AHLA Deciphering Codes: Fraud & Abuse for Coders and Coding Insight for Healthcare Lawyers (Non-Members)


Publisher : American Health Lawyers Association

AHLA Deciphering Codes: Fraud & Abuse for Coders and Coding Insight for Healthcare Lawyers (Non-Members)

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  • Format: 1 Looseleaf volume, 450 pages, Print Book with CD ISBN: 9781422491164


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  • Format: Electronic book: epub ISBN: 9780327175247


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  • Format: Electronic book: mobi ISBN: 9780327175247


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Table of Contents Author/Contributors
Table of Contents

About the Authors

Chapter 1 Introduction and Overview

Chapter 2 Basics of CPT Coding

Chapter 3 ICD-9-CM Diagnosis Coding and Overview of ICD-10

Chapter 4 HCPCS Level II Codes

Chapter 5 Fundamentals of Fraud and Abuse Laws

Chapter 6-A & 6-B Physicians: Legal & Coding Issues

Chapter 7-A & 7-B Emergency Room: Legal & Coding Issues

Chapter 8-A & 8-B Ambulatory Surgery Centers: Legal & Coding Issues

Chapter 9-A & 9-B Critical Care: Legal & Coding Issues

Chapter 10-A & 10-B Radiology: Legal & Coding Issues

Chapter 11-A & 11-B Pathology/Laboratory: Legal & Coding Issues

Chapter 12-A & 12-B Evaluation & Management: Legal & Coding Issues

Chapter 13-A & 13-B Anesthesiology: Legal & Coding Issues

Chapter 14-A & 14-B Surgery: Legal & Coding Issues

Chapter 15-A & 15-B Medicine: Legal & Coding Issues


About the Author

Project Leaders: Rhonda Buckholtz & Robert A. Pelaia

Editors: Brad Ericson & Renee Dustman

Authors: Katherine Abel, Nicole Benjamin, Richard J. Brooderson, Rhonda Buckholtz, Gregory A. Chaires, Julie E. Chicoine, Shelly Cronin, Kerin Draak, Stephanie Ellis, Brad Ericson, Amy Fouts, Michael A. Gardner, Nate Gilmer, Deborah Grider, JoAnn M. Guerrero, Jillian Harrington, Raemarie Jimenez, Jodi Laurence, Terry Leone, Kelly Loya, Theresamarie Mantese, Jonnie Massey, Robert E. Mazer, Leslie Murphy, Gregory M. Nowakowski, Christopher A. Parrella, Abby Pendleton, Liston E. Radney III, David L. Rogers, Donna SanGiovanni, Harry R. Silver, Kevin Solinsky, Jennifer L. Weaver

American Health Lawyers Association (AHLA)

Leading health law to excellence through education, information, and dialogue, the American Health Lawyers Association (AHLA) is the nation's largest, nonpartisan, 501(c)(3) educational organization devoted to legal issues in the healthcare field. AHLA provides a wide variety of resources to address the issues faced by law firms, government, in-house counsel and academia and those who represent the entire spectrum of the health industry.


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The American Health Lawyers Association, the American Academy of Professional Coders and LexisNexis are pleased to bring you Deciphering Codes: Fraud & Abuse for Coders and Coding Insights for Healthcare Lawyers. This unique publication is designed to help coders and attorneys understand and navigate the complex intersection of healthcare coding and the law. This valuable manual discusses the nuances of coding, why proper coding is essential for healthcare facilities and professionals, and the legal implications of improper coding.

The manual begins with introductory chapters on the various sources for codes, including Current Procedural Terminology (CPT), International Classification of Diseases Ninth Revision (ICD-9), and Healthcare Common Procedural Coding System (HCPCS). This is followed by an overview of the applicable fraud & abuse statutes and regulations, including Civil Monetary Penalties Law (CMPL), the False Claims Act (FCA), the Anti-Kickback Statute (AKS), and the Stark Law. These discussions are followed by ten chapters that are dedicated to specific specialty settings in healthcare where coding is a critical element: physicians, emergency rooms, ambulatory surgery centers, critical care, radiology, pathology, evaluation and management, anesthesiology, surgery, and medicine. The importance of a detailed compliance plan for coding is discussed throughout the book, as are cases brought by federal and state governments against healthcare providers for improper coding. Also included is a searchable CD-ROM containing the full text of the manual with links to selected cases, statutes, and regulations. Don't miss out on this indispensable resource for health law attorneys, professional coders and other professionals who need to understand the nuianced world of medical coding.

The eBook versions of this title feature links to Lexis Advance for further legal research options.