ICD-10-PCS Root Operations Crossword Puzzle

It's that time of year!  The start of the school year.  Homework!  Studying!  Exams!  In the spirit of the new school year, test YOUR coding knowledge with the below crossword puzzle on ICD-10 PCS Root Operations.  Click HERE to print the crossword!!  Click HERE for the answers.

Across

4.  free body part from physical constraint by cutting/use of force

6.  joining portions of articular body part to immobilize

7.  expanding orifice/lumen of tubular body part

9.  move to normal/other suitable location all or part of a body part

12. cutting off all or portion of upper/lower extremities

13. correct malfunctioning device/position of displaced device

15. putting in appliance to monitor/assist/perform/prevent function 

    but not take the place of a body part

16. visual/manual exploration of body part

17. putting back all or part of a separated body part to normal/

    other suitable location

18. complete closing of an orifice/tubular body part

19. taking/letting out fluids/gases from a body part

22. cutting out/off a portion of a body part

24. cutting out/off without replacement all of a body part

Down

1.  stopping/attempting to stop postprocedural/acute bleeding

2.  cut into body part to separate or transect

3.  locate route of passage of electrical impulses/functional areas 

    in a body part

4.  taking out/off a device

5.  taking/cutting out solid matter from a body part

6.  breaking solid matter in a body part into pieces

8.  move, without taking out, all/part of a body part to take 

    over function of all/part of a body part

10. restoring body part to normal structure and function

11. altering route of tubular body part

14. replacing device on same body part without cutting skin

20. modifying natural anatomic structure of body part without 

    impact to functionality

21. pulling/stripping out/off all or part of a body part by 

    use of force

23. putting in material to reinforce/augment function of a portion 

    of a body part

OHIMA Board President’s Message (2018-19)

Hello and welcome!  I am excited to serve as President of the Ohio Health Information Management Association (OHIMA). OHIMA’s strategic planning provides us with opportunities to partner with members of our community this upcoming year to accomplish the goals and objectives we’ve set. Together, with your help, I know we can accomplish great things in 2018-2019.

As you may know, the American Health Information Management Association (AHIMA), our national Association, has new leadership. Dr. Wylecia Wiggs Harris now serves as the Chief Executive Officer of AHIMA.  AHIMA has introduced the “2018-2022 Strategic Objectives” to accomplish the vision under the leadership of Dr. Wiggs Harris which is “improving health through trusted information.”

I’d like to take this opportunity to highlight some key points of AHIMA’s strategic objectives so you will have an idea of how together we can help the HIM profession to “Transform healthcare by leading HIM, Informatics, and Information Governance.”

Technological advancements throughout the healthcare industry make it necessary to expand the roles of HIM professionals.  OHIMA, in partnership with AHIMA, is working to prepare our members for the HIM roles of the future.

At the end of 2017, AHIMA released the “Informatics Toolkit for Health Informatics and Information Management Professionals.”  It has been noted in the healthcare industry that HIM professionals bring unique and exceptional skills to roles in data analytics.  For that reason, one objective of AHIMA is to expand the number of new and current members who have a data analytics role as their primary job.

HIM professionals drive the data being collected by healthcare organizations.  So, it goes without saying that HIM professionals are in a position to support healthcare organizations with the management of collected data.  AHIMA wants to take it a step further by equipping HIM professionals with expertise in the use of Information Governance tools to transform the data into information to assist in achieving the strategic objectives of healthcare organizations.  AHIMA strives to increase the adoption of Information Governance practices through the use of the “AHIMA Information Governance Adoption Model” and the “AHIMA Information Governance Toolkit 3.0.”

The OHIMA membership is well-prepared to advance these strategic objectives through partnership and participation.  We are nationally recognized as the Component State Association (CSA) with outstanding participation from its membership!  I encourage you to share your ideas and suggestions with us to help you and our membership grow as HIM professionals.  Feel free to reach out to me at the email address below if you would like to share your thoughts.  Please partner with me as we work to advance the strategic objectives established by AHIMA to realize the goal of ensuring “the right information is delivered to the right person and the right time.”

Sincerely,

Krystal Phillips, RHIA, CHTS-IS 
OHIMA Board President 2018-19 
phillips.580@osu.edu

Telemedicine

Telemedicine.  A relatively new phenomenon in healthcare with its own coding and billing rules.  In this edition of “In the kNOW”, we will look at some of the CPT coding particulars surrounding telemedicine.

Telemedicine means using telecommunications systems (audio and visual) in order to diagnosis and/or treat a patient remotely. 

Appendix P in the CPT Manual lists 79 codes that can be used to report telemedicine services when modifier 95 is added.  These codes are identified in the CPT Manual code list with the symbol of a star (★) preceding the code.  These codes reflect the following services:

• Psychotherapy 
• Psychoanalysis 
• Pharmacological management with psychotherapy 
• ESRD services 
• Remote imaging for retinal disease 
• Remote imaging for monitoring and management of active retinal disease 
• External mobile cardiovascular telemetry 
• Technical support for above
• External patient auto activated ECG 
• Interrogation device evaluations-loop recorder 
• Interrogation device evaluations-implantable cardiovascular monitor system 
• Medical genetics and genetic counseling services 
• Neurobehavioral status exam 
• Health and Behavior Assessment/Intervention 
• Medical Nutrition Therapy 
• Education and Training for Patient Self-management 
• E&M for new patients 
• E&M for established patients 
• Subsequent hospital care 
• Office and inpatient consultations 
• Subsequent nursing facility care 
• Prolonged services 
• Behavioral Change Interventions, Individual 
• Transitional Care Management services

Modifier 95 is used to identify a synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system.  Previously modifier GT was in use for telehealth billing but was discontinued at the beginning of 2018 because a new place of service code (02) indicates telehealth now.  However, GT it is still needed for any distant site telehealth services performed under Critical Access Hospital (CAH) method II billing.  There is also a GQ modifier to be used for asynchronous telecommunication systems visits but that applies only to services in Alaska and Hawaii. 

Medicare requires that the communication take place from a qualifying originating site such as:

• Hospital
• Physician or practitioner’s office 
• Rural health clinic 
• Critical access hospital (CAH) 
• Skilled Nursing Facility 
• Community Mental Health Center 
• Hospital-based or Critical Access Hospital-based renal dialysis center 
• Federally Qualified Health Center

An eligible Medicare beneficiary must be at one of the originating site locations listed above when the telemedicine service takes place.  These originating sites are required to be located in a rural Health Professional Shortage Area (HPSA) or in a county outside of a Metropolitan Statistical Area (MSA).  Some sites have been participating with the Department of Health and Human Services on a demonstration project and therefore, are considered originating sites despite their geographic location.  Due to the complexity of determining the eligibility of an originating site, there is an on-line tool-the Medicare Telehealth Payment Eligibility Analyzer-to assist.

There are specific practitioners who are eligible to perform services and receive reimbursement for telemedicine services.  They are: 

• Physicians
• Nurse practitioners 
• Physician assistants 
• Nurse-midwives 
• Clinical nurse specialists 
• Certified registered nurse anesthetists 
• Clinical psychologists and clinical social workers 
• Registered dietitians or nutritionists

These practitioners, located at the distant site, will use Place of Service code 02 for Telehealth.   They then bill the appropriate CPT code or HCPCS Level II code with the appropriate modifier.  Payment for the originating site is achieved by submitting HCPCS code Q3014.
Now you are in the kNOW!!

About the Author 

Dianna Foley, RHIA, CHPS, CCS  is OHIMA's Coding Education Coordinator. Dianna has been an HIM professional for 20 years. She progressed through the ranks of coder, department supervisor, and department director, to her current role as a coding consultant. 

She recently served as the program director for Medical Coding and HIT at Eastern Gateway Community College. Dianna earned her bachelor's degree from the University of Cincinnati subsequently achieving her RHIA, CHPS, and CCS certifications. She is an AHIMA Approved ICD-10-CM/PCS Trainer and a a presenter at regional HIM meetings and the OHIMA Annual Meeting.