To Whom It May Concern:
I'm not sure who I should really be contacting about this, but I have a few questions regarding the CPMA Exam, and over the information in the textbook, Medical Record Auditor, 2nd Edition. I apologize if this note seems more like a complaint than an inquiry; I've reached the point that I'm frustrated and anxious about whether I'll be prepared to pass my exam in 2 weeks.
I've been studying to take the CPMA exam on my own, since I can't locate anyone offering a preparation course, except for the AAPC's 2-day, $700 seminar in Dallas, which I can't even afford to travel to, much less, attend. I've worked as a commercial insurance specialist for a physician practice management group, following up on outstanding and denied claims for over 150 providers of various specialties, for nearly 3 years. I've appealed countless denials successfully, based on coding guidelines, payer policies, and HIPAA regulations, and have gained a wealth of knowledge on those subjects. I review medical records on a daily basis to determine whether or not claims were coded correctly, whether or not medical necessity has been established for many procedures, and to verify that our claims are consistent with the documentation. When I read about being a medical record auditor, it seemed like something that I would enjoy doing, so I decided to become certified so that I could someday steer my career in that direction. I've followed the suggestions on the AAPC's website to prepare on my own, to the letter. That included purchasing the Medical Record Auditor, 2nd Edition, as a tutorial guide. At the time that I bought the book, about 3 months ago, there was no mention of a 3rd edition's impending release, otherwise I would have waited to get more updated material.
I've gone over all of the material in chapter 6 regarding physician consultation codes, and Medicare's payment policies on them, but since Medicare changed its policy this year to virtually abolish payment for consult codes, I wanted to find out which policy year, if any, will be covered on the CPMA exam, so that I may prepare accordingly.
I've discovered several errors in the textbook that are annoying, and occasionally confusing. For example, Table 3-8 on page 95 has all of the information on the second line shifted one position to the left, so it looks like the required elements for a comprehensive exam are "1997 Single Organ System Exam", and all of the other levels show requirements for the next level up. Also, there are several refences throughout the book, and particularly in chapter 7, to an audit tool and blank charge ticket in Appendix B; neither of which are in my book. My Appendix B is the CMS Documentation Guidelines for 1995 and 1997. I did find 3 audit tools in Appendix C for E/M coding (still no superbill, though), but I wasn't sure which I'm supposed to use for the practice tests. Those kinds of errors made it apparent that little or no proofreading had taken place before this edition was published, aside for spell checking. So when I've missed questions in the "Test Your Knowledge" sections, I can't always be sure if I really didn't answer the question correctly, or if it was another careless mistake. The answers on the CD-ROM rarely offer any rationale, which is important in understanding why I got an answer wrong, and ultimately, what areas I need to focus on improving.
For example, I missed several aspects on one of the audit exercises in Chapter 7 (Case #3), according to my curriculum. I had coded the encounter as 99205, because I interpreted the history and exam to be comprehensive, and the medical decision making as high. I struggled with the MDM, because according the the points system, I thought that the number of diagnosis options and amount/complexity of data were extensive, but that the risk was only moderate, so I was on the fence about whether the overall MDM should be considered moderate or high. I eventually settled on 99205, because the CPT definition says that the presenting problems are usually moderate to high severity, and I could believe that the encounter might have taken around 60 minutes in face-to-face time. I was expecting to see that the correct answer was 99204, if I had missed it - I'm usually only one level off, and I can see where I went wrong, most of the time. I was thoroughly confused when I saw that it should have been 99202, and have a few questions.
Starting with the exam: Why was no credit given to skin or psychiactric? I might be misinterpreting the bullets, but I would have given credit to skin for the notation "no erythema or ecchymoses", under the bullet for "inspection of skin and subcutaneous structures", and the mention of the patient appearing anxious seemed to fit under the patient's state of mind, rather than a constitutional observation. As a follow-up question, what kind of documentation would be a correct example of anxiety documented as psychiactric?
My biggest area of confusion is that the answer key says that 13 bullets were documented, but somehow that only added up to an expanded PF exam. That completely contradicts the tutorials and CMS guidelines, which all indicate that 13 bullets = detailed exam. Where did that answer come from?
Also, I noted that 36415 was not documented, because I didn't find any mention of a venipuncture in the record. It did say that the patient was going to be scheduled for "laboratory studies", but didn't indicate that any blood was drawn during the visit, or that any of the labs would even involve blood at all. I could have seen the link if the notes had said something more specific, like "ordered CBC", or something along those lines, but without even mentioning a lab that was blood-specific, I couldn't see any justification in coding a blood draw that wasn't mentioned in the notes. Also, I wasn't sure if it mattered, but I had the primary diagnosis as 414.00, because there's a note in my ICD-9-CM under 413.9 that states: "Tip: For patients with both angina and coronary artery disease, sequence the CAD [subcategory 414.0] code first."
I'm sorry to present you with so many concerns at once, but I just want to be sure that I understand why I'm not getting the right answers, and I don't have the benefit of having an instructor available to help me see what I'm doing wrong. The answer key for the second edition is not adequate for helping me learn from my mistakes; if I don't know why your answer is right, I can't possibly figure out why my answer is wrong, particularly when dealing with something as complex as E/M coding, where there are numerous opportunities to make a mistake that effects the overall code selection. Additionally, the fact that there are a lot of obvious errors in the book makes me second guess all of the answers, and leaves me doubting that I'm learning everything correctly, even when I do come up with the correct answer. Please explain the rationale regarding the questions I've asked, so that I can correct my course before the test. Thank you.
Have a Great Day!
Brandi Tadlock, CPC-A
