Advanced Coding Scenarios: An Expert Review

To view this page ensure that Adobe Flash Player version 9.0.124 or greater is installed.

Please login or register to make a comment!

© Copyright 2009 American Health Information Management Association. All rights reserved. Advanced Coding Scenarios: An Expert Review Audio Seminar/Webinar December 15, 2009 Practical Tools for Seminar Learning Disclaimer AHIMA 2009 Audio Seminar Series " http://campus.ahima.org/audio American Health Information Management Association " 233 N.

Michigan Ave., 21 st Floor, Chicago, Illinois i The American Health Information Management Association makes no representation or guarantee with respect to the contents herein and specifically disclaims any implied guarantee of suitability for any specific purpose. AHIMA has no liability or responsibility to any person or entity with respect to any loss or damage caused by the use of this audio seminar, including but not limited to any loss of revenue, interruption of service, loss of business, or indirect damages resulting from the use of this program. AHIMA makes no guarantee that the use of this program will prevent differences of opinion or disputes with Medicare or other third party payers as to the amount that will be paid to providers of service.

CPT ® five digit codes, nomenclature, and other data are copyright 2009 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values or related listings are included in CPT ® .

The AMA ... more. less.

assumes no liability for the data contained herein. As a provider of continuing education the American Health Information Management Association (AHIMA) must assure balance, independence, objectivity and scientific rigor in all of its endeavors. AHIMA is solely responsible for control of program objectives and content and the selection of presenters. All speakers and planning committee members are expected to disclose to the audience: (1) any significant financial interest or other relationships with the manufacturer(s) or provider(s) of any commercial product(s) or services(s) discussed in an educational presentation; (2) any significant financial interest or other relationship with any companies providing commercial support for the activity; and (3) if the presentation will include discussion of investigational or unlabeled uses of a product. The intent of this requirement is not to prevent a speaker with commercial affiliations from presenting, but rather to provide the participants with information from which they may make their own judgments. Usage Rights This document is exclusively for use by individuals attending the associated audio seminar or webinar (named on the first page of this document), in conjunction with their attendance of the live or recorded version of the presentation. All material herein is copyright 2009 American Health Information Management Association (AHIMA), except where otherwise noted. It may not be redistributed without prior written permission from AHIMA. Faculty AHIMA 2009 Audio Seminar Series ii Lynn Kuehn, MS, RHIA, CCS-P, FAHIMA Lynn Kuehn is president of Kuehn Consulting in Waukesha, Wisconsin. Ms. Kuehn is a healthcare consultant with over 20 years of experience in operational assessment, professional fee coding and reimbursement systems, data quality, and management of both independent and hospital-based clinic practices. She has authored numerous publications for AHIMA including Procedural Coding and Reimbursement for Physician Services , now in its ninth edition; Effective Management of Coding Services ; CCS-P Exam Preparation Guide ; and A Practical Approach to Analyzing Healthcare Data . Table of Contents AHIMA 2009 Audio Seminar Series Disclaimer ................................................................................................................... .. i Faculty ..................................................................................................................... ii, 1 Presentation Objectives .................................................................................................. 2 Sources for Today's Questions ...................................................................................... 2-4 Who Do We Believe? ...................................................................................................... 5 Diagnostic Coding for Ancillary Tests ................................................................................ 5 Q1 (COPD&) ...................................................................................................... 6 Q2 (avascular necrosis&) .................................................................................... 7 Q3 (billing out diagnosis of findings&) ................................................................. 8 New to Facility Coding Q4 (rounding HCPCS code amt&) ........................................................................ 8 Q5 (surgical global 3 perineal abscess&), Q6 (casting supplies&) ........................... 9 Modifiers ..................................................................................................................... . 10 Q7 (multiple physicians, modifier 27&) ................................................................ 10 Q8 (CA modifier, death&) .................................................................................. 11 Q9 (rotator cuff repairs, modifier 59&) ................................................................ 12 Q10 (discontinued procedure&) .......................................................................... 13 Q11 (x-rays, modifier 76&) ................................................................................ 14 Q12 (OIG workplan, modifier GY&) ..................................................................... 15 Procedures ................................................................................................................... 17 Q13 (foreign body removal&), Q14 (urinalysis collection&) ................................... 17 Q15 (knee immobilizer&) ................................................................................... 18 Q16 (disagreement between sources&), Q17 (H1N1 vaccines&) ........................... 19 Procedures 3 Injections and Infusions ............................................................................. 21 Q18 (IV hydration and pushes&) ........................................................................ 21 Q19 (end times on IV infusions&), Q20 (start time by someone else&) .................. 23 Additional Questions Answered ....................................................................................... 24 If we didn't get to your question ..................................................................................... 25 Audio Seminar Discussion .............................................................................................. 26 Become an AHIMA Member Today! ................................................................................. 26 Audio Seminar Information Online .................................................................................. 27 Upcoming Audio Seminars ............................................................................................ 27 Thank You/Evaluation Form and CE Certificate (Web Address) .......................................... 28 Appendix .................................................................................................................. 29 Resource/Reference List ....................................................................................... 30 CE Certificate Instructions Advanced Coding Scenarios: An Expert Review AHIMA 2009 Audio Seminar Series 1 Notes / Comments /Q uestions Faculty Lynn Kuehn, MS, RHIA, CCS-P, FAHIMA President Kuehn Consulting, LLC Waukesha, Wisconsin AHIMA Books by Ms. Kuehn Procedural Coding and Reimbursement for Physician Services Effective Management of Coding Services CCS-P Exam Preparation Guide A Practical Approach to Analyzing Healthcare Data Available at www.ahimastore.org Advanced Coding Scenarios: An Expert Review AHIMA 2009 Audio Seminar Series 2 Notes / Comments /Q uestions Presentation Objectives Answer your outpatient diagnostic or procedural questions Cite sources from currently published coding advice Additional question and answer session 1 Sources for Today 9s Questions " AHA 9s Coding Clinic for ICD-9-CM " AHA 9s Coding Clinic for HCPCS " AMA 9s CPT Assistant " The Official ICD-9-CM Guidelines for Coding and Reporting, Section IV. Diagnostic Coding and Reporting for Outpatient Services " Medicare Frequently Asked Questions, National Coverage Decisions and other published material 2 Advanced Coding Scenarios: An Expert Review AHIMA 2009 Audio Seminar Series 3 Notes / Comments /Q uestions AHA 9s Coding Clinic for ICD-9-CM cThe official publication for ICD-9-CM coding guidelines and advice d http://www.ahacentraloffice.org/ahacentral office/html/products.html 3 AHA 9s Coding Clinic for HCPCS cThe official publication for Level I HCPCS (CPT-4 codes) for hospital providers and specific Level II HCPCS codes for hospitals, physicians and other health professionals. d Same web location 4 Advanced Coding Scenarios: An Expert Review AHIMA 2009 Audio Seminar Series 4 Notes / Comments /Q uestions AMA 9s CPT ® Assistant Official source on CPT for physicians and professional fee coders AMABookstore.com and search for cCPT Assistant d or https://catalog.ama- assn.org/Catalog/product/product_detail.jsp? productId=prod170136 5 CMS Website www.cms.hhs.gov Transmittals at http://www.cms.hhs.gov/Transmittals/ Frequently Asked Questions at cQuestions d on blue menu bar in upper middle, or https://questions.cms.hhs.gov/cgi- bin/cmshhs.cfg/php/enduser/std_alp.php?p_ sid=yZXrRoNj 6 Advanced Coding Scenarios: An Expert Review AHIMA 2009 Audio Seminar Series 5 Notes / Comments /Q uestions Who Do We Believe? The official source for CPT (HCPCS Level I) codes for the hospital outpatient coder is Coding Clinic. The official source for CPT (HCPCS Level I) codes for the professional fee coder is CPT Assistant. The official source for HCPCS Level II codes is Coding Clinic for all coders. 7 Diagnostic Coding for Ancillary Tests cWe regularly are questioned regarding the codes we have selected and have become much more conservative as a result. This has caused much delay in our department and with the physicians on our staff. Are we trying to be over-specific? d The patient comes for a radiology exam. Their facility method is to code the diagnosis from the order for the services, not the report. 8 Advanced Coding Scenarios: An Expert Review AHIMA 2009 Audio Seminar Series 6 Notes / Comments /Q uestions Diagnostic Coding for Ancillary Testing Q1 3 cThe diagnosis on the order: COPD, SOB. The exam is a chest x-ray. They are requested to code both the COPD and the shortness of breath. d Mayo Clinic, at http://www.mayoclinic.com/health/copd/DS00916 Shortness of breath is the presenting symptom and COPD is the clinical history. 9 Diagnostic Coding for Ancillary Testing The Official ICD-9-CM Guidelines, Section IV, H tells us: List first the ICD-9-CM code for the diagnosis, condition, problem or other reason for encounter/visit shown in the medical record to be chiefly responsible for the services provided. List additional codes that describe any coexisting conditions. In some cases the first- listed diagnosis may be a symptom when a diagnosis has not been established (confirmed) by the physician. 10 Advanced Coding Scenarios: An Expert Review AHIMA 2009 Audio Seminar Series 7 Notes / Comments /Q uestions Diagnostic Coding for Ancillary Testing Q2 3 cThe diagnosis is avascular necrosis right hip, hip pain. The request is for us to code both the necrosis and the hip pain. d Merck Manual Online http://www.merck.com/mmhe/sec05/ch064/ch064a.html Same guideline but different set of circumstances. 11 Diagnostic Coding for Ancillary Testing Avascular necrosis already diagnosed. Pain was the first symptom listed in the Merck Manual. Unless they suspect a new disease process, they are monitoring the disease of avascular necrosis. Hip pain would not be coded. 12 Advanced Coding Scenarios: An Expert Review AHIMA 2009 Audio Seminar Series 8 Notes / Comments /Q uestions Diagnostic Coding for Ancillary Testing Another facility sent us a similar question, asking: Q3 - cCMS has clarified for physicians that read the reports to bill out the diagnosis of findings (radiologist would use the finding of DJD, a pathologist would use their findings). Would the facility also do the same? d Coding Clinic for ICD-9-CM, 1 st Qtr, 2002 13 New to Facility Coding Q4 -The coder says cI coded for a physician for 6 years and very recently changed jobs to code hospital outpatient work. I 9m having a hard time knowing when things are the same and when they 9re different in procedure coding. Do I code drugs the same way I did before? I mean using the HCPCS code amount and rounding up to the next whole unit. d This is the same for Pro Fee and Facility. Coding Clinic for HCPCS, 1 st Qtr, 2005 and 3 rd Qtr, 2005 both cover this issue. 14 Advanced Coding Scenarios: An Expert Review AHIMA 2009 Audio Seminar Series 9 Notes / Comments /Q uestions New to Facility Coding Q5 - cMy other question is about the surgical global. The GYN did an I&D of a perineal abscess 3 days ago. The patient returned for repeat I&D of the abscess of the perineum. Can I code this? Are the globals the same for the facility? d Not the same for Pro Fee and Facility Coding Clinic for HCPCS, 4th Qtr, 2004 handles a similar issue. 15 New to Facility Coding Q6 3 cDo I code casting supplies like I did in the physician office? No one here knows anything about this and I don 9t want to miss the supplies, if I 9m supposed to code them. d Not the same for Pro Fee and Facility Coding Clinic for HCPCS, 2 nd qtr 2002 16 Advanced Coding Scenarios: An Expert Review AHIMA 2009 Audio Seminar Series 10 Notes / Comments /Q uestions New to Facility Coding Q codes are not to be used by the Facility. Casting supplies are to be billed separately but with a revenue code 027X Physicians code the cast supplies using Q codes. Ask if supplies are being coded in the ED, Orthopedics or a cast lab? 17 Modifiers Q7- cWe have lots of specialty clinics and our patients see multiple physicians on the same day. Our visits are coded in the clinics and we spend a considerable amount of time checking for this and applying modifiers before claims are submitted. Is modifier 27 really necessary? d Medicare FAQ ID #2390, last updated on 11-4-09 18 Advanced Coding Scenarios: An Expert Review AHIMA 2009 Audio Seminar Series 11 Notes / Comments /Q uestions Modifiers Modifier 27 seems necessary. CPT Assistant, May 2003, pgs 7-16. It tells us that when more than one E/M service was delivered on the same day, apply modifier 27 to the 2 nd and subsequent visits of the day. Don 9t forget that you need Condition Code G0 when more than one visit occurs in the same revenue code. 19 Modifiers Q8 - cDoes the patient have to die to qualify for the use of a CA modifier? d Coding Clinic for HCPCS, 1 st qtr, 2003 and 4 th qtr, 2005 20 Advanced Coding Scenarios: An Expert Review AHIMA 2009 Audio Seminar Series 12 Notes / Comments /Q uestions Modifiers Q9 3Outpatient coder in a community hospital cOur orthopedist does mini-open rotator cuff repairs with arthroscopic labral debridement and subacromial decompression. My codes are 29826, 23412, and 29822. Which ones get the modifier 59? d 21 Modifiers Coding Clinic for HCPCS, Fourth Quarter, 2004, page 10. Rotator cuff repair includes the labral debridement Codes would be 23412, 29826-59 Would not report 29822. 22 Advanced Coding Scenarios: An Expert Review AHIMA 2009 Audio Seminar Series 13 Notes / Comments /Q uestions Modifiers Q10 -Discontinued procedure? The physician documents this about a percutaneous repair of a finger fracture with 3 bone fragments. cSeveral attempts were made to reduce the fracture. We placed a wire through the distal PIP but x-rays showed less than optimal alignment. Several attempts were made to have the wire align the fracture in all planes, without success. Ultimately a simultaneous, bidirectional wire approach was our only success at proper alignment, confirmed on x-ray. d Coding Clinic for HCPCS, 3 rd qtr, 2007 23 Modifiers The unsuccessful attempts are considered a part of the successful procedure. Different from a discontinued procedure. Procedure was not attempted or partially attempted and, for some reason, was cancelled or not completed. 24 Advanced Coding Scenarios: An Expert Review AHIMA 2009 Audio Seminar Series 14 Notes / Comments /Q uestions Modifiers Discontinued after administration of anesthesia = modifier 74 Discontinued after prep but before administration of anesthesia = modifier 73 25 Modifiers Q11 3 cOur orthopedic department orders pre-and post-reduction x-rays when they set certain fractures. Is this an appropriate situation for the use of modifier 76? It is listed as a hospital outpatient modifier but says it 9s a repeat procedure or service by the same physician. Is this OK on a facility claim? d Coding Clinic for HCPCS, 2 nd Qtr, 2009 26 Advanced Coding Scenarios: An Expert Review AHIMA 2009 Audio Seminar Series 15 Notes / Comments /Q uestions Modifiers Q12 3 cThe OIG workplanlists Medicare Billings with Modifier GY as an area being studied. Why would they care about Modifier GY if it means that we won 9t get payment? Can you explain this? I must be missing something. d Transmittal B-02-020, March 27, 2002 http://www.cms.hhs.gov/Transmittals/downloads/B02020.pdf 27 Modifiers Modifier GA 3Waiver of liability statement on file (Used when service is expected to be denied and an ABN IS on file) Modifier GZ 3Item or service expected to be denied as not reasonable and necessary (Used when an ABN is NOT on file) Modifier GY 3Item or service statutorily excluded or does not meet the definition of any Medicare benefit 28 Advanced Coding Scenarios: An Expert Review AHIMA 2009 Audio Seminar Series 16 Notes / Comments /Q uestions Modifiers Very hard to tell what is cstatutorily excluded d http://www.cms.hhs.gov/PhysicianFeeSched/ Choose PFS Relative Value Files Page down to 2010 Download zipped file Unzip and open PPRRVU10.xls Translation file is RVUPUF10.pdf 29 30 Advanced Coding Scenarios: An Expert Review AHIMA 2009 Audio Seminar Series 17 Notes / Comments /Q uestions Procedures Q13 3Foreign body removal cWe go back and forth with the urgent care physicians about whether they have to make an incision to code for a subcutaneous foreign body removal (10120). They constantly charge it on their pro fee claim and we don 9t think this is right. We don 9t code it. What can we do to make them listen? d Coding Clinic for HCPCS, 3 rd Qtr, 2002. 31 Procedures Q14 - cWe 9ve been told by a compliance reviewer that CPT code 51701 cannot be used to code the collection of urine for urinalysis. Is this true and if so, how do we code this service to get paid? It 9s time- consuming and certainly not the same as regular urine collection. d 32 Advanced Coding Scenarios: An Expert Review AHIMA 2009 Audio Seminar Series 18 Notes / Comments /Q uestions Procedures Coding Clinic for HCPCS, 3 rd quarter 2007 HCPCS code P9612, Catheterization for collection of specimen, single patient, all places of service 33 Procedures Q15 3 cI can 9t figure out how to code a knee immobilizer. Did you know that CPT Assistant and Coding Clinic for HCPCS don 9t agree on this? CPT Assistant says it 9s a splint and Coding Clinic says it 9s a strapping. d Coding Clinic for HCPCS, 2 nd Qtr, 2001, page 7 CPT Assistant, May 2009, page 8 34 Advanced Coding Scenarios: An Expert Review AHIMA 2009 Audio Seminar Series 19 Notes / Comments /Q uestions Procedures Q16 3 cIt 9s come to our attention that CPT Assistant and Coding Clinic for HCPCS don 9t always agree. We 9ve asked for clarification on this from both but don 9t have an answer yet. d PTA of the left subclavian artery CPT Assistant says 35475 (Sept 2008, p 10) Coding Clinic says 37799 (4 th Qtr 2008, p 8) 35 Procedures Q17 3 cI 9m really confused about how to code these new H1N1 vaccines that they just started giving. Apparently there are new codes that aren 9t in the CPT book. I just heard that there are new HCPCS G codes. What am I supposed to do? d Yes, there are new codes Vaccines should be billed at $0.00 or $0.01 because they are free from the government 36 Advanced Coding Scenarios: An Expert Review AHIMA 2009 Audio Seminar Series 20 Notes / Comments /Q uestions Procedures 90663 3Influenza virus vaccine, pandemic formulation, H1N1 90470 3H1N1 immunization administration (intramuscular, intranasal), including counseling when performed 37 Procedures G9141 3Influenza A (H1N1) immunization administration (includes the physician counseling the patient/family) G9142 3Influenza A (H1N1) vaccine, any route of administration 2009 payment for G9141 is $24.89 38 Advanced Coding Scenarios: An Expert Review AHIMA 2009 Audio Seminar Series 21 Notes / Comments /Q uestions Procedures CPT Guidance http://www.ama- assn.org/ama/pub/h1n1/resources/cpt- codes.shtml CMS Guidance http://www.cms.hhs.gov/transmittals/do wnloads/R1803CP.pdf -Page 8 39 Procedures -Injections and Infusions Q18 3 cWe 9re the facility administering the infusions. How do I code IV hydration for 3.5 hours from 8:00 am to 11:30 am and two IV pushes of different medications, one at 9:30 am and the other one at 10:00 am? d CPT Assistant, February 2009, page 17 is the best source available Coding Clinic for HCPCS, 4 th Qtr, 2007 Read every note in the CPT book section 40 Advanced Coding Scenarios: An Expert Review AHIMA 2009 Audio Seminar Series 22 Notes / Comments /Q uestions Procedures -Injections and Infusions Hydration cannot be concurrent so subtract out the time used for the pushes. 3.5 hrs minus .5 hours (15 min x 2) = 3 hrs 96374 31 st IV push 3In hierarchy, the initial code 96375 32 nd IV push 3Sequential push of a new substance/drug 41 Procedures -Injections and Infusions 96361 x 3 3Remaining 3 hours of hydration Note below 96361 says: (Report 96361 to identify hydration if provided as a secondary or subsequent services after a different initial service (96360, 96374, 96409, 96413) is administered through the same IV access) 42 Advanced Coding Scenarios: An Expert Review AHIMA 2009 Audio Seminar Series 23 Notes / Comments /Q uestions Procedures -Injections and Infusions Q19 3 cWe still have challenges getting the end times on IV infusions. Start time doesn 9t seem to be as much of a problem. Is there anything we can do to code this work that was obviously done? d Coding Clinic for HCPCS, 3 rd Qtr, 2007 IV push 43 Procedures -Injections and Infusions Q20 3 cWhat are we supposed to use for a start time when the patient arrives with an IV that was started by someone else, usually the paramedics? d Medicare Claims Processing Manual (100-04), Chapter 4 -Part B Hospital (Including Inpatient Hospital Part B and OPPS), Section 230.2, D on p 116 http://www.cms.hhs.gov/manuals/downloads/clm104c04.pdf 44 Advanced Coding Scenarios: An Expert Review AHIMA 2009 Audio Seminar Series 24 Notes / Comments /Q uestions Procedures -Injections and Infusions Section title: Infusions Started Outside the Hospital Assign cHCPCS code(s) that most accurately describe the service(s) they provide d Does not state how to determine the time 45 Audience Questions Advanced Coding Scenarios: An Expert Review AHIMA 2009 Audio Seminar Series 25 Notes / Comments /Q uestions Our Apologies Our sincere apology if we did not get to your question today We received a large variety of questions and tried to group them together by concept Please post your question in the Coding CoP if we did not discuss your issue during the program Advanced Coding Scenarios: An Expert Review AHIMA 2009 Audio Seminar Series 26 Notes / Comments /Q uestions Audio Seminar Discussion Following today 9s live seminar Available to AHIMA members at www.AHIMA.org Click on Communities of Practice (CoP) 3icon on top right AHIMA Member ID number and password required 3for members only Join the Coding Community from your Personal Page under Community Discussions, choose the Audio Seminar Forum You will be able to: " Discuss seminar topics " Network with other AHIMA members " Enhance your learning experience Become an AHIMA Member Today! To learn more about becoming a member of AHIMA, please visit our website at ahima.org/membership to join now! Advanced Coding Scenarios: An Expert Review AHIMA 2009 Audio Seminar Series 27 Notes / Comments /Q uestions AHIMA Audio Seminars Visit our Web site http://campus.AHIMA.org for information on the 2010 seminar schedule. While online, you can also register for seminars or order CDs, pre-recorded Webcasts, and *MP3s of past seminars. *Select audio seminars only Upcoming Seminars/Webinars Resequence or Renumber? Facts of Life in CPT ® Development January 12, 2010 HITECH and Release of Information January 21, 2010 Facility E-D Coding and Charge Capture January 28, 2010 Advanced Coding Scenarios: An Expert Review AHIMA 2009 Audio Seminar Series 28 Notes / Comments /Q uestions Thank you for joining us today! Remember 2 visit the AHIMA Audio Seminars Web site to complete your evaluation form and receive your CE Certificate online at: http://campus.ahima.org/audio/2009seminars.html Each person seeking CE credit must complete the sign-in form and evaluation in order to view and print their CE certificate Certificates will be awarded for AHIMA Continuing Education Credit Appendix AHIMA 2009 Audio Seminar Series 29 Resource/Reference List ................................................................................................ 30 CE Certificate Instructions Appendix AHIMA 2009 Audio Seminar Series 30 Resource/Reference List American Hospital Association (AHA) Coding Clinic for ICD-9-CM: The official publication for ICD-9-CM coding guidelines and advice Coding Clinic for HCPCS: The official publication for Level I HCPCS (CPT-4 codes) for hospital providers and specific Level II HCPCS codes for hospitals, physicians and other health professionals. http://www.ahacentraloffice.org/ahacentraloffice/html/products.html American Medical Association (AMA) CPT ® Assistant: Official source on CPT for physicians and professional fee coders http://www.AMABookstore.com Search for cCPT Assistant d or go directly to https://catalog.ama-assn.org/Catalog/product/product_detail.jsp?productId=prod170136 http://www.ama-assn.org/ama/pub/h1n1/resources/cpt-codes.shtml Centers for Medicare and Medicaid Services (CMS) http://www.cms.hhs.gov Transmittals at http://www.cms.hhs.gov/Transmittals Transmittal B-02-020, March 27, 2002 http://www.cms.hhs.gov/Transmittals/downloads/B02020.pdf http://www.cms.hhs.gov/transmittals/downloads/R1803CP.pdf - Page 8 http://www.cms.hhs.gov/PhysicianFeeSched/ Frequently Asked Questions at cQuestions d on blue menu bar in upper middle, or https://questions.cms.hhs.gov/cgi-bin/cmshhs.cfg/php/enduser/std_alp.php?p_sid=yZXrRoNj Medicare Claims Processing Manual (100-04), Chapter 4 - Part B Hospital (Including Inpatient Hospital Part B and OPPS), Section 230.2, D on p 116 http://www.cms.hhs.gov/manuals/downloads/clm104c04.pdf Centers for Disease Control and Prevention (CDC) The Official ICD-9-CM Guidelines for Coding and Reporting, Section IV. Diagnostic Coding and Reporting for Outpatient Services http://www.cdc.gov Search for cICD-9-CM Guidelines d Mayo Clinic http://www.mayoclinic.com/health/copd/DS00916 Merck Manual Online http://www.merck.com/mmhe/sec05/ch064/ch064a.html To receive your CE Certificate Please go to the AHIMA Web site http://campus.ahima.org/audio/2009seminars.html click on the link to c Sign In and Complete Online Evaluation d listed for this seminar. You will be automatically linked to the CE certificate for this seminar after completing the evaluation. Each participant expecting to receive continuing education credit must complete the online evaluation and sign-in information after the seminar, in order to view and print the CE certificate.

less