lori Endicott, CPC-A Lori Gruel, CPC-A Lori Herrera, CPC-A Lori Hodges, CPC-A Lori Mucha, CPC-A Lori Potthoff, CPC-A Lori Schaffer, CPC-A Lori Sherman, CPC-A Lori Smith, CPC-A Lori Woods, CPC-A Lorina Aquino, CPC-A Lorren Stacy, CPC-A Lucialie D. Garrett, CPC-A Luis Perez, CPC-A Lyn Larson, CPC-A Lynda PoVey, COC-A Lynda Staffieri, CPC-A Lynn Ferguson, CPC-A Lynn Krug, CPC-A

Lynn Plummer, CPC-A Lynne Canham, CPC-A M Latesh Varma, CPC-A Ma Liesyn Cupcupin, COC-A Mabjan Dudekula, CPC-A Madel Nabua Lauranilla, CPC-A Madhavi Patnam, CPC-A Madhu Gangisetti, CPC-A Madhu Singh, CPC-A Madhu Yeruva, CPC-A Madhur Kohli, CPC-A Maela Toribio, CPC-A Magda Elmoneim, CPC-A Maggie Auffert, COC-A Mahesh Babu Pathri, CPC-A Mahesh Babu Pokala, COC-A Mahesh Dattatraya Shinde, CPC-A Mahesh Nellore, COC-A Mahima Mathew, CPC-A Malgorzata Sciesinska, CPC-A Mallikarjun Muktha, COC-A Mallory Wood, CPC-A Mandy Barber, CPC-A Manigandan Manogaran, CPC-A Manikandan Ravi, CPC-A Manimegalai Perumal, CPC-A Manisha Patel, CPC-A Manjunatha Reddy K, CPC-A Manoah Rull, CPC-A Manoj Kumar Ramagiri, COC-A Manojkumar Akula, COC-A Manuel Jr. Goyena, COC-A Manvendra Singh, CPC-A Manvi Bhadauria, CPC-A Marampelli Govardhan, CPC-A Marc Pabustan, CPC-A Marco Burgos, CPC-A Marcos Evangelista, CPC-A Margaret A Barber, CPC-A Margaret A Pent, CPC-A Margaret Aycock, CPC-A Mari Dehn, CPC-A Maria E Torres, CPC-A Maria Edessa Bautista, CPC-A Maria Eula Perez, CPC-A Maria Maiocchi, CPC-A Maria Pilar Rivera, CPC-A Maria Rasyl Danao Marquez, CPC-A Maria Theresa Francisco, CPC-A Maria Villegas, CPC-A Mariah Cassutt, CPC-A Mariah Hogan, CPC-A Mariam Mirza, CPC-A Mariammal Nadar, CPC-A Marie A Marshall, CPC-A Marie Browne, CPC-A Mariecris Papa, CPC-A Marienela Cachuela Martinez, CPC-A Marina Cook, CPC-A Marissa Denisha Allen, CPC-A Marissa R Cartagena, CPC-A Marites Baja Salpid, CPC-A Mariver Taclan, COC-A Mark Grinberg, COC-A Mark Quiambao, CPC-A Mark Ranum, CPC-P-A Mark Russel De Leon Catayong, CPC-A Mark Woods, CPC-A Marla Gibson, CPC-A Martha Andrus, CPC-A Martha C Spivey, CPC-A Martha M Puche-Martinez, CPC-A Martha Small, CPC-A Martie C Parker, CPC-A Martina Maggiore, CPC-A Mary A Szapiaczan, CPC-A Mary Anitta Varghese, CPC-A Mary Antonette Elcarte, CPC-A Mary Bridge, CPC-A Mary Brishilla Arokia Samy, CPC-A Mary Caroline Meredith, CPC-A Mary E. Gardill, CPC-A Mary Ferrando, CPC-A Mary Gilbert, CPC-A Mary Harvey, CPC-A Mary J Beaula, CPC-A Mary Jane Dolatre Espiritu, CPC-A Mary Johnson, CPC-A Mary Julee Paul Jayakumar, CPC-A

Mary Kate Stevenson, CPC-A Mary Lisa Nikolet, CPC-A Mary Poskus-Fell, COC-A Mary Ruth Rae Rivera, COC-A Mary Salazar, CPC-A Mary Scott, CPC-A Mary Simpkins, CPC-A Mary Spademan, CPC-A Mary V Porter, CPC-A Matthew Bliss, CPC-A Matthew Rumans, CPC-A Maureen Federice, CPC-A Mayko Yang, CPC-A Md Abdul Khaliq, COC-A MD Hussain, CPC-A Meena Somasundaram, CPC-A Meenakshi Sinha, CPC-A Megan C McDonald, CPC-A Megan Greene, CPC-A Megan Hodges, CPC-A Megan Huckaby, CPC-A Megan Jackson Deese, CPC-A Megan Kollmansberger, CPC-A Megan Miljour, CPC-A Megan Ryan, CPC-A Megan Slenker, CPC-A Melanie O’Keefe, CPC-A Melanie Anne Coe, CPC-A Melanie Zappia, CPC-A Melisa Logsdon, CPC-A Melisa Stadler, CPC-A Melissa Adams, CPC-A Melissa Corpuz Rodulfo, CPC-A Melissa De Graff, CPC-A Melissa Evans, CPC-A Melissa Herrick, CPC-A Melissa Luedtke, CPC-A Melissa Martin, CPC-A Melissa Nations, CPC-A Melissa Nicholas, CPC-A Melissa Pereira, CPC-A Melissa Roberts, CPC-A Melissa Shank, CPC-A Melissa Sobieszczyk, CPC-A Melody Etang Dela Torre, CPC-A Melody Faye Weisbaum, CPC-A Melody Kohl, CPC-A Merri Kaye Marcus, CPC-A Mi Yan, CPC-A Michael Atalia Cerbo, CPC-A Michael Jeffrey Millares, CPC-A Michael R Fernandez, CPC-A Michael Sanko, CPC-A Michaelle Waters, CPC-A Michele Davis, CPC-A Michele Rowell, CPC-A Michele Wierman, CPC-A Michelle Gattis, CPC-A Michelle Larson, CPC-A Michelle Lohr, CPC-A Michelle Maheuron, CPC-A Michelle May Bungay, CPC-A Michelle Miratsky, CPC-A Michelle Peterson, CPC-A Michelle Rene Boening, CPC-A Michelle Rodda, CPC-A Michelle Wilson, COC-A Mickie Baca, CPC-A Miguel Teneza, COC-A Mike Grebner, CPC-A Milan Mathew, CPC-A Mildred A Arthur, CPC-A Mildrey Cue, CPC-A Mindy Davenport, CPC-A Mindy Lee Bloom, CPC-A Miranda Kyle, CPC-A Miriam Fried, CPC-A Miriam Rodriguez, CPC-A Missy Meulemans, CPC-A Mitali Madhusmita Mishra, CPC-A Mitchell Huff, CPC-A Mithun Manas, CPC-A Mohamedali K, CPC-A Mohammad Shaheen, CPC-A Mohammed Majid Ali, CPC-A Mohammed Shanawaz, CPC-A Mohanraj Lingappan, CPC-A Mohd Asim, CPC-A Mohd Zaki Abdul Jalil, CPC-A

Molly Hine, CPC-A Monal Patel, CPC-A Monica Coast, COC-A Monica G Duran, COC-A Monica Scott, CPC-A Monica Zordich, CPC-A Monique Boyd, CPC-A Monique Georges, CPC-A Mounika Kumbergavker, COC-A Muhammed Rafi M, COC-A Mujahed Hussain, CPC-A Mukesh Kumar, CPC-A Mukitha Chellapandian, CPC-A Mukund Jawale, CPC-A Munikrishna Boddu, CPC-A Munugala Setty Anil Kumar, CPC-A Muthu Lakshmi Srinivasan, CPC-A N. Padma Usha Phani Kumari, CPC-A Naga Gayathri, CPC-A Naga Subbarayudu, COC-A Nagasilpa Bachu, CPC-A Namit Sudhakar Bhasmare, CPC-A Nancy Cook, CPC-A Nancy Dolan, CPC-A Nancy Dunn, COC-A Nancy Ellen Depase, CPC-A Nancy Forsberg, CPC-A Nancy Goble, CPC-A Nancy L Conway, CPC-A Nancy Michl, CPC-A Nancy Skripsky, CPC-A Nanette Ontimare, CPC-A Naomi Perez, COC-A Naomi Pierson, CPC-A Narasa Reddy Meda, CPC-A Narendra Prabhakar R, CPC-A Naresh Kumar Kasha, CPC-A Narmada Mary, CPC-A Natalie Anderson, CPC-A Natalie Becker, CPC-A Natalie Monroe, CPC-A Natalie Paprocki, CPC-A Natalya Shatrova, CPC-A Natasha Hicks, CPC-A Natasha Nielson, CPC-A Nathan Monroe, CPC-A Naveen Boga, CPC-A Naveena LakshmiK, CPC-A Navin Kata, CPC-A Navneel Sharma, CPC-A Navya Akinapally, CPC-A Nazeer Shaik, CPC-A Neeraja Kantareddy, CPC-A Neethu Am, CPC-A Neeti Chauhan, CPC-A Neetu Gupta, CPC-A Neha Gupta, CPC-A Neisy Arias, CPC-A Nelson Samson, CPC-A Nestor Jr Cura Narciso, CPC-A Nichole Wigness, CPC-A Nick Tomko, CPC-A Nicole Baker, CPC-A, CPC-P-A, CPBNicole Baker, CPC-A, CPC-P-A, CPBNicole Calcanes, CPC-A Nicole Cantelon, CPC-A Nicole Handelong, CPC-A Nicole Howells, CPC-A Nicole Huff, CPC-A Nicole Inman, CPC-A Nicole L Dommer, CPC-A Nicole McMasters, CPC-A Nicole Mower, CPC-A Nicole Olson, CPC-A Nicole Taylor, CPC-A Nikhil Kumar, CPC-A Nikki Earll, CPC-A Nikoma Edwards, CPC-A Nilima Dayal, CPC-A Nimisha Jayaraman, CPC-A Nimisha P Thampi, CPC-A Nina Wilson, CPC-A Niraj Kumar Singh, CPC-A Niranjani Arivazhagan, CPC-A Nisha Leelamony, CPC-A Nisha Varughese, CPC-A Nishat Fatima Quraishi, CPC-A Nishat Iqbal, CPC-A Nithya Devi Arumuga Nainar, CPC-A

Nithya Sundararajan, COC-A Nivedita Bali, CPC-A Nivin Kainattumpilly Vincent, CPC-A Niyati M Gurjar, CPC-A Nolan Christensen, CPC-A Nora Ford, CPC-A Nou Vang, CPC-A Nutan Navnath Argade, CPC-A Odessa Moragas Rios, CPC-A Ola Odewole, CPC-A Olga Tiukaenko, CPC-A Olivia Nicole Mount, CPC-A Omar Tristan Diego, CPC-A Orris Knight, CPC-A Oscar Torres, CPC-A P.. S. Sumesh, CPC-A P.V.N.L. Kumar, CPC-A Padmini Sharma, CPC-A Page Kristine Murray, CPC-A Pahua Thao, CPC-A Pallavi Acharya, CPC-A Palli Hemasundara Rao, COC-A Pamela Memita, COC-A Pamela Sleeper, CPC-A Pamela Zorn, CPC-A Pang Her, COC-A Pankaj Bansal, CPC-A Pankaj Negi, CPC-A Pankaj Papnai, CPC-A Paparaju Srinivas, CPC-A Parimala Kavala, CPC-A Parthiban Rajagobal, CPC-A Patience Mundie, CPC-A Patricia Koagel, CPC-A Patricia McClamma, COC-A Patricia Sarbu, CPC-A Patricia Yoder, COC-A, CPC-A Patricia Yoder, COC-A, CPC-APatrick L Schaefer, CPC-A Patrick Nguyen, CPC-A Patsy A Rocha, CPC-A Paula McDonald, CPC-A Paula Zuck, CPC-A Pavan Kumar Veeroju, CPC-A Pavel Dubrovka, CPC-A, CANPCPeddireddy Rama Prasanti, COC-A Peggy Kiefer, CPC-A Peggy Navin, CPC-A Peggy Seymour, CPC-A Penny Dycus, COC-A Penny Phetteplace, CPC-A Perisamy Natarajan, CPC-A Phoebe Gay Bartolome, CPC-A Phyllis Ritchie, CPC-A Pocha Suryanarayana, CPC-A Pooja Gupta, CPC-A Poonam Gaud, CPC-A Poonam Sharma, CPC-A Poornima Doppalapudi, CPC-A Poornima Nekkanti, CPC-A Prabhu Subramanian, COC-A Prabhu Subramanian, COC-A Prachi Suresh Raul, CPC-A Pragati Yadav, COC-A Prajakta Nikam, CPC-A Prajwal Kumar Reddy Pennabadi, COC-A Prakash Innasimuthu Mr, COC-A Pramanadhi Subramanyam, CPC-A Pramod Kumar Pati, CPC-A Pranit Jayant Churi, CPC-A Pranjali Kshirsagar, CPC-A Prasanthi Maramreddy, CPC-A Pratibha Pardhi, CPC-A Pratik Babasaheb Kulat, CPC-A Pravasini Sabat, COC-A Praveen Kollarkandy, COC-A, CPC-APraveen Pandirla, COC-A Praveena Pauldurai, CPC-A Preeti Dahiya, CPC-A Preeti Goyal, CPC-A Preeti Murugesan, CPC-A Preeti Sinha, CPC-A Primiya Radha Krishnan, CPC-A Priya George, CPC-A Priyanka Naikwadi, CPC-A Priyanka Verma, CPC-A Purushothaman Sekar, CPC-A Purva Raut, CPC-A Pushpa Rani P.L, CPC-A


NEWLY CREDENTIALED MEMBERSPushpalata Venkatesh Sagar, COC-A PushpaLatha T.V., CPC-A Queenie Joy Lalisan, CPC-A Queenie Monique Policarpio, CPC-A Racha Shyamsunder, CPC-A Rachael Lipscomb, CPC-A Rachel Breunig, CPC-P-A Rachel Chatterton, CPC-A Rachel Deirdre Jayne, CPC-A Rachel E Teopaco, CPC-A Rachel Mcallen, CPC-A Rachel Ossino, CPC-A Rachel Wilkinson, CPC-A Radha Babu, CPC-A Radha Sarangapani, CPC-A Radhika G, CPC-A Radhika Thimmampalli, CPC-A Rafaela Gamba, CPC-A Rahul Sharma, CPC-A Rahul Yadav, CPC-A Rajalakshmi Ponkathaperumal, CPC-A Rajasekaran Tamilarasan, COC-A Rajashekar Bramharoutu, CPC-A Rajasubbulakshmi Sundararajan, CPC-A Rajeev Prasad Mamgain, COC-A Rajeswari A, COC-A Rajeswari Sundaramoorthy, COC-A Rajitha Keshireddy, CPC-A RajSandeep Magapu, COC-A Raju Ankam, COC-A Rakesh Bhamare, CPC-A Rakesh kumar G, CPC-A Ram Arthur Tiongan, CPC-A Rama Thiagarajan, COC-A, CPC-ARambabu Pallela, CPC-A Rambabu Pula, COC-A Ramdass Kannupaiyan, COC-A Ramona Thompson, CPC-A Ramonica Pace, CPC-A Ramya Boopalan, CPC-A Ramya Selvaraj, CPC-A Randy Morrell, CPC-A Raquel Cabug, CPC-A Rashi Saraswat, CPC-A Ratish Nair, CPC-A Ravi Sharma, COC-A Raviraj Dayanandan, CPC-A Rayabarapu Deepak, CPC-A Rayan Tomas, CPC-A Rayna Scott, CPC-A Razan Rifaai, CPC-A Rebeca Busquets Villegas, CPC-A Rebecca Cashman, CPC-A Rebecca McCarthy, CPC-A Rebecca Mernack, CPC-A Rebecca Natarajan, CPC-A Rebecca Pichette, CPC-A Rebekah Blackwood, CPC-A Reena A S, COC-A Reena Raju Edappara, CPC-A Reesa Jeanine Turturro, CPC-A Regina Enriquez, CPC-A Regina Lydia-Mary Duncan, CPC-A Rehmat ali Khan, CPC-A Rekha Prasad, CPC-A Rekha Shivaji Sutar, CPC-A Renata Cheagle, CPC-A Rene Lopez Roman, CPC-A Renee Howell, COC-A Renee Karras, CPC-A Renee Mace, CPC-A Renee Raleigh, CPC-A Resmy Achuthan, CPC-A Reynard Hirang Hilahan, CPC-A Rhia Bartolo, CPC-A Rhonda Bertrand, CPC-A Rhonda Louviere, CPC-A Rhonda Warren, CPC-A Rhonda Williams, CPC-A Rich Deister, CPC-A Richa Sharma, CPC-A Richelle Cajeta Pactolin, CPC-A Richmond Lintag, CPC-A Rick Tyrone Del Rio, CPC-A Ricki Larmour, CPC-A Rithika Raj, CPC-A Ritu Gorsi, CPC-A Rizaldy Peleo Reyes, CPC-A Ro Hannah Vivares Alviola, CPC-A

Robert Bouwens, CPC-A Robert Jones, CPC-A Robert Molloy, CPC-A Robert Nutz, CPC-P-A Roberta Winters, CPC-A Robin Hachey, CPC-A Robin Jerold Varghese, CPC-A Robin L Hahn, CPC-A Robin Monica Creighton, CPC-A Robin Moses D, COC-A Robyn Bell, CPC-A, CPPMRocio Banuelos, COC-A Rohith Kumar, CPC-A Rolando Serapia Murillo Jr, CPC-A Ronak Tibrewal, CPC-A Ronald Aaron Cadsawan, CPC-A Ronnie Turnmire, CPC-A Roopa Dadlani, CPC-A, CPMARosalee Campbell, COC-A Rosanne Hannon, CPC-A Rosarie Anne Juta Pascual, CPC-A Rose Ann Chronowski, CPC-A Roseanne Martinez, CPC-A Rosella Marie Zita, CPC-A Rosio Sarino, CPC-A Rotisha Johnson, CPC-A Rowena Alonzo, CPC-A Roxanne Heredia, COC-A Roxanne O’Brien, CPC-A Rupa Mehta, CPC-A Rupali Ghosh, CPC-A Rupali Popat Sakhare, CPC-A Ruth Angel Celia Jeyaseelan, CPC-A Ruth Rivers, CPC-A Ruth S Chapman, CPC-A Ruvelle Joyner, COC-A Ryan Griswold, CPC-A S. Sudheer Reddy, CPC-A S. Sumithra, CPC-A Sabrina Sampson, CPC-A Sachin ., CPC-A Sachin Aggarwal, CPC-A Sadanand Devram Kurhade, CPC-A Sadhna Ratan, CPC-A Sahab Khan Pulikkal, COC-A Sai Kumar Lingala, CPC-A Sai Varsha, CPC-A Sajeesh Augustine, CPC-A Sajina Thomas, COC-A Salini Rajesh, CPC-A Sally West, CPC-A Samadhan Gore, COC-A Samantha Johnson, CPC-A Samantha Marie Suddath, CPC-A Samantha Taylor, CPC-A Sameer Ahamed, CPC-A Samuel Nieves, CPC-A Samuel Stone, CPC-A Sandeep Kondameedi, CPC-A Sandeep Ramagiri, CPC-A Sandeep Vurukuti, CPC-A Sandra A DeArmond, CPC-A Sandra Barnette, CPC-A Sandra Batko, CPC-A Sandra Bruer, CPC-A Sandra Claire Banuag Bellezas, CPC-A Sandra Deterville, CPC-A Sandra K Moore, CPC-A Sandra Pyant, CPC-A Sandy Wilson, CPC-A Santhiya Chandrasekaran, CPC-A Santosh Kumar, CPC-A Santoshi Ramaraju, CPC-A Sanyukta Singh, CPC-A Sara Fash, CPC-A Sara Hibbard, CPC-A Sara Hoover, CPC-A Sara Kathryn Jones, CPC-A Sara S Howard, CPC-A Sarah Clear, CPC-A Sarah Klutz, CPC-A Sarah Lee, COC-A Sarah Lyn Bloodworth, CPC-A Sarah Schummer, CPC-A Sarah Swindell, CPC-A Saranya Chandran, COC-A Saranya Govindan, CPC-A Saranya Paneer Selvam, CPC-A Saranya Shanmugam, COC-A

Saraswathi C, COC-A Sarath Rajan, COC-A Saravanan Velayutham, CPC-A Sarina Ancema Dofeliz, CPC-A Sarita Singh, CPC-A Sarith K, CPC-A Sasi Kumar, COC-A Satheesh Jogu, COC-A Sathish Chandrasekaran, CPC-A Sathiya Gunasekaran, CPC-A Sathya Rangasamy, CPC-A Satyendra Vijendra Rojekar, CPC-A Saurabh Rajendra Yadav, CPC-A Saurav Srivastava, CPC-A See Lo, CPC-A Seema Sawant, CPC-A Selvin Babu, CPC-A Senthilkumar Raju, COC-A Sepideh Gooran, CPC-A Serena Leigh, CPC-A Shabna Najeeb Mutton, CPC-A Shadab Asim, CPC-A Shafeena S, CPC-A Shaima CT, CPC-A Shaina Stevens, CPC-A Shalene Scherr, CPC-A Shalia Glenn, CPC-A Shalini Sathisbabu, CPC-A Shani Rapaport, CPC-A Shanna Aguirre, CPC-A Shannon Lindloff, CPC-A Shannon Scheri, CPC-A Shanthi Balasubramanian, CPC-A Sharad Kumar, CPC-A Sharath Kanth S, COC-A Sharla Varner, CPC-A Sharon Buggs, CPC-A Sharon Garfield, CPC-A Sharon Hale, COC-A Sharon Watson, CPC-A Shashi Mohan Bharadwaj, CPC-A Shauna Lea Russell, CPC-A Shauna Pearson, COC-A Shawna Hoskins, CPC-A Shawna Hutto, COC-A Shayna Anderson, CPC-A Sheena Munia Olarte Baco, CPC-A Sheesh Ram, CPC-A Sheeta Mane, CPC-A Sheila D Robinson, CPC-A Sheila Norton, CPC-A Sheila Rodriguez, CPC-A Shelby Perry, CPC-A Shelly Pitsenberger, CPC-A Shelly Scott, CPC-A Sheree Lynn Rieker, CPC-A Sherly Chacko, CPC-A Sherri Sommerer, CPC-A Sherry Pfeffer, CPC-A Sherry Thomas, CPC-A Sheryl A Mullendore, CPC-A Sheryl Watson, CPC-A Shifa Faisal, CPC-A Shihas Shihab, COC-A Shiji Jose, CPC-A Shikha Kumari, CPC-A Shinil Vijayan, COC-A Shona Arbrouet, CPC-A Show Reddy Salibindla, COC-A Shrikant Pawar, CPC-A Shripad Prakash Kundale, CPC-A Shubhi Sharma, CPC-A Shuchi Vaishnav, CPC-A Shweta Dasarwar, CPC-A Shweta Mukund Zaveri, CPC-A Shweta Rana, CPC-A Shyamala Kathirvel, COC-A Siddhesh Tamboli, COC-A Sidhesh Nair, CPC-A Sidney Heger, CPC-A Siegfried Punzalan Nunez, CPC-A Siju Thampi, CPC-A Silambarasan Jayapal, CPC-A Silvia Chacon, CPC-A Simon Aubrey Steadman, CPC-A Simrandeep Singh, CPC-A Sisira Sivan, CPC-A Sisy Vang, CPC-A Sithara Rajan, CPC-A

Siva Rama Krishna Kolla, CPC-A Siva Sankar Vairavasamy, CPC-A Sivagami Sathish, CPC-A Sivakumar J, CPC-A Sivanandham Elangovan, COC-A Sk. Abdul Raquib Baksh, CPC-A Smita Jadhav, CPC-A Sneha Pokiya, CPC-A Snehal Babanrao Kapote, CPC-A Snehali More, CPC-A Sona Anil, CPC-A Sonia Boedigheimer de Leon, CPC-A Sonia Cavazos, CPC-A Sonja Peisl, CPC-A Sophie Yu, CPC-A Soujanya Gunti, COC-A Soumya Rajan, CPC-A Spandan Karre, CPC-A Sravanthi Jakkula, COC-A Sreeji Jayanandadas, COC-A Sreenath Sreekumari, COC-A Sri Ganesh Goparaju, CPC-A Sridevi Jagadeeswaran, CPC-A Sridevi R.V., CPC-A Sridhar Reddy Kudumula, COC-A Srikanth Chalasani, CPC-A Srikanth Chandragiri, CPC-A Srilakshmi Gundu, COC-A Srinath Hulke, COC-A Srinivasa Chari Duriseti, CPC-A Srinivasa Rao.B, CPC-A Srinivasa Reddy Kunduru, COC-A Srinivasulu Kandlakunta, CPC-A Stacey Schropp, CPC-A Stacey Suncin, CPC-A Staci Haney, COC-A Stacy Gilhooly, CPC-A Stacy L Kutz, CPC-A Stacyann Jackson, CPC-A Steeban Dayakaran, COC-A Stefany Goodenough, CPC-A Stephanie Brohl, CPC-A Stephanie Caldon, CPC-A Stephanie Clouatre, CPC-A Stephanie Gannon, CPC-A Stephanie Lanier, CPC-A Stephanie Lorenz, CPC-A Stephanie Vantzelfde, CPC-A Stephen Crafts, CPC-A Stephen William Pedro, CPC-A Stetson Gleason, CPC-A Subashini Rajagopalan, COC-A Subathra Krishnan, CPC-A Subbu Rayudu, COC-A Subha Gopakumar, CPC-A Subramony Sriram, CPC-A Sucheeka Bhalla, CPC-A Sudeshna Banerjee, CPC-A Sudha S Nair, CPC-A Sudhakaran Narayanaswamy, CPC-A Sudharsan Kuppusamy, CPC-A Sudheer Pinni, CPC-A Sudhir Maruthi Oulkar, CPC-A Sudipta Ghosh, CPC-A Sue Cox, CPC-A Suganthi Mathyas Mrs, COC-A Suganya Pattabiraman, CPC-A Suganya Raman Ms, CPC-A Sugapriya Rajagopal, CPC-A Suguna Varatharajan, CPC-A Suja Menon, CPC-A Sumathi Devarajan, CPC-A Sumati Nirankari, CPC-A Sumit Anand, CPC-A Sumit Kumar Singh, CPC-A Sunanda Dudhnath Jaiswar, CPC-A Suneel Kumar, CPC-A Sunil Sangolkar, CPC-A Suraneni Chaitanya, CPC-A Surekha Katam, COC-A Suresh Dhanalakota, COC-A Suresh Gelli, COC-A Suresh Kumar Yadav V, CPC-A Suresh Naidu Yarra, COC-A Suriyakumari Raja, COC-A Surya Rajendran, CPC-A Susan Duchaine, CPC-A Susan Hampton, CPC-A Susan Schairer, CPC-A

Susan Stevens, CPC-A Susan Suchowski, CPC-A Susanna Rogers, CPC-A Suzanne Livingstone, CPC-A Swathi Anumolu, CPC-A Swati Gajula, CPC-A Swati Jha, CPC-A Swati Prakash Khandwekar, CPC-A Sweetlinshali Chellan, CPC-A Sweety Choudhary, COC-A Sweta Singh, CPC-A Sydney Lee Anderson, CPC-A Syed Khalid Anwar, CPC-A Syeda Isaru Zohra, CPC-A Talesha Duffy, CPC-A Tamara Arias, COC-A Tamara Lynne Clementoni, CPC-A Tami Tuttle, CPC-A Tammy Borgia, CPC-A Tammy C. Bronson, CPC-A Tammy Conger, CPC-A Tammy Duane, CPC-A Tanish Kumar Narang, CPC-A Tanvee Maheshwari, CPC-A Tanya L Wilson, CPC-A Tanya Manriquez, CPC-A Tanya Santana, CPC-A Tapan Rajaram Lad, CPC-A Tara Elaine Buerkman, CPC-A Tara Phillips, COC-A Tarun Kumar, CPC-A Tasha Pulec, CPC-A Tashia Howard, CPC-A Tathireddy Venkateswarreddy, CPC-A Teresa Alferez, CPC-A Teresa Dawn Beukenhorst, CPC-A Teresa Lea Branham, CPC-A Teresa Matthews, CPC-A Terri Ebbinghouse, CPC-A Terry Bjoin, CPC-A Tessy Tom, COC-A Theresa M Cusella, CPC-A Theresa Peterson, CPC-A Theresa Whiteley, CPC-A Thiyagarajan Munuswamy, CPC-A Thomas Neumann, CPC-A Thomas Ruffalo, CPC-A Thota Shiva Prasad, CPC-A Thurmandy Smith, CPC-A Tiffany Delker, CPC-A Tiffany F Chase, CPC-A Timothy James Apgar, CPC-A Tina Clarke, CPC-A Tina Cloutier, COC-A, CPC-A, CPC-P-A Tina Crawford, CPC-A Tina Moua, CPC-A Tiphani Miller, CPC-A Tirsa Ramirez-Belloso, CPC-A Toni Bussmann, CPC-A Tony Cherian, CPC-A Tonya Thompson Scruggs, CPC-A Toogar Chandar, CPC-A Tori Boggs, CPC-A Tori Patton, CPC-A Tracey Gay, CPC-A Tracey Waldburg, CPC-A Tracy Ann Zdilla, CPC-A Tracy Boyer, CPC-A Tracy Donyavi, CPC-A Tracy Kopitsch, CPC-A Tracy L. Rentner, CPC-A Trang Do, CPC-A Treva Thomas, CPC-A Trina Thweatt, COC-A Trisha Martinez, CPC-A U Samrat Reddy, CPC-A U. L. Bhargavi, CPC-A Uday Kumar Kaluvala, CPC-A Uday Muthyala, COC-A Uma Ravirala, CPC-A Umesh Vyas, CPC-A Usha Latha Eedula, COC-A Usha Shyam, CPC-A Uttara Vaiti, CPC-A Vaibhav Gupta, CPC-A Vaishnavi Praveen, CPC-A Valerie Murphy, CPC-A Vamshi Krishna, CPC-A Vanessa Dawn Maez, CPC-A


NEWLY CREDENTIALED MEMBERSVanessa Garcia, CPC-A Vanessa Mallory Smith, CPC-A Vanessa Rodrigues-Gorn, COC-A, CPC-AVaratharaj Perumal, CPC-A Varnia Casimir Bryant, CPC-A Varun Kumar, CPC-A Varun Singh, CPC-A Vasanti Nipurte, CPC-A Vasiliy Babich R.N., CPC-A Veeramohan Reddy Baddigum, COC-A Velpula Lokesh, CPC-A Veneza Wells, CPC-A Venkata Krishna Thanneeru, CPC-A Venkatesh Gowni, CPC-A Venugopal Polaki, COC-A Vernell Hester, COC-A Vernita Russell, CPC-A Veronica Harvey, CPC-A Veronica Hawthorne, CPC-A Veronquie Dawson, CPC-A Versha Rathore, CPC-A Vibin P S, CPC-A Vicki Carr, CPC-A Vicki Schmeling, CPC-A Victoria Bauman, CPC-A Victoria Hicks, CPC-A Victoria Lane Smith, CPC-A Victoria Steeley, CPC-A Vidhyaprabha Ekambaram, CPC-A Vidya Yadav, CPC-A Vijay Kumar Kondamudi, CPC-A Vijayakumar Konda, COC-A Vijendar Kondam, CPC-A Vijit Kunjir, CPC-A Vimala K, COC-A Vinceeli Sindhuja.M, CPC-A Vincent Ray Regala, COC-A Vinita Bagwe, CPC-A Vinod Mankumare, CPC-A Vipin M, CPC-A Virgenmina Lugaro, CPC-A Virginia McEntee, CPC-A Vishal Pawar, CPC-A Vishal Sharda, CPC-A Vishwanath Dhorashetty, CPC-A Visukumar Subramani, CPC-A Vivek Choudhary, CPC-A Vivek Prasad Mishra, CPC-A Vivek Vijayakumar, CPC-A Vivian Cortez, CPC-A Vivian D Davis, CPC-A Vonda Butler, CPC-A Vrinda Shah, CPC-A Wade Brodsky, CPC-A Weigong He, COC-A, CPC-A, CPC-P-A Wendi Cain, CPC-A Wendy Kortuem, CPC-A Wendy Rosati, CPC-A Wendy Vaughn, CPC-A Whitney Barrington, CPC-A Whitney Ung, CPC-A Will Thomas Taylor, CPC-A William Boulware, CPC-A William French, CPC-A William Haydo, COC-A Winchel Nembra, CPC-A Wynne Selke, CPC-A Yamini Krishnamoorthy, CPC-A Yamini Manne, CPC-A Yamneswari Dhevi Janarthanan, CPC-A Yara Demoulin, CPC-A Yarka Karasek, CPC-A Yazhini Rajarajan, CPC-A Yehlen Bautista, CPC-A Yelagapudi Mohan Rao, COC-A Yesenia Castrejon, CPC-A Yogesh Dilip Barde, CPC-A Yogesh Pal, CPC-A Yojana Binawade, COC-A Yolanda Stowe, CPC-A Yomaira V Payamps, CPC-A Yu Lin, CPC-A Yukashini Krishnamurthi, CPC-A Yuvanjili Rajlin, CPC-A Yuvaraj Ramakrishnan, CPC-A Yvonette Green, COC-A Yvonne Copley, CPC-A Yvonne M Miller, CPC-A Yvonne Vazquez, CPC-A

Zaffer Nivasdeen L, COC-A Zeba Khan, CPC-A Zhauntae Dotson, COC-A Zulfiqar Mehboob Lakhani, CPC-A

SpecialtiesSpecialtiesSpecialtiesAbigail Wolter, CPC, CPMA Addiss Maldonado Mendez MD, CPC, CPMA, CEDC

Adrianna Dawn Foster, CPC, CPMA Adrianne Hudspeth, CPC-A, CCVTC Adrienne Miller, CPC, CPMA Adrienne M Diaz, CPC, CRC Agabie Arpy Darakjian, CPC, CRC Alberta L Reynolds, CPC, CPMA, CRC Alisha Dancy, CPB Alison K Minnick, CPC, CPCO Amanda Briggs, CPC, CPMA, CCC, CEMCAmanda Cluck, COC, CIC Amanda Dodell, CPB Amanda Grady, CPC, CUC Amanda Jensen, CPB Amanda McAloon, CPC, COBGC Amanda Nunez, CPC, CPMA Amanda Rollins, CPC, CPMA Amber Socher, CPCD Amy Branch, CPC, CPB Amy Liu, CPC, CPPM, CASCC, COSC Amy Moshier, CPC, CEMC, CIMC Amy Powell Gross, COBGC Amy Rummelhart, CPC, CHONC Amy Siano, CPC, CCC Amy Woulf, CPC, CPMA Andia M Hewitt, CPC, CUC Andrea J Bowers, CPC, CPMA Andrea Juanita Humphrey, CPC, CPMA Andrea Keeler, CCC Andrea Watson, CPC, CPMA, CPC-IAngela Creech, CPC, CRC Angela M North, CPC, CEMC Angela Marie Gutierrez, CPC, CPCD Angela Mikkelson, CPC-A, CPMA Angela Mobley, CGSC Angela Suddith, CPB Angela Tuck, CPPM Angelita Aguelo Salarda, CPC, CPMA Angie Lynn Billingsley, CPC, CEMC Anita M Johnson, CPC, CPMA, CRC Ann Madison, CPC, CPB Anna Szczesny, CPB Anne Koleson, CPC-A, CPPM Annette V Slade, CPC, CGSC Antonio Garfield Fraser, CPC, CEDC Archana Kulkarni, CIC Ardith Charles-Harris, CGSC Arrana Ashton, CPC, CEMC Ashley E Gilmore, CPB Ashley Kissinger, CPC, CPMA Ashley Maleki, CPC, CPMA Ashok Ganganaguntla, COC-A, CPMA Barbara Ann Messinger, CPC, CIC Barbara Aubry, CPC, CPMA Barbara Baker, CPC, CEDC, CEMCBarbara Lewis, CPC, CEMC, CGICBarbara MacIntyre, CPC-A, CPMA Bart Jeff Stein, CPC, CEMC Belann Bennett, CPC, COSC Bernice Cage, CPC, CPMA, COBGC Beth Mooney, CPC, COSC Bethany Brown, CPPM Bethany Leiendecker, CPC, CPB Beverly Ann Abernathy, CPC, CIMC Beverly Macaraig, CRC Beverly Schmidt, CRC Blesson Mathews, CPCO Bonnie Smallidge, CPC, CEMC Bonnie Wellmeier, CPB Bonny E Harris, CPC, CPMA, CEMCBrandy Brimhall, CPC, CPCO, CPMA Brandy Montgomery, CPC, CPMA Brandy Wiktorowski, CPB Brenda Edwards, CPC, CPB, CPMA, CPC-I, CEMC, CRC

Brenda Huynh, CPC, CEMC Brenda R Warren, CPC, CPMA Brenda S Jennings, CPC, COSC

Brenda Zucaro, CPB Brian Shin, CPC-A, CASCC Bridget Kathleen Surovick, CPC, CIMC Bridgette Martin, CPC, CEMC, CGICBritanny Davila, CGSC Brittany Faber, CPC, CPMA Brittney Cook, CPC, CPMA Brittney Winn, CPC-A, COSC Camille VanDerSteen, CPC, CCC Candace M Sexton, CPC, CRC Caren J. Swartz, COC, CPC, CPB, CPMA, CPC-I, CRC

Carey Clifford, CPC, CPB Carmelle Venturina, CIRCC, CRC Carolyn S White, CPC, CPMA, CGSC, CRC, CUC

Carolyn V Papa, CPC, CRC Carrie Clements, CPC, CPPM Cassandra A Hill, COC, CPMA Cassandra Elledge, CPC, CANPC Catherine A Caronia, CPC, CPCO Cathy Ann Richman, CPC, CPMA Chanel Burnett Joseph, CPC, CPMA Charise N Owens, CPC, CPMA Charita Lynne’ Farley, CPC, CPMA Charlotte A Delaremore, CPC, CPMA Charmion Cosse, CPC, CIRCC Chaya Wieder, CPC, CPB Chelsea Graham, CPPM Cheryl A Gervasio, CPC, CEDC Cheryl Christiansen, CPC, CPMA Cheryl D Johnson, CPC, CANPC Cheryl Denise Jefferson, CHONC Cheryl L Marasco, CPC, COSC, CSFACCheryl Lindley, CPC, CEMC, CGSC Cheryl Lindley, CPC, CEMC, CGSCCheryl Robbins, CPMA Cheryl Y Baumgardner, CPC, CPMA Chris Cranor, CPC, CPPM Christi Leigh Lemire, CPC, CPMA Christina Hill, CPC, CPB Christina J McLain, CPC, CPMA, CEMC Christina Marie Borst, CPC, CPMA Christine Ehda, CPC, CPB Christine Warecki, CPC-A, CEMC Christy Lashon Mansuy, CPC, CEMC Christy Winkles, CPPM Chrys Vickers, CPC, CGSC Colleen Henry, CPC, CPMA Constance Hildreth, CEMC Consuelo Garcia Saenz, CPC, CEMC Cordelia Rose Moreland, CPC, CPMA Corina Bucsi, CPC, CPB Corlis Norman, CPMA Cory Glyn Arnold, CPPM Courtenay Werner, CPMA Cristina Cecilia Brunelle, CPC, CEMC Cristina Martinez, CPC, CEMC Crystal Amjad, CPC, CRC Crystal Freeman Gooding, CPMA Crystal Lednum, CPC, CPMA, CPC-ICynthia Ann Colangelo, COC, CPC, CPB Cynthia Craft Ballenger, CPC, CPPM Cynthia Hill, CPCO Dana Caudell, CPC, COSC Dana Harding, CPB Danette Muntz, COC, CPC, CPB Daniel Scott McMahan, CPC, CPPM Danielle Coyne, CPPM Danielle Galley, CEDC Danielle Shree Lanagan, CPC, CPB Daphne Anne Smith, CPC, CRC Daphne Kasprzak, CPC, CPMA D’Arcy A Scalzo, CPC, CEMC Darlene Gallegos, CPC, CANPC David Avalos, COC, CPC, COSC David L Cripps, CPC, CCC Dawn Anderson, CPC, CPMA Dawn Correira, CPC, CPMA Dawn Kantz, CPC, CPPM Dawn M Addy, CPC, CCVTC Dawn Strong, CPC, CRC Deb Webber, CPB Debbie Christian, CPPM Debbie A Ricci, COC, CPC, CPB Debbie Bolton, CPC, CPMA Debbie Maxwell, CPC, CPPM Debora Santiago, CPC-A, CPMA Deborah A Teter, CPC, CPCO

Deborah Ait Alla, CPPM Deborah Bertolino, CPMA Deborah Gordon, CPC, CPMA, CFPCDeborah Kantner, COBGC, CRC Deborah L Guillies, CPC, CRC Deborah M Cooper, CPC, CPMA, CFPCDeborah McDougald, CPPM Debra Hellinger, CPB Debra Lauren Shepherd, COC-A, CPMA Debra Phelps, CEDC Deepa Chandran, COC, CPPM Deepa Patel, CPC, CPB, CPMA Del Ann England, CPCD Delanna Stephens, CPC, COSC Delina Frias, CPC, CIRCC, CPMADelores Kim Frieben, CPC, CPB, CPPMDenise Borrell, CHONC Denise C Dennis, CPC, CEDC Denise D Duran, CPC, CPPM, CPC-I, CRC Denise Jones, CPC, CPMA Denise Novoa, CPC, CRC Dennis Yu Lim, CPC, CRC Derek R Albright, CPC, CRC Deshanda Y Middleton, CPC, CPMA, CPPMDesiree Marie Dalke, CPC, CPPM Devan Pillai, COC-A, CPB Dharmatej Gangadhar, CPC, CPC-P, CPMA

Diana Lea Foster, CPC, CPMA Diana M McWaid, CPC, CRC Diane Brooks, CPB Diane L Matsunaga, CPC, CPMA Diane M Bendy, CPC, CEMC Diane Newell-Healey, CPC, CPMA Diane Smith, CPC, CPMA, CPPMDivya Bhatt, CPC, CPMA Dominika Sadej, COC, CPC, COBGC Donna Dressick, CPC, CPMA Donna Gorham, CHONC Donna Hody, CPC, CEMC Donna Marie Harp, CPC, CFPC Donna Toney, CPC, CPMA Dora Creasy, CPC, CPMA Doris Higgins, CPC-A, CPB Dorothy Powell, CEMC Douglas Palmer, CPC-A, CRC Dr Archana Sunil Dadhich, CPC, CPMA, CEMC

Eden Elizabeth Weber, CPC-A, CPB Eileen Camillone, CPC, CPMA Elena Kontorova, CPC, CASCC Elizabeth O Struzyk, CIRCC Elizabeth P Zamudio, CPC, CPMA, CPEDC, CPRC

Elizabeth Redman, CPC, COSC Elizabeth Thompson, CPC, CEMC Elizabeth W Kairo, CPC, CPMA Elizabeth Wade Hankins, CPC, CPMA Ellen Best, CPC, CCC Emily Lam, CPB Emily R. Carlson, CPC, CIRCC Emily S Stevens, CPC, CSFAC Ericson Salmo, CRC Erika Ortega Rivas, CPC, CANPC, CRC Erin Gallelli, CPC-A, CPMA Eumaira M Quintero-Feinstein, CPC, CEMC, CFPC

Eunice M Sanchez, CPC, CRC Eveleen S Vanderbilt, CPC, CRC Faith D Chonofsky, CPCO, CPMAFlorence Paisley, CPC, CPCD Gao Nhia Vang, CPC, CPC-P, CPB Geetha Ganesan, CPCO Gena Alexander Fortune, CPC, CEDC, CGSC

George Nartey, CPCO Gina Wright, CPC, CRC Ginger Bibiloni, CPPM Ginger McCullum-Hamilton, RHIA, CPC-A, CPMA

Gloria A Miller, CPC, CPMA, CPPM Gloria Ayala, CPC-A, CEMC Grace Hu, CPB Greeshma Sasi, CIC Guadalupe Hernandez, CPC, CPMA Guadalupe Jurado, CPC, CPMA, CPC-IGuillermina Simmons, CPC, CPC-P, CRC Gwendolyn Loraine Patterson, CPC, CRC Hang Jones, CPB

Haritha Gubbala, CIC Heather Bradley, CPC-A, CPB Heather Kopanski, CPB Heather L Ernest, COC, CPC, CRC Heather McPeek, CIRCC Helen Montalvo, CPC, CUC Hema Viswanathan, CPB Hollie Haynes Garrett, CPC, CPB, CPEDCHolly Pappas, CPC-P, CPMA Ida M Thornton, CPMA Ingrid Phillips-Mason, CPC, CEDC Jackie Ujano, CPC, CPMA Jamie Allen, CPC, CPB, CGSC Jamie Edwards, CPCO Jamie Gwaltney, CPC, CGSC Jamie Sweeney, CPC, CPPM, CEMCJan Turley, CPC, CPCO, CPMAJana Mulliken, CPCO Janet Billas, CPPM Janice Gollihur-Davidson, CPC, CPMA, CPC-I

Janine Valentine, CPC, CRC Janis Arleen Klawitter, CPC, CPB, CPC-IJanis Kuykendall, COC, CPC, CANPC, CEMCJean Marie Williams, CPC, CPMA Jeanette M Vennum, CPC, CRC Jeanne M McLellan ,CMM, CCPM, COC, CPMA

Jeanne Marie Lombardo, CPC, CPB Jeff Gosnell, CPMA Jenifer S Carey, COC, CPMA, CPC-IJennifer Sachan, CPC, CRC Jennifer Anne Henderson, CPC, CCC Jennifer Anne Moore, CPC, CPPM Jennifer Clutts, CPC, CRC Jennifer Flippin, CPC, CEMC Jennifer Kemp, CPC, CPEDC Jennifer L Deal, CPC, CEMC Jennifer L Squyres, CPC, CRC Jennifer L. Bauguss, CPC, CPMA, CEMCJennifer Nunez, CPC, CPPM Jennifer Steen, CPC, CCVTC Jennifer Stinnett, CPC, CPMA, CRC Jennifer Veronica Gordon, CPC, CANPC Jennise Murphy, RHIA, CPC, CRC Jenny Lynn Roberts, CPC, CPMA Jermaine Jay Powell, CPC, CPMA, CEMC, CHONC

Jess Burke-Vang, CPC, CENTC Jessica Hallock, CPC, CPMA Jessica Putman, CPB Jessica Riggs, CPC, CASCC Jessica Schuster, CPC, CGSC Jill Smithers, CPC, CEMC Jimcer Torres, CRC Joan Lemaire, CPC, CFPC, CGICJoanne Horton, CPC, COBGC Joanne Minelli, CPB Jodi Schwing, CPPM Jodie Stackpole, CPC, CPMA JoeAnn Nicole Wallace, CPC-A, CPMA Joel Hockin, CPPM John J Ursiny, CPC-A, CRC Johnna Sharon Derain, CRC Jonathan Scott Lukas, COSC Joyce D Covington, CPC, CRC Juana Morales, CPC, CRC Judith Heberling, CPB Judith Pfutzenreuter, CPC-A, CPB Judith T Bouffard, CPC, CPMA Judy L Smith, CPC, CPB, CPMA, CPC-IJulia Kenney-Hall, CPC, CEMC Julie A Rajala, CEMC Julie Ann DeBroux, CPC, CEMC Julie Ann Johns, CPC, CENTC Julie Dylla, CPC, CIRCC Julie Hanna, CPB Julie M. Leonard, CPC, CPCO Julie-Leah J Harding, CPC, CEMC Juliette Psama Fuller, CPC, CPMA June Brown, CPMA, CHONCKaitlin Green, CRHC Kandace Morris CCS-P, CPC, CPB, CPMA, CEMC

Kara Elizabeth Pedigo, CPC, CPMA, CCC, CEMC, CPCD

Karen A Palladino, CPPM Karen Dixon, CPMA Karen Love, CPC, CEMC


NEWLY CREDENTIALED MEMBERSKaren Schad, CPC, CRC Karin Quiterio, COSC Katalin Kerekes, CPC, CGSC Katarzyna M Pinkowska, CPC, CPMA Katherine A Landro, CPC, CRC Katherine Hill, CPC, CPB Katherine Weidner, CCPC Kathleen B Rexer, CPC, CASCC, CRC Kathleen Carr, CPC, CPB Kathleen Fedak, COSC Kathleen Meadows, CPB Kathleen Moran, CPC-A, CPPM Kathleen R Rhodes-Riker, CPC, CPPM, CCC Kathleen Russell, CPCO Kathryn Hansen, CPC, CPMA Kathy Bankston, CHONC Katie Riley, CPC, CEMC Katie Walsh, CENTC Katy Matte, CPC, CPPM Kaysha Virasawmi, CFPC Keesha L Coram, CPC, CRC Kelli Graff, CCC Kelly Debbage, CPC-A, CPB Kelly Diane Smith, COC, CEMC Kelly Dunn, CPC, CIRCC, CCCKelly Lynn Hamm, CPC, CRC Kelly Paras, CPC, CPMA Kelly Scheerer, CPC, CPMA Kelly Scruggs, CPPM, CHONCKelsey Hill, CPC, CPMA Kendra Nilson, CPC, CPMA Kenia Fajardo, COSC Kent Fitzsimmons, CPB Kenzie Rossi, CPC-A, CPB Kera K Weaver, CPC, CEMC Keri Calnan, CPC-A, CPB Kim Dalton, CPC, CPCO Kim Montenegro, CPC, CPMA, COSC Kimberley R Holt, CPC, COBGC Kimberly Ann Waidler, CPC, CASCC Kimberly Crist, CPC, CPMA Kimberly Dawn Fisher, CPC, CPC-P, CEDC, CEMC

Kimberly Zeilenga, CPC, CRC Kim-Marie Walker, CPC, CPMA, CCVTCKirit Patel, CPC, CPMA Krishna Vijaya Rallabhandi, CPC-A, CEMC, CHONC, CRC

Kristal Stripling Gladden, CPC, CPB Kristen Keith, CPC, CRC Kristen Royal, CPRC Kristin Burg, CPC, CPMA Kristina Lea McWhorter, CPC-A, CRC Kristina Marie Schaab, CPC, CPMA, CPC-I

Kristine Cooper, CPMA Krystal Christenberry, CPB Kyle Zucco, CPC-A, CPMA, CPPMKymarra T Brown, CPC, CPMA, CPPM, CEMCLakia S Thompson, CPC, CPMA LaMia Harris, CPC, CPB LaRae W Jarboe, CPC, CPMA Lashel Denise Church, CPC, CPB, CPPM, CPC-I, CEMC

LaTonya Johnston, CPC, CPMA, CRC Laura Catherine Stovall, CPC, CUC Laura Christenson, CPB Laura Hutchins, CPC, CGSC, CUCLaura Irene Rogers, CPC, CEMC Laura Manser, CEMC Laura Wagner, CPC, CPB Laurie Mullen, CPC, CEMC Laverne Cichon, CPMA Leah Rachel Christy, CPC, CPMA, COSCLeatrice Marie Hamilton, CPC, CEMC Leolinda Q Ejercito, CPC, CRC Lesa Meis, CPC, CPB Leslie McClements, CCVTC Levilyn Garcia Macalalad, CPC, CEMC Linda Brewton, CPB Linda Davis, CPC, CEMC Linda Heinen, CPC, CEMC Linda Marie Bohm, COC, CPC, CRC Lindsay Roper, CPC, CPB Lisa Evans-Smith, CPC-A, CPB Lisa Dawn McCauley, CIC Lisa M Paulo, CPMA Lisa Marie Burns, CPC, CPMA Lisa Marie Grublis, CPC, CRC

Lisa Nicole Phillips, CPC, CPMA Lisa Purnell, CPC, CPMA, CRC Lisa Purnell, CPC, CPMA Lisa R Rung, CPC, CPCD Lisa S Bialka, CPC, CPPM Lisa Selby, CPC-A, CPB Lisa Velasquez, CPC, CPMA, CEDCLisa Zavala, CPB Lizabeth Cioffi, CPC, CPMA Loida E Collazo, CPC, CPC-P, CPMA, CEMC, CRC, CUC

Lois Whitcomb, CGIC Lolita A Ham, CPC, CPMA Loni Y Hodel, CPC, CPCO, CPMALora Jane Knight, CPC, CPMA Lorene Moore, CPC, CPMA Lori Baker, CPC, CEDC Lori Petrozza, CPC, CPB Lori Zander, CPC, CPMA, CPC-ILynn Cooper, CPB, CPPMLynn J Brisendine, CPC, CPMA Mandy Jean Tharp, CPC, CPB Manuelita L Yabut, CPC, CRC Marcia McAvin, CPC, CPC-P, CASCC Marcy L Sloan, CPB Margaret I Crawford, CPC, CANPC Margaret S Mantyh, CPC, CPRC Maria A Joseph, CPC, CEMC Maria Elizabeth Baca, CPC, CFPC Maria F Rios, CPC, CPMA Maria Serfontein, CPPM Maria Teresa Sanchez, CPC, CENTC Marianne Schmidt, CPC, CPMA Marilin Morales Gonzalez, CPC, CPMA Marilyn Garry, CPC, CRC Marilyn Hart Niedzwiecki, COC, CPC, CIRCC Marilyn S McCauley, CPC, CPMA, CFPC Marilyn Vatter, CIRCC Marine Gharagyozyan, CPB Maritzabel Garcia, CPC-A, CRC Marjorie Hackett-Wallace, CPC, CPMA Marjorie Hutzayluk, CPC, CPPM Mark Connolly, CPPM Marla Wsiaki, CPPM Marqueta Pledger, CPPM Mary Callen, CPC, CANPC Mary M McGuire, CPC, CPMA Mary Schannach, CEDC Mary Theresa Schmid, CPC, CPMA Mary Victoria McGhee, CPC, CEMC Maryanne Heath, CPC, CPMA Mateshia Wright, CPC, CRC Matthew Brown, CPPM Maureen Hoffman, CPC, CRC Megan Brennan, CPC, CPMA Megan K Bruce, CPC, CCC Megan Rene Veach, CPC, CEDC Megan Renee Burch, CPMA Meggin Senz, CPC, CRC Meghan C Painter, CPC, CPCO Melanie D Rivera, CPC, CGSC Melanie Hong, CPC, CEDC, CEMCMelanie Staiman, CPC, CPB Melanie Zinser, CPMA, CPC-I, CANPC Melinda Corbett, CPC, CPB Melinda Jennings, CPC, CRC Melinda Marcel Raiford, CPC, CPMA Melissa A Schneider, CPC, CPMA, CEMCMelissa Baker, CPC, CPCO, CPMAMelissa Ducharme, COC-A, CASCC Melissa Gridley, CPC, CGSC Melissa Insisiengmay Hendry, CPC, CPMA

Melissa M Francis, CPC, CEMC, CFPCMelissa May Cihak, CPC, CANPC Melissa Rennie, CPC, CPB Melissa Vasquez, CPC, CRC Melodie Warren, CPC, CPCO Melody Powers, CPC, CPMA Meredith Quinn, CPEDC Mia Thomas, CPB Michael D Miscoe, Esq, CPC, CPCO, CPMA, CASCC, CCPC, CUC

Michael S Resan, CPC, CPC-P, CPB Michael Wu, COC, CPC, CPC-P, CIRCC, CPMA, CPC-I, CANPC, CCC, CCVTC, CEDC, CEMC, CENTC, CGIC, CGSC, CHONC, COBGC, COSC, CPCD, CPEDC, CUC

Michelle A Blessie, CPC, CEMC Michelle A Pineiro, CPB Michelle Amber Mace, CPC, CPMA Michelle Andrews, CPC, CPB, CEMCMichelle Bobo, CPPM Michelle Buckner, CPC, CEMC, CHONCMichelle Eckery, COBGC Michelle Mills, CPC, COSC Michelle Q Hancock, CPC, COBGC Michelle Ray, CSFAC Michelle Smith, CPB Michelle West, CPC, CPMA Milena Angelova Douglas, COC, CIC Mischel D Sims, COC, CPC, CPC-P, CIRCC, CPC-I, CEMC

Misty Sebert, CPC, CCC, CCVTC Monica Mitzenmacher Watson, CPC, CPMA, CIC, CRC

Monika Rose, CPC, CRC Morgan Jones, CPC, CPRC Myra Kinnaird, CPPM Namrata Mehta, CPC, CPB Nancy Grandmaison, COSC Nancy Price, CPC, CPMA Nancy Sharon Mureddu, CPC, CRC Natalie Ann Lewis, CPC, CPMA Nataliya Kurchiy, COC, CPC, CPB Navaneetha Krishnan Narayanan Alavandar, CPC, CPMA

Nichole R Snyder, CPC, CRC Nicole Daniel, CASCC Nicole A Benson, CPC, CPMA, COSC Nicole Scherman, CPB Nicole Stratton, CPC-A, COBGC Nikki Lechel, CIRCC Nikki Taylor, COC, CPC, CPMA Noelia Galvan, COBGC Notchea N Ward, CPC, CPMA Olga Hollmann, CPC, CPC-P, CRC Omega Renne, CPC, CPCO, CPMA, CEMC, CIMC

Pam Vanderbilt, CPC, CPPM Pamela Branaman, CPC, CUC Pamela Gillies, CPC, CPMA Pamela Jill Settles, CPC, CRC Pamela Lichell Summons, CPC, CPMA Pamela Ransom, CPC, CPMA Pamela Stevens, CPC-P, CPB, CEMC Patrice Lemon, COC-A, CPC-A, CRC Patricia A Smith, RHIT, CPC, CPMA Patricia Cole, CHONC Patricia F Browning, COC, CPC, CPPM Patricia Jordan, CPC, CPMA, CEMCPatricia Kresch, COC, CPC, CIRCC, CPMA, CCC

Patricia Lynn Elliott-Kashima, CPC, COSC Patricia Merdian, COC, CPC, CPB, CPMA, CEMC

Paula A Preston, CPC, CPC-I, CHONC Paula Cordova, CPC, CGIC Paulette Hileman, CPC, CRC Pavel Dubrovka, CPC-A, CANPC Peaches Fieweger, CPB Peg Spence, CPB Peggy S Blue, CPC, CEMC Perla Baustista, CRC Perry Barnhill, CPC, CPCO, CPMAPhyllis Dobberstein, CPC, CPCO, CPMA, CCCPilar Mason, CRC Prasanti Sripada, CPB Praseeda Sreekumar, CPMA Rachel Batenhorst, COBGC Rachel Garena, CPC, CCC Rachel Herbert, CIRCC Radhika Rajeev, CIC Rahab Rodriguez, CPC, CPMA Raja Arun, CPC-A, CPMA Randall John Tolosa, CPC, CPMA Ravva Venkateshwar, CPC, CPCO, CPMARebecca D Dioneda, CPC, CUC Rebecca Hardy-Bakalik, CPC, CSFAC Rebecca J Schreier, CPC-P, CPMA Rebecca Poff, CPC, CPMA, CHONC Regina M Morris, CPC, CPMA, CEMC Reinna Laureano, CRC Remy A Negrete, CPC, CRC Renay A Hoffman, CPC, CPB, COBGCResmi Ravikumar, CIC

Rhoda Balamiento, COC, CPC, CRC Rhonda Dearwester, CPC, CPB Rhonda Humphrey, CPC, CPPM Robbin A Lake, CPC, CPMA Robert F Ryder, CPC, CPMA Robert Hruby, CGSC Robert Mark Jeffers, CPC, CRC Robin L Plowman, CPC, CPMA, CEMCRobin M Black, CPC, CPMA, CEMC, CFPC

Robyne Laughlin, CPB Rochelle Scroggins, CPC, CHONC Ron Todaro, CPPM Ronda Kay Seubert, CPC, CPMA Roopa Dadlani, CPC-A, CPMA Rosaleen Marie Durham, COC, CPC, CEMC Rose Marie Van Parys, CPC, CPMA Rowena Tio, CRC Roxanne Betton, CPC, CFPC Ryan P Mathes, CPC, CRC Ryan S Gosselin, CPC, CPMA Sabrina Hamilton, CPC, CPEDC Samuel Ramjattan, CPC, CPC-I, CEMC Sandra J Clement, CPC, CGSC Sandra Terrell Jones, CPC, CEMC, CRC Santosh Kumar Gullipalli, CIC Sara June Wiseman, CPC, CPPM Sara Michelle Roberts, CPC, CPB Sarah Ann Hess, CPC, CGSC Sarah Dale, CPC, CPB Sarah Good, CPCD Sarah Green, CPC-A, CPB Sarah Taylor, CPC, CPMA, CUCSarah W Ashe, CPC, CPMA Scottie Stone, CPC, CEMC Sean Delthony, CPC, CPMA Serina Gonzalez, CPC, CPRC Shanise Tolentino, CPC, CEDC Shanna M Sweeney, CPC, CPCO Shannon Holby, CPC, CPMA Shannon J Farlow, CPC, COSC Sharla Yvonne Haynes, CIRCC Sharon M Tran, CPC, CPMA, CRC Sharon Moehle, CPC, CPMA Sharon Rose Clement, CPC, CPPM Sharon Young, CPC, CRC Sharona Eliaszadeh, CPC, CRC, CUCShawna A Keller, CPC, CPMA Sheila Mcintosh, CPC, CEMC Sheila Rae Wells, CPC, CPMA Shelly Maynard, CPB Shelly Turner, COBGC Sheree Goodman, CPC, CPMA Sherese M Crawford, CPC, CRC Sherry Powell Wilson, CPC-A, CPMA Silvio R Martinez, MD, CPC, CPMA Slobodanka Randjelovic Kostic, CPC, CRC Sonal Patel, CPC, CPMA Sonda Eunus, CPB Stacie A Coburn, CPC, CRC Stacie ReSue, CPC, CPMA Stefanie Richardson, COC, CANPC, CASCC, COSC

Stephanie Mellor, CPC, CRC Stephanie Morgan Green, CPC, CASCC Subhash Subramanian, CPC-A, CIC Sunita Bacchus, CPB, CPPMSunita Bacchus, CPB, CPPM Sunni A Munoz, CPC, CPMA Susan Anderson, CPC, CEDC Susan Carol Straumanis, CPC, CPMA Susan Faulk, CPC, CPMA, CRC Susan Freeman, COBGC Susan Michelle Apperson, CPC, CGSC Susan Plecker, CPB Susan Silva, CPC, CPMA Susan Smart, CPMA Susana Lee, CPC, CRC Susana Vazquez, CPC, CPMA Susanne Feinour, CPC-A, CHONC Susanne Wegner, CGIC Svitlana Glova, CPB Swathi Mashetti, CIC Tamara E. Taylor, CPPM Tamara Jean Ellett, CPC, CRC Tamara Lynn Hicks, CPC, CPPM Tammie Toner, CPC, CPMA Tammy Combs, CPC, CIMC

Tammy Noelle Hagan, CPC, CPMA Tanya Citron, CPMA Tara Belvin, CPC, CASCC Tara O’Daniel, CPC-A, COBGC Tatyana Kuptsevich, CPB Teresa B Deas, CPC, CGSC Teresa Harper, COC, CEDC Teresa Kelly, CIRCC Teri Wendel, CPB Terri L Gilbert, CPC, CPMA Terri Lyn Blevins, CPC, CPMA, CCC Theresa Colella, CPEDC Thomas Wudarski, CPMA Tiffany Speer, CPC, CPCO Tiffany Taticek, CPPM Tiffany Y. Haskins, CPC, CPCO, CRC Tim Stelma, CPC, CPMA Tina Betcher, CPC, CPMA Tina L Wendt, CPC, CPCD Toni M Collier, CPC, CPMA, COBGCTonya Horne, CPC, CPMA Tonya Marie McKown, CPC, CEDC Tonya Sisk, CPC, COBGC Tora Walker, CEMC Tracey Townsend, CPC, CPMA Traci Jurgensen, CPC, CIC Tracie Leah Hughes, CPC, CPMA, CEDCTracy Bowers, CPC, CPPM Tracy Elaine Wheeler, CPC, CPMA Tracy Morris, CPC, CPEDC Tracy R Johnson, CPC, CRC Tricia Jolin, CPC, CIRCC Trudy Cooper, CPC, CIRCC Twyla D Worsham, COC, CPC, CEDC Valeria Jane Knotts, CPC, CEMC Valerie Eide, CPC, COSC Vandana Rana, CPC-A, CEDC Vanessa Michelle Hetzel, CPC, CPB Veronica Y Caldeira, CPC, CPMA Vicki Sue Stull, CPC, CPMA Victoria Montoya Burns, CRC Viola Apostoli, CPC, CEMC Virginia A Outlaw, CPC, CPB, CPPM Vivienne Broughton, CPC, CEDC Wanda Ann Spell, CPC, CPMA Wanda Marie Zirnstein, CPC, CRC Wendy Chapman, CPC, CEMC Wendy Kay Nosar, CPC, COBGC Wendy Moorman, CPB Wendy Sue Muszynski, CPC, CPMA William Jamie Lujan, CPC, CIRCC, CENTCWindette Solomon, CPC, CRC Wradelyn Abellera, CRC Xiomara Gonzalez, CPC, CPMA Xuejiao Chen, CPC-A, CPMA Yaimara Suarez, CPC, CPMA Yamilka Alvarez, CPC-A, CPMA Yarenis Calderon, CPCO Yvette Ramirez, CUC

ICD-10 Quiz Answer (from page 37)The correct answer is D. Temporal factors are not a key documenta-tion concept for scleroderma conditions.


Tell us a little bit about your career — how you got into coding, what you’ve done dur-ing your coding career, what you’re doing now, etc.In 2004, my job in the newspaper business ended and I needed to find a new job. I remember seeing the words “medical cod-ing” on a book several years earlier. I looked online and discovered AAPC. AAPC was chock-full of information, from the mind-set of a coder to the job description and na-tionwide salaries. I felt my mindset was right on target as a coder. I took the four month medical coding course based in Yorba Linda, California (a two- to three-hour drive from home), and passed the Certified Profession-al Coder (CPC®) exam on the first attempt.With a CPC-A® in hand, I sent out 168 “ca-reer transformation” resumes throughout my area. Five months later, I was hired for an orthopedic surgery coder position. I was the only coder for 17 surgeons of all subspecial-ties. At home, I studied orthopedic anatomy, terminology, coding, modifiers, and Medi-care guidelines. I slept, ate, and breathed coding for months! The clinic employed bill-ers and collectors, which afforded me to see the full circle of reimbursement, and I gained insight into insurance companies’ denial/ap-peal practices. After working off my appren-ticeship, I took and passed the Certified Or-thopaedic Surgery Coder (COSC™) exam.In 2008, I became an independent coder, working from home. I sent a few hundred letters to orthopedic clinics offering my cod-ing services. I understood how important coding was to the compliant health of a clin-ic, and I expected to be inundated with calls. Unfortunately, that was not the case. I re-ceived my first call for coding services af-ter six months. I now have two surgeons who I code for, one in Washington and one in Alaska. In 2009, I moved to Utah to work in an or-thopedic clinic as an internal surgery audi-

tor and patient advocate for billing inqui-ries. In 2012, I completed a book, DOCU-MENT SMART, M.D. for Orthopaedic Sur-gery, which can be purchased only through me. I am in the process of writing a human-itarian book.

What is your involvement with your local AAPC chapter?In 2013, I was education officer for South Salt Lake Valley, Utah, local chapter. I gave two presentations on shoulder surgical cod-ing. I attend meetings regularly, and I get ex-cited when I learn something new outside of my specialty.

What AAPC benefits do you like the most?AAPC understands many coders do not have the financial means for obtaining continu-ing education units, so they offer courses and information that are low- or no-cost. I see AAPC as an innovative compa-ny extending into additional ar-eas of the medical field, helping people to become knowledge-able and certified.

What has been your biggest challenge as a coder?My biggest challenges have been trying to sell my coding services and writing my first book. I was astounded when I discovered many surgeons code their own operative re-ports; the likelihood of them understanding what needs to be documented for their pro-cedures is minimal.

How is your organization preparing for ICD-10?As an independent coder, I’ve purchased and studied the ICD-10 crosswalk book. I’ve tak-en the ICD-10 Anatomy & Pathophysiolo-gy Training course, and I am pursuing addi-tional ICD-10 studies, as well as networking with other coders.

If you could do any other job, what would it be?I would love to be a freelance photographer.

How do you spend your spare time? Tell us about your hobbies, family, etc.From December 2014 to March 2015, I trav-eled to see my daughters: my youngest, Jessi-ca, in Washington and my oldest, Sarah, in Los Angeles. Jessica is a volunteer in the pe-diatric ward at a hospital. Sarah is a flight at-tendant based out of Melbourne, Australia. It was wonderful to be with them and con-nect again. I am incredibly proud of how outstandingly conscientious and caring they are. Traveling the South 101 from Washing-ton to Los Angeles rekindled my passion for photography. I also enjoy coding orthope-dic surgeries and helping surgeons, coders, and collectors with the challenges of surgi-cal documentation.

Minute with a Member

Darlene Austin, CPC, COSCAuthor and Independent Coding Contractor for Orthopedics

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