“We have one final surprise tonight – and it’s something we’ve all been able to keep a secret,” laughed Angie Christen. She was holding a large, white album with a ribbon tied around it.
“Betsy, can you please come up here?”
It was the final night of Health Information Associates 25th Anniversary celebration and, to mark the momentous occasion, founder and CEO Betsy Bailey invited all HIA employees and their guest to the Salamander Resort in Middleburg, Virginia. The three-day event was exactly what she had hoped for, a nonstop celebration with everyone that helped the company reach this milestone.
“We wanted to give you something to show how much we appreciate you, this company, and all it has brought to our lives,” continued Christen as Bailey made her way to the stage.
The past three days had been a truly humbling experience for Bailey – she never imagined her one-woman coding consulting company , which she started in a home office in North Carolina, would turn into one of the most respected in the industry, creating more than 250 jobs in its 25 years.
But the celebration was also bittersweet as there was one very important member of the HIA family missing – her dad, Deane Beamer, with whom she founded the company with in 1992. Beamer passed away in 2012 at the age of 78.
Once Christen gave the album to Bailey and she realized its contents, she was speechless. In the album were handwritten letters from every HIA employee. Many of them had been with the company for more than a decade. Each letter told a different story of how they came on board with the company and what the HIA family meant to them.
It was a pinch-me-moment for Bailey.
“I still don’t know how this all happened,” she laughed.
Growing up, Bailey and her dad had a special bond – especially when it came to business.
“I loved it. Especially those dinner table conversations, talking about the healthcare industry and bouncing ideas off of each other,” she said. “It’s just how I grew up.”
Beamer, a veteran of the United States Air Force, studied at the Medical College of Virginia where he received his Master’s Degree in Hospital Administration. He completed his residency at Memorial Mission Hospital in Asheville, North Carolina and then moved to Marion, Virginia to serve as CEO where he was instrumental in establishing Smyth County Community Hospital. After retiring from SCCH, Beamer consulted and served in various interim hospital CEO positions throughout the Southeast.
Bailey attended Emory & Henry College for three years, before transferring with her now husband Bruce to the Medical College of Virginia where she received her BS in Health Information Management. Following graduation she took a job as the Director of Medical Records at Tidewater Memorial Hospital from 1987-1988 (now Riverside Tappahannock) and then moved on in 1988 to the Director of HIM at Humana St. Lukes Hospital in Richmond, Va. (now Parham Doctors Hospital )
Bailey’s husband, having completed his Masters in Health Administration, was offered a job as Assistant CEO at Humana Clinch Valley in Richlands, Virginia in 1990 (now Clinch Valley Medical Center) It was following their relocation to Richlands that Bailey entered the healthcare auditing world as a self-employed consultant. Her first client in 1990 was her Dad’s hospital. Once Beamer saw his daughter’s findings and the educational opportunities for his coding staff, he spread the word to other area hospitals that this is something they really should be doing. Bailey added several more hospitals to her small business.
“I honestly wanted to help these not-for-profit hospitals get the reimbursement they deserved because the smaller facilities were struggling in those days. In addition, I loved teaching what I knew about coding to their staff.”
It was also during this period that Bailey had her first child, Beth Ann, in 1991.
As Bruce’s career progressed, the couple moved to North Carolina to pursue an opportunity at Lake Norman Regional Medical Center in Mooresville.
“Supporting Bruce’s career and being a mom were important to me,” she said. “But I also wanted to continue to grow my own business and keep my coding skills sharp. I guess you could say I wanted to have it all.”
It was in 1992 that Bailey landed her largest client to date – a group of HCA hospitals based out of Richmond, VA. At the same time she found out she was pregnant with her second child, Tyler.
“I remember thinking ‘there’s no way I can handle this all on my own and do these contracts justice,’” said Bailey. “That’s when my dad advised me that it may be time to hire someone to help me.”
That same year, Bailey with the support of her dad founded Health Information Associates, Inc. They hired their first employee, Pam Riddle, that same year. In the year to follow she hired her next two employees Amanda Williams (now Roeschke) and Patti Kulp, both who were former classmates at Medical College of Virginia with her…and are still with the company to this day.
“And I guess that’s when it all started,” laughed Bailey.
In the first five years, Bailey also hired Christen, now VP of Operations at HIA and Joel Shealy, now VP of Business Development.
“I swear, even in the early years, I just thought ‘this is so much fun, I get to work with my best friends every day and do something I love.’”
“It still hadn’t hit me.”
As the coding review relationships continued to grow, more and more clients began looking for other ways to take advantage of HIA’s expertise. Soon the requests for as needed coding support to cover vacations, maternity leaves and vacancies began rolling in and another mainstay service line was born. Interim Coding Management was not far behind and eventually services were expanded to encompass the physician coding and compliance side.
Bailey says the gradual growth of HIA over the next several years – during which she also welcomed her third child, Rachel – was by design.
“We grew slowly but steadily. We didn’t want to take big risks and I never wanted to hire someone if I couldn’t guarantee consistent work for them,” she said. “Clients were patient with us because they knew the quality of work we produced – so they would wait until we could fulfill the contract.”
Bailey says Christen and Shealy were instrumental to HIA’s growth.
“Every corner we turned another opportunity presented itself and we would say ‘okay what do we need to do to get to this level?’ – but we never made huge leaps or ventured outside of our area of expertise, coding,” said Bailey. “We made every decision as a team.”
By 1999, HIA had clients in 26 states. It was that same year that Bailey took over the company as sole owner, with Beamer continuing to serve as an advisor.
By 2011, the company had more than doubled in size.
Today, HIA has clients spanning 45 states and continues to employ only the best in the industry.
“For me, these aren’t just employees – they are family,” said Bailey.
The sentiment rings true to all that HIA does – from its slogan The People Behind the Numbers to its annual meeting, instead called the Family Reunion.
“Even as we continue to hire on more people, we still maintain the core values we established so many years ago,” said Bailey. “HIA is only as good as its people – and I truly believe we have the best of the best in this industry.”
Bailey often refers to HIA as another child of hers, and she believes the culture she has established for the company is not something to take for granted.
Case and point: she wants her kids to work elsewhere for at least two years until they even consider joining the company.
“I don’t believe in just giving your children a handout because you have a successful business,” she said. “Of course, you always want them to be interested in what you are doing, but it’s up to them to figure that part out. I would love to have them all working for HIA someday but this may not be the path for all of them – they have their own interests and I support that.
That sentiment made this year’s celebration that much more special for Bailey, whose daughter Beth Ann Moran, 26, joined the company as part of the recruitment team nearly two years ago.
“To see her have the same love and respect for this company and its people that I do – it makes me unbelievably proud,” said Bailey.
Moran says joining the HIA family “officially” is a dream come true.
“I grew up with most of you and I feel so lucky to be a part of this amazing company,” said Moran during the event Salamander. “I saw how hard my mom worked and how much she and my ‘Big Daddy’ cared for all of you, so it really is special for me.”
For Bailey, it’s a full circle moment.
“Now it’s Beth Ann and me, in addition to my husband, sitting at the dinner table, talking business and bouncing ideas off of each other,” she said.
Bailey paused for a moment as she looked at the album of letters before continuing.
“I can’t thank you all enough for taking a leap of faith and joining me on this journey,” said Bailey. “Working with you all day in and day out has been the greatest joy of my life.”
She could only think of one other person who would be more overjoyed than her in that moment.
“I have no doubt that my dad is up there, celebrating harder, screaming louder, than any of us right now,” she said. “He is so proud of all we have done.”
In the weeks following the celebration, Bailey says she reads the letters often daily.
“They are constant reminders of how lucky I am to be in this position and they serve as motivation on those days when you are feeling down or stressed,” she said.
As for what is next for HIA, Bailey says she will do what she’s always done, work with her team to ensure they are on the right track.
“The industry is changing so much and, we have to change with it. Or change before it,” she said. “We need to be prepared for what’s coming – and we will be.”
Bailey says the company will navigate the changes the same way they always have – as a team.
“I think we are successful because the people working here have a say – their voices matter,” she said. “And that’s something – no matter how much we grow – that’s something we’ll never change.”
We have finished with the step-by-step coding tidbits on coding of spinal fusions. If you were not able to catch Parts 1-13 of this series focused on spinal fusions, please visit hiacode.com/topics/series/spinal-fusion-coding/.
In Part 12, we focused on intra-operative peripheral neuro monitoring used during spinal fusion surgery. In Part 13, we are going to focus on harvesting of autograft and is it coded. Remember in Part 6, we learned that autograft is bone from the patient.
In Part 11, we focused on identifying the computer assisted navigation used during spinal fusion surgery. In Part 12, we are going to focus on intra-operative peripheral neuro monitoring.
In Part 10, we focused on identifying whether or not hardware from a previous spinal fusion is coded. In Part 11, we are going to discuss computer assisted navigation.
In Part 9, we focused on identifying if decompression was also performed and if so, on which body part. In Part 10, we are going to focus on identifying if hardware was removed from a previous fusion site.
In Part 8, we focused on identifying if a discectomy was performed, and if so, if it was a partial or a total discectomy. In Part 9, we are going to focus on identifying if a decompression was performed, and if so, was it of the spinal cord, spinal nerves or both?
In Part 7, we focused on identifying any instrumentation that may be used during a spinal fusion. In Part 8, we are going to focus on identifying if a discectomy is performed and if this is an excision or a resection of the disc.
In Part 6, we focused on identifying the type of bone graft product used for the spinal fusion. In Part 7, we are going to focus on identifying any instrumentation or device used.
In Part 5, we focused on identifying the approach being used for the spinal fusion. In Part 6, we are going to focus on identifying the type of bone graft used for the spinal fusion.
In Part 4, we focused on determining the spinal column being fused. In Part 5, we are going to focus on identifying what approach is being used to complete the spinal fusion (anterior, posterior or both).
This past year, HIA implemented “Buddy Up,” a program designed to help the new hire have a smooth transition into their new HIA roles with the assistance of a “buddy.” What is a Buddy? The Buddy is simply a peer who can guide the new hire in order to make them feel more comfortable. We are very proud of this program and have many success stories that we would like to share. Take a look at the wonderful feedback we have received below.
In Part 3, we focused on determining the level of the fusion(s) and how to determine the number of vertebrae fused. In Part 4, we are going to focus on identifying which column is being fused (anterior, posterior or both).
Part 3: Spinal Fusion Coding — Determine the Level(s) or Region of Fusion and Number of Vertebrae Fused
In Part 1, we learned the diagnoses associated with the need for spinal fusions, and in Part 2 the need to identify if the fusion is an initial or refusion of the vertebrae. In Part 3, we are going to focus on determining the level(s) of fusion, as well as the number of vertebrae fused.
In Part 2, we are going to look at the differences between initial fusion and a refusion. In ICD-9, there were specific codes to show if the fusion was an initial fusion, or if it was a refusion. In ICD-10-PCS, initial fusions and refusion procedures are coded to the same root operation “fusion.”
This is Part 1 of a 14 part series focusing on education for spinal fusions. Spinal fusion coding is a tough job for coders. There are so many diseases/disorders that result in the need for spinal fusion, and even more choices in reporting the ICD-10-PCS codes.
The official definition from the Centers for Medicare & Medicaid Services (CMS) states that a Medicare overpayment is a payment that exceeds amounts properly payable under Medicare statutes and regulations. When Medicare identifies an overpayment, the amount becomes a debt you owe the Federal government.
The question asked in a physician query may be the most important element of the document. Query questions need to be as simple and concise as possible. The physician should have no doubt what the coder is asking.
Coding complications of transplanted organs has always been a coding dilemma. With the implementation of ICD-10-CM that didn’t change. However, coders have multiple directives to help in determining what a complication of the transplant is vs. non-transplant conditions and diseases.
We interviewed our most productive coders, reviewers and members of our education team, asking them what steps they take to find a rhythm that works for them. This week, we talked with Beth Martilik, MA, RHIA, CDIP, CCS, Assistant Director of Education, about the steps she takes to find her routine.
With the implementation of ICD-10-CM came more codes for reporting many different conditions and diseases, and atrial fibrillation is one of those. For many years there was only one code available for reporting this condition, even when the physician further specified the type of atrial fibrillation that the patient had. In ICD-10-CM, there are four codes to report atrial fibrillation.
We have a case where the physician removes mucoid casts found during bronchoscopy. We have also seen mucus plugs removed during bronchoscopy. The MD performs bronchial washings then removes a large amount of tenacious and thick mucoid casts via bronchoscopy. Is this coded drainage, extirpation or excision? What body part is used?
The key to making the query process more efficient is to look for words or documentation while reviewing the record that may signal a potential query opportunity and to note the finding at that time. By the time a coder reaches the end of a record, documentation may have been found to eliminate the need for the query.
Question: This patient is noted to have “Lymphangitic carcinomatosis of lungs with mediastinal lymph nodes.” How would I code the diagnosis? Would I code metastatic cancer to the lung (C78.01) or metastatic cancer to the lymph nodes (C77.1)?
This would be considered a “mechanical” complication of the stent graft since the MD states it is a fracture of the endograft and it is folded over on itself. I would change T82.898A TO T82.598A for Other mechanical complication of other cardiac and vascular devices and implants, initial encounter. I did not use “displacement” because the surgeon did not state that the graft was displaced, only that it collapsed upon itself causing obstruction.
We interviewed our most productive coders and reviewers, asking them what steps they take to find a rhythm that works for them. This week, we talked with Valerie Abney, CDIP, RHIT, CCS, about the steps she takes to find her routine.
Osteoporosis alone is responsible for over a million fractures every year. Stress fractures are not as common but they do occur. There are more than 1 million total joint replacements in the U.S. each year, so there was a need to create codes for injuries that occur around or near the prosthesis. These are called “periprosthetic” fractures.
Back in April, the Office of the Inspector General (OIG) published a report detailing its findings from a review of two groups of high-risk diagnosis codes, acute stroke and major depressive disorder. The objective was to determine whether selected diagnosis codes submitted to the Centers for Medicare and Medicaid Services for use in CMS’s risk adjustment program complied with Federal requirements.
There seems to be differences of opinions on the issue of a 40w0day gestation Can you clarify if P08.21 should be assigned for 40w0day infant or if it would not be assigned unless the infant’s gestation age was 40w1day or greater?
Coders may find situations where a patient is documented as meeting SIRS or sepsis criteria, or has some clinical indicators reflective of possible sepsis, but the physician never documents sepsis as a diagnosis. Should the coder always query for sepsis in these instances?