Thursday, January 23, 2014
Confessions of a Vegetarian Coder—or, why I hate M.E.A.T.!!
First-- I hope I’m not offending anyone. The spirit of this post is lighthearted, and I’m having a little bit of fun. BUT, I’m also serious about proper coding, and that’s my only intent. Better documentation and coding helps us all in many ways, and should lead to better and more efficient medical care for the members of our medical groups and health plans. It also affects our reimbursement. Done correctly, though—a wealth of important information is obtained, to help our members to obtain access to excellent treatment programs, that enhance their lives and living.
So, there is NOTHING official about “MEAT”, it’s just a handy acronym that someone thought up one day. It’s cute. It sort of addresses what’s needed for ANY diagnosis, not just risk adjustment or so-called “HCC Coding” (which also doesn’t exist). By law, under HIPAA, what is required for any ICD-9 code is defined by what is in the ICD-9-CM Official Guidelines for Coding and Reporting, found here , and Coding Clinic (see the 2nd paragraph of the guidelines). You can’t replace 107 pages with 4 letters, two of which mean the same thing!
If you look at MEAT for just a minute, you can see it’s not official, and pretty meaningless:
Monitoring (or Medication)
Evaluation and Assessment mean exactly the same thing! And no “Official Guideline” for anything, much less something that leads to Federal Government payment, would be complete at 4 letters, 6 if you include the “or”.
EVERY condition that is submitted as an ICD-9 code has to meet the Official Guidelines. There’s no exception because something doesn’t risk adjust. Just writing the word “Stable” does not magically mean you can code something. Or just because the diagnosis listed under the “Assessment” heading in a chart note doesn’t mean someone assessed it. What is under that word are conclusions, 90 times out of 100, not an evaluation of the patient or an assessment. If you look at the word “evaluation” in dictionary.com, it says this:
1 an act or instance of evaluating or appraising.
2. (especially in medicine) a diagnosis or diagnostic study of a physical or mental condition. (emphasis added)
Here’s where the word “meat” or “substance” comes into play. There really has to be some substance to an evaluation. Just writing:
Diabetes with neurological manifestations
in a chart note does not mean the doctor evaluated ANYTHING or can code 250.60
First of all ________manifestations isn’t a diagnosis at all. By itself, it means nothing. No matter what someone from somewhere told you, you cannot just write “stable” or “continue on meds” next to a couple of words and you now have something you can code. I have seen it fail in CMS RADVs more than once. And I think that failing something like that is proper. It never should have been coded in the first place!
On the other hand, if you can see in that chart note that the physician did a foot exam, and documented the patients symptoms of burning or tingling in their feet, did a monofilament exam—NOW YOU HAVE SOMETHING!!!!!!!!!
Now he or she can say in the “Assessment” section:
Diabetes with diabetic polyneuropathy. Patient started on Neurontin, 300 mg, TID
TA DA!! We have something that we can code!!! YAY!!!!!!!!!!!!! There is the "meat" that's needed. An evaluation and/or some indication that the condition was either assessed, being treated (actively) or it has an impact on the treatment of other diseases as the ICD-9 requires.
When people talk about “HCC Coding” being somehow different, there isn’t really a citation they can point to, or an example. On the other hand, CMS DOES have specific signature requirements for a medical record, but that isn’t a coding issue per se. It is a Medical Record issue. So, in my diet, I’m a happy omnivore, savoring a juicy steak when I can. But when it comes to “M.E.A.T.” and coding, I’m a vegetarian coder all the way.
Stacey Hernandez, CCS-P