ACFAS coding seminar

[Boba Foot]

I've seen much discussion of coding lately, but haven't seen much as far as seminars goes. I'm going to be going to ACFAS in Austin this next spring for the first time, and as a graduating resident, and am interested in this coding for noobs seminar they are running. Can anyone speak to whether it is likely worth an extra $125 and flying in early for, or if perhaps there is a better/cheaper seminar that would be more beneficial? I plan to open my own place, so billing and coding will be pretty important.

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[heybrother]

CRAP - This is an edit. Ignore my post. I saw Austin/coding scenario and figured this was the main surgical coding course. I stand by most of what I said but its not as applicable. Probably worth it once, but more valuable would be an ethical attending who lets you code all your clinic encounters 3rd year and gives feedback/has you chase modifiers etc. Anyway.

I think its a good conference to go to once, but I think more important than the things they say is finding out where the things come from - and when I went they didn't actually reveal that. It at times had a little bit of the "we're revealing things to you from on high".

I'll give a few examples -

They asked everyone if they did a double calc osteotomy whether they'd bill 2 units. Then they revealed that the MUE for calcaneal osteotomy is 1.

Its a good example for teaching MUEs, but the most valuable thing for MUEs is teaching people where the excel table is that contains this. Then you can look up how many flexor tenotomies or matrixectomies you can bill at once etc in PP.

They have this new reveal section where they talk about changes for the year. This all comes from literally a Medicare MSK document (I've linked to it previously on this forum). I had the feeling while I was sitting there of - damn, I'm going to have to keep coming to this conference to hear these new reveals when in fact the information is in a publically available pdf we should all be looking at each year.

They cover a lot of scenarios of essentially these inpatient surgeries where the patient is having multiple staged procedures - essentially saying you can make money on each new iteration/case. If you aren't going to do inpatient - this isn't as valuable.

They also cover a lot of ground of trying to demonstrate different combinations of surgeries ie. you as a resident may have done a scope, stabilization, peroneal whatever - debridement, repair etc - but how do you bill it. The tricky part they covered some of these cases so fast I was often left with the feeling like I still wasn't sure which combination of codes could be used together and the book didn't necessarily spell them out.

Final thing - be very skeptical of anything anyone says about a new code you add into a combination procedure. I was at a conference recently and I wish I could remember the examples that were given. One guy gave 2 specific add on codes that I found very sketchy. I think one of them was the suggestion that if you do an FHL transfer you can also add some sort of code for releasing/freeing the muscle belly ..aponeurosis/fascia of the FHL.

People have said it more eloquently, but in general your codes should simply and as specifically as possible - describe what you actually did.

They do cover some basics of modifiers and what not but they historically push that this is not a clinic course. Its an operative course. They won't teach you how to code 11719s and other podiatry gems.

I went to the San Antonio version.

 

[Feli]

I find the AAPPM ones to be significantly better in terms of bang for your buck. It is just a lot more useful for stuff you do nearly every day.

The ACFAS ones aren't bad, and if you are there for the meeting anyways, that's good value and the outline looks good for residents. Get as many good meetings of all kinds for the student and resident rates while you can (ACFAS and Pod Institute for scientific info, AAPPM for coding... APMA and Present for nothing ever). The ACFAS coding ones that you do the whole trip just for a 2 day $600 coding lecture as an attending is questionable unless they are maybe in driving distance or you have huge CME allowance/days (hosp jobs usually). You have to remember that most of the big ACFAS guys are hospital employ or in ortho groups where the billers do most of it. Surgical coding is time consuming but you can basically just look stuff up with APMA Coding Resource or books or Google or similar. Even some of theirs at ACFAS revert into coding C&C and wounds and office stuff once the Q&A part starts... much to the chagrin of the speakers, lol.

 

[podfam3008]

CRAP - This is an edit. Ignore my post. I saw Austin/coding scenario and figured this was the main surgical coding course. I stand by most of what I said but its not as applicable. Probably worth it once, but more valuable would be an ethical attending who lets you code all your clinic encounters 3rd year and gives feedback/has you chase modifiers etc. Anyway.

I think its a good conference to go to once, but I think more important than the things they say is finding out where the things come from - and when I went they didn't actually reveal that. It at times had a little bit of the "we're revealing things to you from on high".

I'll give a few examples -

They asked everyone if they did a double calc osteotomy whether they'd bill 2 units. Then they revealed that the MUE for calcaneal osteotomy is 1.

Its a good example for teaching MUEs, but the most valuable thing for MUEs is teaching people where the excel table is that contains this. Then you can look up how many flexor tenotomies or matrixectomies you can bill at once etc in PP.

They have this new reveal section where they talk about changes for the year. This all comes from literally a Medicare MSK document (I've linked to it previously on this forum). I had the feeling while I was sitting there of - damn, I'm going to have to keep coming to this conference to hear these new reveals when in fact the information is in a publically available pdf we should all be looking at each year.

They cover a lot of scenarios of essentially these inpatient surgeries where the patient is having multiple staged procedures - essentially saying you can make money on each new iteration/case. If you aren't going to do inpatient - this isn't as valuable.

They also cover a lot of ground of trying to demonstrate different combinations of surgeries ie. you as a resident may have done a scope, stabilization, peroneal whatever - debridement, repair etc - but how do you bill it. The tricky part they covered some of these cases so fast I was often left with the feeling like I still wasn't sure which combination of codes could be used together and the book didn't necessarily spell them out.

Final thing - be very skeptical of anything anyone says about a new code you add into a combination procedure. I was at a conference recently and I wish I could remember the examples that were given. One guy gave 2 specific add on codes that I found very sketchy. I think one of them was the suggestion that if you do an FHL transfer you can also add some sort of code for releasing/freeing the muscle belly ..aponeurosis/fascia of the FHL.

People have said it more eloquently, but in general your codes should simply and as specifically as possible - describe what you actually did.

They do cover some basics of modifiers and what not but they historically push that this is not a clinic course. Its an operative course. They won't teach you how to code 11719s and other podiatry gems.

I went to the San Antonio version.

Can you please add the link for the Medicare MSK document again? Thanks in advance.

 

[NobodyDPM]

I personally would not trust what lecturers from ACFAS or the APMA have to say about billing and coding.

Their information is...errrr...less than accurate at best, and down right wrong at worst. Sorry.

 

[DYK343]

I learned that an arthroplasty of the 2nd toe with Weil is actually 7 separate billable procedures!

 

[air bud]

I learned that an arthroplasty of the 2nd toe with Weil is actually 7 separate billable procedures!

This is the way. Don't forget to turn that weil into a 2 part cut and use that wafer and insert into lapidus for a 20900 or whatever bone graft code that is.

 

[air bud]

CRAP - This is an edit. Ignore my post. I saw Austin/coding scenario and figured this was the main surgical coding course. I stand by most of what I said but its not as applicable. Probably worth it once, but more valuable would be an ethical attending who lets you code all your clinic encounters 3rd year and gives feedback/has you chase modifiers etc. Anyway.

I think its a good conference to go to once, but I think more important than the things they say is finding out where the things come from - and when I went they didn't actually reveal that. It at times had a little bit of the "we're revealing things to you from on high".

I'll give a few examples -

They asked everyone if they did a double calc osteotomy whether they'd bill 2 units. Then they revealed that the MUE for calcaneal osteotomy is 1.

Its a good example for teaching MUEs, but the most valuable thing for MUEs is teaching people where the excel table is that contains this. Then you can look up how many flexor tenotomies or matrixectomies you can bill at once etc in PP.

They have this new reveal section where they talk about changes for the year. This all comes from literally a Medicare MSK document (I've linked to it previously on this forum). I had the feeling while I was sitting there of - damn, I'm going to have to keep coming to this conference to hear these new reveals when in fact the information is in a publically available pdf we should all be looking at each year.

They cover a lot of scenarios of essentially these inpatient surgeries where the patient is having multiple staged procedures - essentially saying you can make money on each new iteration/case. If you aren't going to do inpatient - this isn't as valuable.

They also cover a lot of ground of trying to demonstrate different combinations of surgeries ie. you as a resident may have done a scope, stabilization, peroneal whatever - debridement, repair etc - but how do you bill it. The tricky part they covered some of these cases so fast I was often left with the feeling like I still wasn't sure which combination of codes could be used together and the book didn't necessarily spell them out.

Final thing - be very skeptical of anything anyone says about a new code you add into a combination procedure. I was at a conference recently and I wish I could remember the examples that were given. One guy gave 2 specific add on codes that I found very sketchy. I think one of them was the suggestion that if you do an FHL transfer you can also add some sort of code for releasing/freeing the muscle belly ..aponeurosis/fascia of the FHL.

People have said it more eloquently, but in general your codes should simply and as specifically as possible - describe what you actually did.

They do cover some basics of modifiers and what not but they historically push that this is not a clinic course. Its an operative course. They won't teach you how to code 11719s and other podiatry gems.

I went to the San Antonio version.

Deep compartment fasciotomy? How do you think that FHL muscle belly is going to magically change directions....

 

[DYK343]

This is the way. Don't forget to turn that weil into a 2 part cut and use that wafer and insert into lapidus for a 20900 or whatever bone graft code that is.

Now youre thinking. Dont forget to bill it as a midfoot multi joint fusion because you threw a screw from the base 1st met into the 2nd met. Bonus.

 

[heybrother]

Can you please add the link for the Medicare MSK document again? Thanks in advance.

https://www.cms.gov/files/document/chapter4cptcodes20000-29999final112021.pdf

It contains painful things like the below

32. If the code descriptor of a HCPCS/CPT code includes the phrase “separate procedure”, the procedure is subject to NCCI PTP edits based on this designation. The CMS does not allow separate reporting of a procedure designated as a “separate procedure” when it is performed at the same patient encounter as another procedure in an anatomically related area through the same skin incision, orifice, or surgical approach.

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So - I link the document but then the question is - how would you know if it changed/link changed etc. It seems that link probably remains constant on this page from the NCCI

Medicare NCCI Policy Manual | CMS

www.cms.gov

 

[heybrother]

Now youre thinking. Dont forget to bill it as a midfoot multi joint fusion because you threw a screw from the base 1st met into the 2nd met. Bonus.

I still remember how dirty I felt the first time I was asked to do this. "Don't forget to call it a spot weld fusion". Ugh.

 

[GreenHousePub]

They asked everyone if they did a double calc osteotomy whether they'd bill 2 units. Then they revealed that the MUE for calcaneal osteotomy is 1.

For a double calcaneal osteotomy I bill the first calcaneal osteotomy regular then I bill the second one with a -59 modifier.

 

[air bud]

I went to one right out of residency. I found it incredibly valuable. I had no experience with billing/coding in residency. Fortunately I was salaried in a MSG so my coding errors didn't affect me too much. I certainly could have put more emphasis on it. I returned to it a second time at ACFAS a few years ago, and didn't like it as much. Same lecturers. I think the problem is that at ACFAS it is crammed into one day, whereas the standalone course is a day and a half and truly allows for much more discussion. I would recommend everyone goes to it within their first few years of being in practice. After that, if you haven't learned stuff by now then you have bigger issues. I leaned more stuff now via my friends and other co-residents. And experiencedDPM. Don't get on his list.

 

[heybrother]

For a double calcaneal osteotomy I bill the first calcaneal osteotomy regular then I bill the second one with a -59 modifier.

The variation I've heard is to submit with a 22 modifier. However, the other version I've heard is you submit without the modifier and then resubmit or something like that with the goal being you get paid before you try and fight for the modifier because otherwise you won't get paid anything for eternity.

 

[air bud]

For a double calcaneal osteotomy I bill the first calcaneal osteotomy regular then I bill the second one with a -59 modifier.

My understanding is it doesn't matter what you do it won't pay the second one.

 

[ExperiencedDPM]

The MUEs for the 28300 have changed and it is now 2.

Before taking any coding course, find who is teaching the course. Are the course instructors really “experts”?

Look at the ACFAS course and look at who is teaching the course. Challenge what makes them “experts”.

If you took a course in arthroscopy, you would expect a true “expert” to teach you. Not a self proclaimed expert.

I am not an APMA fan, but I believe their course is better

The 28730 billing for throwing an additional screw across the intercuneiform is 100% fraud. Tossing a a screw across an joint with no joint exposure and prep is not a fusion.

As someone posted above, download the CMS document NCCI policy 2021. It will provide you with better information and will keep you out of jail.

It’s free and the single best resource I’ve ever used. Even though it is a government document, most insurers default to it, so they don’t have to reinvent the wheel.

If I remember correctly , the most relevant chapters for podiatry are 1,3,4 and either 8 or 9.

Download this for free and save money on the ACFAS seminar. And see if you can find out anything that makes the instructors “experts”.

 

[air bud]

The MUEs for the 28300 have changed and it is now 2.

Before taking any coding course, find who is teaching the course. Are the course instructors really “experts”?

Look at the ACFAS course and look at who is teaching the course. Challenge what makes them “experts”.

If you took a course in arthroscopy, you would expect a true “expert” to teach you. Not a self proclaimed expert.

I am not an APMA fan, but I believe their course is better

The 28730 billing for throwing an additional screw across the intercuneiform is 100% fraud. Tossing a a screw across an joint with no joint exposure and prep is not a fusion.

As someone posted above, download the CMS document NCCI policy 2021. It will provide you with better information and will keep you out of jail.

It’s free and the single best resource I’ve ever used. Even though it is a government document, most insurers default to it, so they don’t have to reinvent the wheel.

If I remember correctly , the most relevant chapters for podiatry are 1,3,4 and either 8 or 9.

Download this for free and save money on the ACFAS seminar. And see if you can find out anything that makes the instructors “experts”.

Well there you go had no idea 28300 MUE was 2

 

[NobodyDPM]

I went to one right out of residency. I found it incredibly valuable. I had no experience with billing/coding in residency. Fortunately I was salaried in a MSG so my coding errors didn't affect me too much. I certainly could have put more emphasis on it. I returned to it a second time at ACFAS a few years ago, and didn't like it as much. Same lecturers. I think the problem is that at ACFAS it is crammed into one day, whereas the standalone course is a day and a half and truly allows for much more discussion. I would recommend everyone goes to it within their first few years of being in practice. After that, if you haven't learned stuff by now then you have bigger issues. I leaned more stuff now via my friends and other co-residents. And experiencedDPM. Don't get on his list.

Bold mine. Therein lies the problem. In conferences along the whole spectrum of medicine.

It's the same people. All the time. And most either are completely clueless, but could get money to the conference via sponsors, so they are invited over and over again, are boring as **** to listen to, or a combination of both.

Honestly, for those of you still in residency, find an attending that knows his or her stuff with billing/coding, spend some time with them, and ask them if it's okay to call them once your out with questions. Save your money on these horrible conferences.

 

[NobodyDPM]

Just as an FYI, for someone to be considered as a lecturer for the ACFAS conferences, you either have to have a paid sponsor, or have attended an ACFAS conference in the last few years. When I asked about the latter, they told me so that I was aware of the quality of the lecture I was expected to give. I laughed and told them that I guess if you bring in enough money, they don't really care about the quality of your lecture, huh? I have yet to attend an ACFAS conference. 20+ years in practice.

Maybe that's changed, but even now, in order to apply to be on one of their committees, the application asks you when was the last ACFAS conference you attended. There is no "none" option and you can't continue your application unless you tell them. What one has to do with the other, I have no idea. I mean, I do pay my dues every year...

 

[msion]

I just delete those emails about coding conferences when I get them.
Know the medicare guidelines and track your top CPTs and learn the associated ICD 10s. Standardize it.
The only time when billing gets complicated is when you try to unbundle the procedure and trying to justify it.
A 28296 is just one line of coding, but if you are trying to say you also did a capsulotomy, soft tissue balancing and partial ostectomy then that's another story.
But someone still needs to attend these conferences. If our associations can't collect enough money from these then they will raise our membership dues.

 

[air bud]

Hey guys here now at acfas coding 2022. Will update you with the newest MUE for tissue biopsy so you can take that many separate sites and bill each one individually.

 

[heybrother]

Would love to know if its appropriate to bill a 22 modifier on common office procedures. Thanks!

11721, Q8, 22, etc.

 

[air bud]

Would love to know if its appropriate to bill a 22 modifier on common office procedures. Thanks!

11721, Q8, 22, etc.

Sorry bro, this is for SURGEONS. Explicitly states will not cover wound care, nails and calluses. See you at APMA.

 

[ExperiencedDPM]

Hey guys here now at acfas coding 2022. Will update you with the newest MUE for tissue biopsy so you can take that many separate sites and bill each one individually.

I hope you didn’t really spend your money for that course.

 

[air bud]

I hope you didn’t really spend your money for that course.

Already here at acfas and need the CME. But yeah I know...

 

[ExperiencedDPM]

Already here at acfas and need the CME. But yeah I know...

By the way, you can access the Medicare site to determine MUEs for free. Any commercial insurers follow these guidelines.

Damn, you actually took that course…..how are you going to look at yourself in the mirror?