Karen Scott, MEd, RHIA, CCS-P, CPC

Karen Scott, MEd, RHIA, CCS-P, CPC kscottseminars@comcast.net
CPT 2011 Karen Scott, MEd, RHIA, CCS-P, CPC

Agenda CPT Changes by book section Including rationale and examples
Guidelines and notes CPT Codes are copyright protected by the AMA. Discussion and examples used are for educational purposes only.

Resequencing continues
Codes are not always in numerical order Most placed in family where they clinically make the most sense Symbol # O reinstated/recycled code

Modifier Modifier 50 Bilateral procedures instructions modified
Unless book says otherwise, if bilateral procedures done at same session use modifier 50 76/77/78 Repeat procedure, unplanned return to OR By same physician or other qualified health care professional Do not use on E&M codes

E&M Tables Just before the Evaluation and Management Section
Tables to visually be able to determine E&M Level

E&M Service Guidelines
Time Two new paragraphs “face to face” Office and other other outpatient visits “unit/floor time” Hospital and other inpt visits Prolonged time Use appropriate add-on code for place of service/type of service provided Non-Face-to-Face For office services Also known as pre and post encounter time Should not be counted as extra and is not included in time component But is part of the service package

SELECTING LEVEL OF SERVICE
3. Counseling time Dominates the encounter More than 50% of time spent in counseling Time is the key factor Includes time spent with parties assuming responsibilities for care/making decisions Does not have to be family members Must be documented appropriately

Hospital observation Initial Obvs Care
New/Established Patient Obvs Status for supervising physicians Initiation, supervision of care plan, periodic reassessments Use consults or subsequent obvs care codes for other physicians Patient admitted to hospital after obvs On same date, use initial hosp. inpt codes Other than initial/discharge date, use subsq. Obvs codes Adm/Disch. From obvs or inpt on same date, use appropriate codes Don’t code obvs discharge with hospital admission codes

Subsequent obvs care Now have time as a factor 99224-xx226
Extended obvs care over the first day, per day, similar to subsequent hosp. inpt. 2/3 components All codes include medical record review, review of results of dx studies/changes in pt’s status since last assessment Resequenced codes Showing up with # and Bullet symbols Now have time as a factor

Hospital inpt services
Reminder to review guidelines to use these appropriately Obvs vs. subsequent hospital, resequenced codes New Coding Tip Significance of Time factor Only averages Intraservice time face to face vs floor/unit

Obvs/inpt adm/dis same date
Reminder note Date of service Admitted or discharged on different date Use other codes

Consultations Coding Tip p. 18 Definition of Transfer of Care
Very important in selection of correct code Attending “relinquishes care” for all/some of patient’s problems Accepting physician “explicitly agrees to accept responsibility” Transferring physician not providing care for problem(s) turned over Do not use if agreement to transfer made prior to first visit Ok to use if can’t make determination until after first visit occurs. Site does not matter

ED Coding Tip Time Not part of description in ED codes
Difficult to measure time spent with each patient New/Established pt No difference between new/established pt

Critical care Professional services reporting Inclusive components
Distinguish between physician and facility reporting Facilities can use any of the codes; not included in package Coding Tip Same information as addition to notes

Preventive medicine Services that can be reported separately include such as Vaccines, including new admin codes Lab/x-ray, ancillary testing Screening tests

Inpt neonatal icu Review definitions
Critically injured pediatric patient Ped critical care pt transport guidelines Inclusive services Same as for critical care and also include , 75, 76 Intensive care services codes

Anesthesia section No changes

Surgery section No guideline changes General
Added codes for services that are not considered Fine Needle Aspiration, such as: needle biopsies List of codes that should be used instead of FNA Removed code that was placed in list incorrectly

Integumentary Debridement Defined-removed excision from heading
6 revised codes 3 new codes 2 deleted codes 6 new cross references 4 instructional notes

Debridement specifics
Wound debridements reported by depth of tissue removed, surface area of wound Reported for injuries, infections, wounds and chronic ulcers Depth measured using deepest level of tissue removal Multiple wounds: add surface area of wounds at same depth Don’t combine from different depths

Example multiple wounds
Two separate debridements to bone, one is 12 cm and one is 5 cm, size is combined (17) Use code 11044 Location doesn’t matter-codes are by depth (subq, bone, etc.) May need to use modifier 59 if multiple codes needed Coding Tip

Debridement Revised notes Revised Codes
Notes: if only skin is debrided, use active wound care codes, not these surgery codes Revised Codes Includes removal foreign matter in open fx/dislocation Took out codes for full and partial thickness Added size, first/each additional 20 sq cm Xx010 added “at the site”, removed the (s) next to fracture and dislocation, making it singular

Repair/closure Complex repair Prep Does not include
Changes made due to changes in debridement section Wounds needing more than layered closure Scar revision, debridement, stents, retention sutures, etc. Prep includes creating defect for repair/debridement complicated lacerations/avulsions Does not include Excision of lesions Excisional prep of wound bed Debride open fx or dislocation

Instructions On when separate debridement is coded
Extensive debridement to match new codes in that area When to code separately involvement of tendons, blood vessels, nerves

Skin graft/replacement
P. 68 Coding Tip for wound prep Definitions for surgical preparation Includes removing dead tissue May need to code other procedures in conjunction/these may be secondary to other primary procedures New heading for Application of skin replacements/skin substitutes Code based on type used

Flaps Note moved from under x5650 to flap guideline section
Regions refer to donor site when tube formed for transfer at later date Or when delayed flap occurs prior to transfer

Musculoskeletal General Incision
Code deleted, notes included to direct coder Incision soft tissue abscess Revised code 05 added “and drainage” “subfascial”, and examples Deleted terms “deep, complicated” Halo application x0664 Took out “requiring general anesthesia” Bone and other Grafts Revised codes Divided by type of material, morselized or structural, for spine surgery, 31 is no long used just for children

Revised codes Spine fx treatment x2315 New codes 22551-52
Took out with/without anesthesia New codes Arthrodesis Cervical below C2, each additional interspace Include discectomies at same level as arthrodesis Revised x2851 Took out example of “threaded bone dowel(S)” not used very often Instructional note: if using intervertebral bone device/graft, use 2093x codes

Pelvis/hip joint Excision codes revised x7065-71
Took out “with/without” Added “includes … when performed” Moved specific locations out of examples and into main body of descriptions

ARTHROSCOPIES New codes p. 147 (resequenced)
Surgical hip reconstructions X Femoroplasty Tx cam lesion Acetabuloplasty Tx pincer lesion With labral repair Don’t report if secondary to acetabuloplasty or in conjunction with 29862, 63

Respiratory Endoscopy New codes 31295-97
Surgical sinus includes sinusotomy and dx endo Includes fluoro if performed Watch “do not report” codes Most are unilateral New codes Endoscopies Dilation of sinus ostia is done through displacement of tissue by any method, typically with balloon dilation Maxillary sinus ostium Transnasal or by canine fossa Frontal sinus ostium Sphenoid sinus ostium

Bronchoscopy 31634 With occlusion using balloon while assessing air leak and admin of fibrin glue or other types of substances Used to treat fistulas in broncho-pleural region Usually “last effort” in past but is now more common Includes fluoro and mod. Sedation when performed

Cardiovascular 33411 revised Correction of anomalies (Newborns)
Added “sinus” for clarification Tx enlarged Noncoronary sinus Correction of anomalies (Newborns) X Pulmonary artery band placements Hybrid approach, stage 1 Insertion of catheter for stent placement with cath removal/closure, transthoracic Hybrid approach stage 1 Reconstruction complex anomalies incl palliation single ventricle Aortic outflow obstruction Aortic arch hypoplasia Creation cavopulmonary anastomosis Removal of bands Hybrid stage 2, Norwood, bidirectional Glenn, debanding If main pulm artery banded to tx septal defect, use xx690

Aneurysms Thoracic aortic aneurysm X3860-64
Ascending graft with bypass Added terms to make more descriptive Iliac Aneurysm endovascular repair Revised took out “graft placement for repair”, added in language to be more specific Remodeling of aortic root

Angioplasty Several deleted codes Transluminal atherectomy
35471 revised to become parent code for percutaneous transluminal balloon angioplasty Transluminal atherectomy All codes have been deleted

Bypass grafts Revised codes Composite Grafts Injection Procedures
X5526, x5626 Added aortoinnominate and aortocarotid to the list of veins included Composite Grafts Notes revised for standardization regarding vein harvest/anastomosis Two or more segments harvested from limb not going through bypass Injection Procedures Review notes under x6218

Central Venous Access Table with the codes in book (199)
Other CVA Procedures Notes to show usage with blood collection from existing line or device Cannot use with these other services Except lab codes

Other transcatheter procedures
Revised stent codes Added in lower extremity to list not included in these codes Except: Coronary Carotid Vertebral Iliac Other extremities

Endovascular revascularization
New section, instructional notes and codes x Used for procedures on lower extremities To treat occlusive disease Can be open or percutaneous More extensive procedures include less extensive procedures Use highest level code Only one code per family

Territories Diagram page 210
Three arterial vascular territories with specific rules for each Iliac Includes three vessels Common iliac Internal iliac External iliac Femoral/popliteal Entire territory in one leg “single vessel” Tibial/peroneal Three vessels Anterior tibial Posterior tibial Peroneal arteries Common peroneal trunk is included, does not count as fourth vessel

Multiple territories In same leg If extends across territories
One primary code used for each territory tx Can use add on codes If extends across territories If can be opened with one stent, just use that one code Bifurcating lesions May need to use primary and add on codes in iliac and tibial territories In fem/pop, all branches are included so only one primary code would be used

Other issues Modifiers used if treating more than one limb
Even if using different therapy modes Can code also any mechanical thrombectomy and thrombolysis Remember, codes are set up like hierarchy Use highest level in family

Lymphatic/diaphragm 38900 Diaphragm Repair
New add on code to describe intraoperative id/mapping Sentinel lymph nodes (blue stained) Includes injection of dye Diaphragm Repair Notes to direct coder to appropriate codes for hernias Several codes for hiatal hernia repairs deleted and moved to digestive section

Digestive system Laparoscopy
New add on code for surgical esophageal lengthening procedure Collis gastroplasty Wedge gastroplasty Same procedure- open 43338

Repair Two new codes for Esophagogastric fundoplasty
Partial/complete Laparotomy Thoracotomy Hernia Repairs Paraesophageal hiatal hernia Via laparotomy or thoracotomy Incision-thoracoabdominal Using mesh/prosthesis

Stomach Revised x3605 to make it stand alone code since the code above it was deleted Intubation x Intubation and aspiration Diagnostic or therapeutic Single/multiple specimens Gastric or Duodenal

Colonoscopies Clarification notes
Patient prepped for total but can’t get past splenic flexure, use colonoscopy code with modifier 53 Used to give instructions for modifier 52 Same note under Coding Tip above colonoscopy codes

Revised to specify open Introduction Complete cholecystostomy
Biliary tract 47480 Revised to specify open Introduction Complete cholecystostomy

Abdomen Laparoscopy with insertion tunneled catheter
X9324 revised to include “tunneled”, removed “permanent Placement of interstitial device for radiation New codes lap vs. open Intraabdominal, intrapelvic, retroperitoneum Includes image guidance Add on code Tunneled catheter insertion Complete procedure With subq port For dialysis

Urinary system Kidney ablation 50250 revised
To include ultrasound guidance and monitoring Same as laparoscopic ablation at x0542 New code x3860 (was Cat III Code) Radiofrequency remodeling bladder neck and urethra Female stress incontinence

Male Genital Laparoscopies Other procedures Revised 55866
Radical prostate removal Includes robotic assistance if done Other procedures Added approach Needle

Female genital Introduction, vaginal 57155,56 Revised and new code
Insertion uterine tandem/vaginal ovoids Afterloading apparatus For brachytherapy

Maternity care Instructional notes
Postpartum care is services after delivery Delivery includes: Admission H&P Uncomplicated labor management Vaginal or cesarean delivery Delivery only codes can be used with E&M if needed for post delivery management

Nervous system Stereotaxis 61781-83
Computer assisted navigation, cranial Intradural Extradural Spinal Add on codes

Nerve blocks 64479 -84 Paravertebral spinal nerves
Added image guidance as part of the code package Paravertebral spinal nerves Also image guidance is included Commonly fluro or CT If imaging not used, coder is instructed to use Ultrasound guidance, use 0213T-18T

Neurostimulators 64566-70 New codes Tibial neurostimulator
Used to tx urge incontinence, epilepsy Perc needle electrode, single tx Incision for implant cranial nerve stimulator Revision/replacement Removal of array and pulse generator

Other procedures 64611 chemodenervation Neuroplasty Parotid
Submandibular salivary glands Bilateral Neuroplasty X Surgical decompression/freeing intact nerve from scar tissue Includes external neurolysis and transposition to repair/restore nerve Revised codes to show these are open procedures

Eye Cornea procedures Scleral Excisions 65778-80
New codes for Placing amniotic membrane on ocular surface for wound healing Self retaining Single layer sutured Ocular surface reconstruction Scleral Excisions Dilation aqueous outflow canal With/without device retention

Ear Inner ear incision/destruction X9801-02
Labyrinthotomy removed “or without cryosurgery or including other nonexcisional destructive procedures” and single/multiple

Operating microscope Use as add on code unless procedure already includes List of inclusive (don’t use op microscope with any procedures on the list)

Radiology Abdominal CT Table for Combo with pelvis CT p. 369
New codes x416-78 With/without contrast, body regions without followed by contrast

Aortic procedures Radiology codes to work with new surgery codes for endovascular revasc., legs Includes new rules on usage (p. 372) Revised codes x5954 added “using ilio-iliac endoprosthesis X5960, 62, 64 including iliac and lower extremity Deleted Transluminal Atherectomy codes with notes to direct coders to surgery and cat III codes

Ultrasound Extremities
Complete ultrasound exam of extremity definition Notes to explain usage of 76882 New codes x

Radiology guidance Notes to explain usage
Code x7003 removed transforaminal epidural from ( )

Radiation Tx management
Instructional notes to guide in usage Units of 5 “fractions”/treatment sessions Requires/includes minimum of one patient exam

Lab/pathology 80104 Drug Assays, multiple drug classes other than chromatographic method, each procedure Hematology X5597 and 98 phospholipid neutralization platelet Hexagonal phospholipid Immunology X6480, 81 Tuberculosis test, cell mediated, gamma interferon Enumeration of T-cells that produce gamma interferon

More lab Transfusion X6902 blood typing
Antigen testing donor blood, each test Note: multiple units tested for same antigen, use code only once per antigen per unit Infectious agent antigen detection new codes X Influenza virus, reverse transcription, multiple types Add on code each additional type/subtype

pathology X8120 21 using computer assisted technology
Cytopath in situ hybridization –FISH, urinary tract specimen, 3-5 probes 21 using computer assisted technology X8172 elevation of FNA with study to see if enough sample, first eval, each site New code xxx77 immediate study on sample, each separate additional eval episode, same site Xx363 exam/selection retrieved archival dx tissue(s) for analysis Xx749 unlisted in vivo/transcutaneous lab

Medicine section Immunization Admin for Vaccines/Toxoids 90460-70
Instructional notes and new codes Admin codes are used with codes for the actual product given New codes that include counseling are face-to-face “component” = each antigen in vaccine “combination” = multiple vaccine components Admin, up to age 18, any method, with counseling, first Add on code, each additional See instructional notes for usage H1N1 admin, IM or IN, includes counseling

Vaccine product codes XX644 Xxx50, 62, 63, 70
Meningococccal conjugate, groups C & Y and Hemophilus influenza B, tetanus toxoid conjugate 4 dose schedule, children 2-15 months old, IM Not FDA approved yet Xxx50, 62, 63, 70 Revised due to new code descriptions Xx Not FDA Approved yet Flu, live, pandemic, IN Flu, split virus, pandemic,, preserv free, IM Flu, split virus, pandemic, adjuvanted, IM Flu, split virus, pandemic, IM

Psychiatry Consultation instructions Inclusive components Exam
Information exchange with providers, family, etc Report preparation Initial eval only, not treatment included Use E&M codes for follow up visits Additional consult requests, new or same problem, can use office consults a second time Be aware of transfer of care rules, same as consults in E&M section

Therapeutic Psychotherapy Two new codes, other services
Use codes for type of therapy Interactive, insight, behavior modifying, support Place of service Office, inpatient Face to face time spent With pt present Did separate E&M service occur? Follow rules on counting time spent for both psychotherapy and eval/mgmt Two new codes, other services 90867, 68 Transcranial magnetic stimulation tx Planning Delivery/management per session

Gi Services 91010 Deleted codes 11, 12 Xxx13 Xx117
Revised esophageal motility study Deleted codes 11, 12 Xxx13 With stimulation/perfusion, add on code Use only once per session Xx117 Colon Motility Study Min 6 hrs continuous recording

Eye services New codes 92132-34 Ophthalmoscopy Scanning services
Using computer technology Anterior posterior segments Optic nerve or retina Unilateral or bilateral Ophthalmoscopy Xx227-28 Remote imaging Detecting retinal disease Monitoring/management active retinal disease Unilateral/bilateral Watch Do Not Report Notes

Cardiovascular Watch usage notes Instructional notes under X2981
Codes for coronary stenting Coronary angioplasty, atherectomy Inclusive in stenting procedures Add on codes xxx73, 74, 78, 79 not inclusive so should be coded separately

Cardiovascular monitoring
New heading, instructional notes, revised codes Diagnostic, in-person or remote to assess heart rhythm New definitions Attended surveillance Electrocardiographic rhythm derived elements Mobile cardiovascular telemetry Changed terminology “wearable” to “external” Deleted codes 30-37

More definitions Implantable/wearable devices evaluation (p 474)
Implantable cardiovascular Monitor Implantable loop recorder

Cardiac caths Revision of definitions New instructions on usage
Inclusive components New codes X3451 right heart cath with O sat, output measurement 52 left heart cath including injection(s) for Lt ventriculography 53 combo Lt/Rt cath with injection(s) for Lt ventriculography

Catheter placement 54-61 cath placement in artery(s) for angiography including injection(s) for angiography 55 with placement(s) in bypass graft(s) including injection(s) for bypass graft angiography Internal mammary, free arterial venous grafts 56 with Rt cath 57 same description as 55 but injections are for both angiography and Rt heart cath 58 with Lt cath including injection(s) for LT ventriculography, when performed 59 same description as 58 but also includes placement(s) in bypass graft(s) with bypass graft angiography 60 with Rt and Lt cath 61 with Rt/Lt cath with injection(s) for LT ventriculography, cath placement(s) in bypass graft(s) with bypass graft angiography

Other cath procedures 9xx62 63 Add on code for admin of drug
Lt cath by transseptal puncture Through septum Or transapical puncture Add on code 63 Add on code for admin of drug Such as inhaled nitric oxide, IV infusion nitroprusside, dobutamine, milrinone, other Incl. assessment of hemodynamic measurements Before/during/repeated 64 add on code for exercise study with measurement assessment during and after procedure Bicycle/arm ergometry

Injection Procedures Inclusion notes
Sometimes coded separately, sometimes are inclusive so watch instructions carefully Normally don’t include catheter introduction, do include repositioning of catheters, autom power injectors New add on codes 9X563-68 During cardiac caths Selective angiography during congenital heart cath Selective opacification of graft(s) Selective lt ventricle/atrial angiography Supravalvular aortography Pulmonary angiography

Other cardio Repair septal defect Non-Invasive Vascular DX Studies
Note to show these include Rt Cath, injections for angiograms Non-Invasive Vascular DX Studies Instructional notes Using hand-held/Doppler device, no output or no bidirectional flow analysis is included Notes on Physiologic studies Limited vs. complete studies Arterial Studies of Extremities Revised codes Bilateral codes, use modifier if unilateral Specified number of levels in codes, bidirectional doppler

Sleep studies and neuro codes
New codes and instructions x Unattended Sleep time Instructional notes with intraop neurophysiology and Special EEG tests (p. 498) Ongoing testing during surgery per hour EEG codes time is important per 24 hours, use of modifier 52 not needed if more than 12 hours Physician time important in some codes Medical genetics and CNS Testing (p. 502) Genetics counseling per 30 minutes face to face, min 15 minutes Min 31 minutes on CNS testing

More medicine codes Infusion/injection services
X6446 New code for chem admin into peritoneal cavity, indwelling port/catheter Watch includes/do not code notes Active Wound Care Revisions x More specific regarding details of debridement Was Removal of devitalized tissue from wound, selective, no anesthesia, less than/=to 20 sq cm Special Reports p. 514 Instructions on xxx91 within 30 days of care plan services xxx90 or 91 shouldn’t be used if more specific code available

Category II Codes Several New Codes throughout
Pt Management for plan for F/Up care for major depressive disorder (MDD) Pt History for seizure type/frequency, epilepsy causes and Parkinson's dz review Exam pt interview by physician on/before dx of MDD DX screening BMI, Cervical CA Screening, Pulm function test, revised CT/MRI reports, Blood typing, Group B Strep screening, Tumor staging, EEG, psych disorders assessed, cogn. Impairment Therapeutic/Prevent Interventions Screening and counseling for tobacco usage, antidepressants considered but not prescribed, duration of anesthesia documented, Parkinson's dz Follow up considering neuro eval for epilepsy tx Pt Safety new codes side effects of anti-epileptic drug, Parkinson's

Category III code additions
0208T-0259T New Section for Atherectomy Supra-Inguinal Arteries Arteries above inguinal ligaments Any method Endovascular procedures, percutaneous or open Don’t include selective catheterization, transversing lesion, embolic protection, other intervention for same vessels, closure of arteriotomy

OPPS Final Rule 2011 pdf Nov. 24, 2010

Supervision Requirements
Changed the definition of "immediately available" Delayed for rural and critical access hospitals (CAHs) new category "nonsurgical extended duration therapeutic services“ require direct supervision during an initiation period, followed by a minimum standard of general supervision no longer require physicians to be present in every off-campus provider-based department (PBD) change definition of immediately available "physically present, interruptible, and able to furnish assistance and direction throughout the performance of the procedure but without reference to any particular physical boundary."

Nonsurgical extended duration therapeutic services
extended duration extending beyond normal business hours significant monitoring component typically conducted by nursing or other staff low risk-typically would not require direct supervision often during the service Not be a surgical service that includes recovery time observation, intravenous infusion, subcutaneous infusion, and therapeutic, prophylactic, or diagnostic "initiation of the service" beginning portion of service ends when patient is stable and supervising physician/non-physician practitioner believes remainder of service can be delivered safely under his or her general direction and control without the physician's physical presence hospital campus

Critical care services
CPT revising guidance for hospital reporting purposes to show inclusive services do not pertain to hospitals separate reporting of ancillary services/charges when provided with critical care No extra payment-already factored those costs into critical care APC payment rate

CPT Codes moved 19295 (Image guided placement, metallic localization clip, percutaneous, during breast biopsy/aspiration) will be paid when not reported on claim with any other procedure with status indicator of ‘‘S,’’ ‘‘T,’’ ‘‘V,’’ or ‘‘X.’’ Can be inserted prior to procedure for which the localization needed status indicator ‘‘Q1’’ (packaged when reported with a procedure with status indicator of ‘‘S,’’ ‘‘T,’’ ‘‘V,’’ or ‘‘X’’; otherwise separately paid APC 0340 (Minor Ancillary Procedures), $48.72

Outliers outlier payment equals 50 percent of amount by which cost of furnishing service exceeds times the APC payment amount when both 1.75 multiple threshold and the final fixed-dollar $2,025 threshold met

Movement of CPT Codes APC 0209, $772 93229
Wearable mobile cardiovascular telemetry with electrocardiographic recording, concurrent computerized real time data analysis and greater than 24 hours of accessible ECG data storage APC 0209, $772

reassign Codes 43216, 43242, 43510, and 43870 from APC 0141 to APC 0422, $1,137 43240 to APC 0141, $605 43228 to APC 0422, $1,137 63661, 63662, 63663, and to APC $1,480.

OPPS Payment for Drug Administration Services
continue to use five-level APC structure APC 0436 $26 APC 0437 $36 APC 0438 $75 APC 0439 $127 APC 0440 $204

Payment for Hospital Outpatient Visits
continue to define new or established patient status Whether or not patient has been registered as inpatient or outpatient of the hospital within the past 3 years.

Codes removed from inpt only list
Reconstruction of mandibular rami; horizontal, vertical, C, or L osteotomy; without bone graft, APC 0256 T Open treatment of orbital floor blowout fracture; periorbital approach with bone graft (includes obtaining graft) 0256 T Amputation, forearm, through radius and ulna; reamputation APC 0049 T

Other issues An increase to the drug packaging threshold from $65 to $70 A slight increase in separately payable drug reimbursement from ASP + 4% today to ASP+5% in the future Co-insurance and deductibles for preventive services The outpatient hospital quality initiative

Resources CPT 2011 Professional Edition
CPT 2011 Changes, An Insider’s View 2011 OPPS Final Rule

Karen Scott, MEd, RHIA, CCS-P, CPC

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