Code Numbers in Lieu of a Diagnosis-- Dangers in the EMR

One of the most frequent questions I get asked is "isn't selecting the diagnosis (code) in the EMR good enough documentation?" The answer is no, and a recent Coding Clinic broaches this subject.  I will expand a little on their thoughts.

Basically, Coding Clinic Q4 2015 received a question if physicians could use a code number in lieu of a diagnosis. Their answer was a resounding no--but they went a little further.

Coding Clinic told the inquirer that it was not appropriate for providers select a code number from a list of codes in place of a written diagnostic statement.

Their rationale is that the ICD-10 is a statistical classification, not a diagnosis. Further, they indicated that many clinical diagnoses may be included in an ICD-10 code, and it may be important to document these diagnoses.  They went on to say that it was the provider's responsibility to provide clear documentation of a diagnosis.

The abbreviated ICD-10 descriptions are often so shortened they make no sense--and can't be called a diagnosis.  One reason that writing a code in lieu of a diagnosis is inappropriate is that the code chosen may simply be wrong--without a narrative description (of sufficient specificity), there's no way to even know if it's right.  Coding is done from a narrative, not from a number.

This issue was very common in ICD-9.  Think back to all of the "Diabetes with _____________manifestations".  These codes were chosen all the time, and could not be supported--there was no way to know what the "manifestation" was, without further description by the physician.  A manifestation isn't a disease description--it's a whole array of possible diseases. Without further documentation by the physician, it's not possible to know what that disease is.  In ICD-10, with its added complexity, this issue will arise over and over again.  It is the clinician's responsibility to ensure that their documentation makes sense, and includes sufficient information to validate that the code chosen is correct.  The act of choosing a code is not enough.

EMRs are great time savers.  But they are not a substitute for adequate documentation by the physician to determine if the selected code is correct.

So, I recently read a funny blog....

About Coding of all things.  It's called Coder Coach.  And the author does a code for the day, with a focus on humor.  I'm not as funny as she is, so I'm not even going to try.  But I think that I will try to be more diligent about posting--and I think I'll try to do a code a day (or week...or something).

Let's face it--ICD-10 has been a royal pain of an implementation.  So, by focusing on a new code with some regularity, I might be able to lend a hand.  No time like the present!

We'll start off, not with a code, but with at category.  This category may be the most misused category of codes I've ever seen.

I've been coding for more years than I like to admit.  Let's say north of 30.  While I've seen instances where these codes (and their predecessors in ICD-9) could have been used correctly, I've never actually seen them used correctly.  They are: Neoplasms of  Uncertain Behavior.  In ICD-10 they are found in the section Neoplasms of Uncertain Behavior, Polycythemia Vera and Myelodysplastic Disorders (D37-D48).

When I see a code for neoplasm of uncertain behavior submitted, no matter the body area, it's always because:

1. The physician hasn't biopsied the lesion yet, and so he/she is uncertain of the histology; or
2. The physician has biopsied the lesion, but hasn't yet received the pathology report

Neither of these is the correct usage of the code.  The beginning of the code section explains the correct use of the codes, but unfortunately, one of the downsides of Electronic Health Records (EHRs) is that none of these instructions are visible to most users.  Here's the instruction, straight from the ICD-10:

Note: Categories D37-D44, and D48 classify by site neoplasms of uncertain behavior, i.e., histologic confirmation whether the neoplasm is malignant or benign cannot be made.

As you might guess, the instances where you can correctly use these codes are relatively rare.  So, unless the pathologist cannot tell you whether to neoplasm is benign or malignant, these codes should not be used. 

This code category points out the importance of the coding instructions and guidelines.  As noted, these are generally lost in an EHR--that's not to say EHRs are bad, simply that they have their limitations.   So, what's a coder (or the physician who is coding) to do?  I strongly recommend that coders AND physicians read the sections of the Coding Guidelines that apply to them.  That means any specialty specific guidelines, and the entire Outpatient coding section.  You should also review the section of the code book that includes common codes you use.  And, when faced with the new and unusual (like these), take a quick glance at the book to see if there are special instructions like we found here. 

Now, if you have an EHR, you don't have to buy the code book to do that.  Every year, we post a full text copy of the ICD-10 on HCC University.

I'm going to do my best to keep posting these coding tips.  If I fall behind, feel free to email me at Coding@scanhealthplan.com to remind me.  I sometimes suffer from mild memory loss, NOS (R41.3)

New Content on HCCUniversity.com

There’s been a lot of activity on HCC University!  Since my last email, we’ve posted several new things:

First, an updated Pocket Documentation Tip Sheet, which includes instructions for ICD-10 guidelines.  This tip sheet can be printed and folded to fit in a lab coat pocket, and will help clinicians meet some of the documentation challenges they face on a daily basis.

Next, we’ve updated the Primary Care Superbill.  As before, it includes CPT  II codes that help you meet both 5 Star AND Fee-for-service PQRS requirements!  Now, it’s been updated to include ICD-10 codes for many common illnesses seen in a Primary Care practice.

Finally, we’ve posted a new presentation on ICD-10 Guidelines.  This brief, physician oriented presentation will help providers understand the rules of ICD-10, where to find them, and why they must be followed.  It shouldn’t take any more than 20 minutes to go through, but provides a wealth of information to help you choose the correct ICD-10 code. 

For all of you who have asked---yes, the Risk Score Calculator will be updated for 2016 payment year.  We’re in the midst of doing that now, and hope to have it available right after the first of the year.  

As always, if you have suggestions for tools for HCC University, please let me know. 

If you have coding questions, please contact us at Coding@scanhealthplan.com.

Happy Holidays all!  And a wonderful 2016!

Best,

Stacey

New Video on Roadto10.org

CMS has published a new, post implementation video on their website, Roadto10.org.  Per the announcement:

In this Centers for Medicare & Medicaid Services (CMS) ICD-10 video, Sue Bowman from the American Health Information Management Association (AHIMA) and Nelly Leon-Chisen from the American Hospital Association (AHA) discuss the unique characteristics and features of the ICD-10 coding system. Topics include:

• What is a valid code
• Guidelines for coding and reporting
• Coding process and examples: 7th character, unspecified codes, external cause codes, laterality
• How to submit coding questions
• Resources for coders 

Visit the Medicare Fee-For-Service Provider Resources webpage for a complete list of Medicare Learning Network resources on ICD-10.

Free HIMSS/AHIMA CEU Available From the National Center for Health Statistics

The National Center for Health Statistics has a free CEU available for HIMSS and AHIMA members. The topic is the National Hospital Care Survey.

The stated objectives are:

• To introduce you to the National Center for Health Statistics (NCHS)
• To describe the National Hospital Care Survey (NHCS)
• To tell you why you should participate in NHCS
• To describe what participation involves
• To describe how NCHS ensures confidentiality and complies with the Health Insurance Portability and Accountability Act

You can access the training program HERE.

CMS Posts Revised Instructions for Billing Services On or After 10-1-2015

CMS Medlearn Matters (MLN) has re-issued SE 1408 - Medicare Fee-For-Service (FFS) Claims Processing Guidance for Implementing International Classification of Diseases, 10th Edition (ICD-10) – A Re-Issue of MM7492.  Although this is a FFS guidance, it was referenced in the September 2015 Encounter Data Processing System Newsletter, for guidance on submission of claims/encounters on or after the 10-1 transition date to ICD-10.  There are two important new pieces of information included:

v  The submission of Inpatient Home Health Services (Part B) services—type of bill 32X * (use the thru date)

v  The submission of DME claims that span dates of service before 10-1 and on or after 10-1 (use the from date)

I think there will be a number of DME claims like this, so the update is important.

You can review the update on the CMS website, here.

* The type of bill 32X is not exclusively used for this type of service. This is only for Part B only Medicare  members who are in an inpatient hospital setting, receiving Home Health services there. 

Updated "Ask a Coder" questions on HCC University!

We've added 9 new questions, most about ICD-10, to the Ask a Coder section on HCCUniversity.com.  In addition, most of the older questions have been updated to include ICD-10 information.

On the Full Encounter Data/ICD-10 page, we've added an updated CMS Encounter Data Processing System (EDPS) Newsletter, which reminds physicians and DME suppliers that ICD-9 and ICD-10 cannot be billed on the same claim/encounter.  If there are services both prior to and on or after 10-1-15, you must split them and put them on separate claims.

For hospitals, the discharge date determines which coding system applies to the whole claim.  So, if a patient is admitted on 9-20-15, and discharged on 10-1-15, all services will be billed under the ICD-10 coding system.

Finally, remember you can ask risk adjustment related coding questions by submitting an email to coding@scanhealthplan.com.

Stay tuned for more exciting news from HCCUniversity.com!

Updated Job Openings in HealthCare Informatics

We've recently had a position filled, so I wanted to be sure and post an updated list of jobs open in our HealthCare Informatics family.  If you're interested in one of the positions, click the link, and read the full job description.  You can apply online!  All of the positions are in our Long Beach office.

Job Title	Requisition Number	Position Type	Standard Hours
Healthcare Informatics Analyst II	14-1588	Full Time - Regular	40
Encounter Data Specialist - Report Analyst	15-1769	Full Time - Regular	40
Project Manager - HCI	15-1863	Full Time - Regular	40
Sr. Encounter Data Specialist - Technical Reporting Analyst	15-1904	Full Time - Regular	40
Health Care Analyst Sr.	15-1919	Full Time - Regular	40

Important Information on ICD-10 Excludes 1 Notes

Although the general ICD-10 instruction is that an Excludes 1 note means you cannot code two conditions together, the National Center for Health Statistics has posted an exception on their website. The NCHS is one of the 4 cooperating parties for ICD-10, and is responsible for posting the ICD-10 code book and guidelines.  The exception reads as follows:

"We have received several questions regarding the interpretation of Excludes1 notes in ICD-10-CM when the conditions are unrelated to one another. Answer: If the two conditions are not related to one another, it is permissible to report both codes despite the presence of an Excludes1 note. For example, the Excludes1 note at code range R40-R46, states that symptoms and signs constituting part of a pattern of mental disorder (F01-F99) cannot be assigned with the R40-R46 codes. However, if dizziness (R42) is not a component of the mental health condition (e.g., dizziness is unrelated to bipolar disorder), then separate codes may be assigned for both dizziness and bipolar disorder. In another example, code range I60-I69 (Cerebrovascular Diseases) has an Excludes1 note for traumatic intracranial hemorrhage (S06.-). Codes in I60-I69 should not be used for a diagnosis of traumatic intracranial hemorrhage. However, if the patient has both a current traumatic intracranial hemorrhage and sequela from a previous stroke, then it would be appropriate to assign both a code from S06- and I69-."



You can read the exception on their website, as well as download important ICD-10 documents at: http://www.cdc.gov/nchs/icd/icd10cm.htm

Healthcare Informatics Job Postings

We just wanted to post all of our current Healthcare Informatic Job Postings for you.  You can click on the link to be taken to the job description, and information on how to apply for the job.  We hope you'll consider joining the Healthcare Informatics family!

Job Title	Requisition Number	City	Standard Hours	Post Date
Healthcare Informatics Analyst II	14-1588	Long Beach	40	10/06/2014
Data Analyst - HEDIS & Medicare Star	15-1694	Long Beach	40	02/06/2015
Encounter Data Specialist - Report Analyst	15-1769	Long Beach	40	04/10/2015
Project Manager - HCI	15-1863	Long Beach	40	07/02/2015
Sr. Encounter Data Specialist - Technical Reporting Analyst	15-1904	Long Beach	40	08/20/2015
Health Care Analyst Sr.	15-1919	Long Beach	40	08/27/2015

New Healthcare Informatics Job Posting

The position below was posted on October 5.  Please be sure to check out last Thursday's post for other positions still available as part of our Healthcare Informatics Family!  Just click on the job title to be taken to the full posting for the position.

Healthcare Informatics Analyst II

14-1588

Healthcare Informatics

Long Beach

CMS ICD-10 Ombudsman and Coordination Center Available

I received the email below from CMS today, and thought I would share it with you.

CMS has established a coordination center and an ombudsman to help providers

 through this difficult transition to ICD-10. These are fantastic resources for providers,

so that they can resolve issues once they've exhausted their attempts to find the right

code for a situation.  It's reprinted below, and we hope you find it helpful.

Because of CMS formatting that I can't change, it does appear a little funny on our site, but the information is so useful, I hope you'll look past that.

News Updates | October 7, 2015

ICD-10 Ombudsman and ICD-10 Coordination Center Here to Support Your Transition Needs It’s important that you know help’s available if you have problems with ICD-10: ICThe ICD-10 Ombudsman, Dr. Bill Rogers, can be your impartial advocate You can contact the ICD-10 Coordination Center ICD-10 Ombudsman Dr. Rogers, a practicing emergency room physician, is known to many of you   already. Since 2002, he has been the Director of the Agency’s Physicians  Regulatory Issues Team, assisting physicians, other practitioners, and medical societies in identifying and simplifying Medicare policies and regulations. His role  as ombudsman will be to be a one-stop shop for you with questions and concerns  and to be your internal advocate inside CMS. ICD-10 Coordination Center The Coordination Center is a dedicated group of Medicare, Medicaid, and    information technology systems experts drawn from across CMS. They have  the full support of the entire CMS staff to address any issues quickly and   completely. First-Line ICD-10 Information and Support For general ICD-10 information, we have many resources on our                CMS ICD-10 website and Road to 10 webpage. Contact the MAC for Medicare claims questions. Your MAC                             is your first line for Medicare claims help. MACs cannot                                     respond to questions about Medicaid or Commercial health plans. If you have a Medicaid claim question contact your State Medicaid Agency. If you have a commercial or private health plan claim question               , please contact your health plan directly. Keep Up to Date on ICD-10 Visit the CMS ICD-10 website and Roadto10.org for the latest news and  resources, including the ICD-10 Quick Start Guide. Sign up for  CMS ICD-10 Email Updates and follow us on Twitter.

Using Diagnoses From Prior Encounters

One of the most common questions we get is whether or not a diagnosis from an earlier encounter can be used for a current encounter.

Standard coding advice has always been that a diagnosis cannot be "pulled forward" to a new encounter. Coding Clinic, Q3, 2013 has addressed this issue.  In part, the Coding Clinic advice says:

"Conditions documented on previous encounters may not be clinically relevant on the current encounter.... However, if the condition is not documented in the current health record, it would be inappropriate to go back to previous encounters to retrieve a diagnosis without physician confirmation."

Coding Clinic indicated this advice applies to both ICD-9 and ICD-10 coding.  We hope this advice will clear up this frequent question.

ICD-10 Reminders!

The long awaited day is here--and ICD-10 is a reality.  Just a few reminders for claim/encounter submissions around the implementation date.

1)  Claims/encounters cannot contain both ICD-9 and ICD-10 codes.  If you have dates of service before 10-1 and on or after 10-1, the services should be split onto separate claims.
2)   If it is a hospital insurance claim/encounter, the "date of service" is the discharge date, and all services should be submitted with the coding system in effect on the discharge date.
3)  Still need help?  Check CMS' roadto10.org for more information.
4) Don't forget HCCUniversity.com.  We have several presentations on ICD-10 that should help!

Good luck, and happy coding!!

Job Openings in Healthcare Informatics

Below are the current job openings in our Healthcare Informatics Department.  As a reminder, all are full time postitions, in our Long Beach Office.  You can apply by clicking on the job title link.

Job Title	Requisition Number	Area of Interest	Position Type	Standard Hours
Healthcare Informatics Analyst II	14-1588	Healthcare Informatics	Full Time - Regular	40
Data Analyst - HEDIS & Medicare Star	15-1694	Healthcare Informatics	Full Time - Regular	40
Encounter Data Specialist - Report Analyst	15-1769	Healthcare Informatics	Full Time - Regular	40
Project Manager - HCI	15-1863	Healthcare Informatics	Full Time - Regular	40
Sr. Encounter Data Specialist - Technical Reporting Analyst	15-1904	Healthcare Informatics	Full Time - Regular	40
Health Care Analyst Sr.	15-1919	Healthcare Informatics	Full Time - Regular	40

Annual Wellness Visits in Medicare Advantage and Fee-for-service

We continue to receive questions from Medical Groups about the Annual Wellness Visit (AWV).  As we've noted previously, CMS limits the AWV, either initial or subsequent, to once a year in FFS Medicare, and requires that health plans provide this service annually.   However, more and more groups are, as a best practice, performing the same sort of comprehensive health risk assessments (HRA) included in the AWV twice a year, and wonder if there is anything that prohibits them from doing so.

While CMS limits the use of the procedure codes G0438 or G0439 to once a year, neither CMS or SCAN limits the performance of a comprehensive health risk assessment to once a year.  SCAN encourages physicians to update the member's personalized prevention plan of service (PPS) and/or health risk assessment whenever they feel appropriate for their patient, given their patient's health and risk factors.

You may wish to incorporate this into the member's annual preventive services exam (99381-99397)-allowable by most health plans once per year,  or any extended or comprehensive outpatient E/M service (99214-99215).  There is no limitation to outpatient E/M services, and we encourage you to use them as an opportunity to make sure that your member's HRA and prevention plan of service are on track and members are obtaining the preventive services ordered.

In summary, while the procedure codes for the AWV are limited to once a year, there is nothing that stops a physician from performing any or all of the components of an AWV at any time during the year.  SCAN supports preventive care to ensure the highest level of health and independence for our membership, and recommend that physicians provide the HRAs, PPSs and other components of an AWV whenever they feel clinically indicated for their members.

Exciting Employment Positions Available at SCAN Health Plan!

Going forward, we will be featuring open employement opportunities at SCAN here on the HCC University Blog.  We hope you'll consider joining what we believe to be one of the best and brightest teams in the industry.  Current Long Beach, California positions include:

Job Title	Requisition Number	Area of Interest	Position Type
Healthcare Informatics Analyst II	14-1588	Healthcare Informatics	Full Time - Regular
Data Analyst - HEDIS & Medicare Star	15-1694	Healthcare Informatics	Full Time - Regular
Encounter Data Specialist - Report Analyst	15-1769	Healthcare Informatics	Full Time - Regular
Project Manager - HCI	15-1863	Healthcare Informatics	Full Time - Regular
Sr. Encounter Data Specialist - Technical Reporting Analyst	15-1904	Healthcare Informatics	Full Time - Regular
Health Care Analyst Sr.	15-1919	Healthcare Informatics	Full Time - Regular

Click the link of the position you're interested in, to be taken to a complete Job Description,  Embedded within the job description is link for you to submit your application!

We hope you'll consider joining the HealthCare Informatics team, at SCAN Health Plan.

Check back here regularly to see new positions.

CMS Posts New ICD-10 Clinical Content

CMS continues to post clinical content, common ICD-10 codes and coding vignettes for providers.  The latest is OB/ GYN, and it can be viewed here. 

One problem with some of CMS content in the past--they assumed that physicians understand documentation requirements, and all content tells physicians what to code for what disease.   The site has been beefed up, and there are Clinical Documentation tips now

I strongly recommend this site for clinicians and coders alike--coders and physicians must follow the same rules when coding--and all of those rules are based on clinical documentation and the ICD-10 Official Guidelines for Coding and Reporting, available free of charge on the National Center for Health Statistics website.  All other ICD-10 content is there as well at www.cdc.gov/nchs.

Although the guidelines are long, physicians can read only those specialty specific guidelines that they normally treat, along with the section on Outpatient Coding (all physician coding uses the outpatient guidelines, regardless of where the services were rendered).

And remember, SCAN contracted providers can send coding questions to us at: Coding@scanhealthplan.com.

The SCAN Tools Team

SCAN Memo On Encounter Data Submission Deadlines

The SCAN Encounter Data Team has published the memo below, and sent it to all Encounter Data contacts.  We're reprinting the content here, to enable you to better support your Encounter Data staff in timely submissions.  As noted below, if you have questions regarding this memo, please email them to Encounters_Operation@scanhealthplan.com with the subject line ‘SCAN Dates for Submission of Risk Adjustment Data to CMS’.

______________________________________________________________________

To: All SCAN Provider Partners, including Groups, Hospitals and Ancillary Providers
CC: SCAN Encounter Data Team
From: SCAN Health Plan
Date: 7/2/2015
Re: *IMPORTANT* -- SCAN Dates for Submission of Risk Adjustment Data to CMS
Below are SCAN dates for the next five CMS Sweeps for risk adjustment data. Please note, in addition to the CMS deadline for Health Plans, SCAN has created two key submission dates for our Provider Partners: 1) SCAN Target Date and 2) SCAN Deadline.
SCAN Target Date
The “SCAN Target Date” (yellow in the below matrix) is the date after which any new data received is subjected to increased scrutiny and is at some risk of not being processed with CMS for that sweep. This date is approximately 4 weeks prior to each of the CMS deadlines, and has been set to ensure that SCAN has adequate time to complete processing prior to the cut-off by CMS. Again, any data received after this date will be subject to additional scrutiny which may include (but is not limited to) successfully passing a random chart validation. After the additional scrutiny is concluded, the data will be submitted to CMS but SCAN cannot guarantee that this will occur prior to the CMS deadline for Health Plans.
Note: If your organization uses a clearinghouse, all encounter data should be received by the clearinghouse well before the SCAN Target Date to ensure CMS processing. Any files that are submitted directly to SCAN (i.e. ICE files), must also be received by the SCAN Target Date.
SCAN Deadline
The “SCAN Deadline” (red in the below matrix) is the date after which any data received will NOT be processed for that sweep. This is an important change that SCAN is making for each CMS sweep period. This will be the final date SCAN will receive any data that may be sent to CMS prior to the Sweep Deadline for Health Plans.
Note: While the SCAN Deadline is the critical date for each sweep, it is especially so for the final CMS sweeps (highlighted in blue in the below matrix) for any given calendar year. Please mark your calendars now for 1/22/2016, the next SCAN Deadline prior to a final sweep!

Updates!

With the ICD-10 implementation date just around the corner, we at SCAN, and you as our Provider partners are working very hard.  There's so much information to filter through, it sometimes seems impossible to keep up with.

CMS has posted their DRAFT CPT/HCPCS filtering list.  What is on the list is not hugely problematic, but what's missing (Modifiers) is.  As you know, modifiers alter the meaning of the CPT/HCPC codes, and inclusion of some of those modifiers may be important.  Health Plans have until August 21st to comment.  You can rest assured that we're studying the list, and will make comments to CMS in a timely manner.

CMS also posted another important file: The updated CMS-HCC and Rx-HCC files.  As you know, CMS posted a draft file a little over a month ago--they've now taken it down and replaced it.  They are not calling this the final ICD-10 mapping, so we'll be sure to monitor the CMS website and post updates here.

We've posted a number of new Q and As on the Ask-a-coder page.   In addition, we've completely new Helpful Links page.  All of the links are now categorized, making it easier for you to find exactly what you're looking for.

Just as an FYI--when we have special or time sensitive posts to HCCUniversity.com, we usually send out an email blast.  These are sent infrequently, and usually no more often  than once a month.  If you'd like to be added to our growing list of HCCUniversity readers, please send your name and email address to coding@scanhealtplan.com, and we'll be sure to add you.

That's it for today.  As we get closer to ICD-10, we 're sure to hear things from CMS that are of importance to you. We'll pass them along here, on HCCUniversity.com and through our email blasts.


Stacey Hernandez, CCS-P          

Opportunity for *FREE* CMEs and CEUs

CMS is offering a new training course which will allow physicians and nurses to obtain free CMEs, and a new MedLearn training course that will allow coders (check with your accrediting body) to obtain CEUs!

First, CMS is offering a new article on Improving Care through Care Coordination via MedScape. Gain credits from this CME article on Improving Quality of Care Through Care Coordination. The article focuses on:
 • CMS programs aimed at improving care coordination and transitions
• Helpful, evidence-based strategies for providers to improve patient care coordination, including upcoming changes to billing and processes To view the articles, you must be a registered Medscape user. There is no cost to join. Links to CMEs are also available through the CMS Earn Credit web page!

For coders, CMS is offereing free CEUs for a new Medlearn Web Based Training Course (WBT) on the Home Health Benefit.  Many of CMS' web based training courses offer CEUs approved by the AAPC.  Check out all of the  WBTs here.

Check back here frequently for new information to help you navigate Medicare.

New Documents Posted to HCC University--and a Request

With the ICD-10 implementation date looming, we're increasing our focus on ICD-10 documentation and coding issues.  October 1 is very close!

We have recently posted a new link to the American Health Information Management's (AHIMA) ICD-10 superbill for primary care.

In addition, we've posted the full text of the Official ICD-10 Coding Guidelines and the 2015 ICD-10 Alphabetical Index, and the 2015 ICD-10 Tabular Listing of Diseases.

On our Presentations page, we have a Diabetes Coding in ICD-10 presentation.

We're currently creating a set of single page documentation tips for common coding situations.

But we know there's more we can give you to help you with this transition. We'd like you to send us suggestions for the following:

• Specific disease categories that you feel could benefit from a tip sheet
• Specific body system or disease states you feel you need presentations for you to use with your physicians, or for yourselves.

While we can't promise we'll be able to fill all requests, we'll do our very best.

Please send your suggestions to coding@scanhealthplan.com.  As always, we appreciate your feedback and help.

Thanks so much!

SCAN HCC Tools Team

ICD-10 Clinical Documentation Improvement Document

For those of you tasked with training and/or coding in ICD-10, there's an excellent resource on the American Health Information Management Association (AHIMA) website.  It's a 72 page document on clinical documentation improvement for ICD-10.  In other words, it's a guide to helping both coders and clinicians understand the documentation requirements for a number of ICD-10 codes.

While encoders and crosswalks may be able to point you in the right direction, all coding is done based on the documentation in the medical record.  This guide can help you understand the documentation requirements for a number of diagnoses and services.

The document is accessible to both AHIMA members and non-members in their body of knowledge, and can be downloaed here.

Advance Notice of 2016 Medicare Advantage and Part D Rates Released

On Friday, February 20, CMS released the proposed rules for Medicare Advantage Payment for 2016.

Comments to the proposed rule are due to CMS on March 6, 2015.  You can download the proposed rule on the CMS website.

The final rule will be released on April 6, 2015 in accordance with the law, and you'll be able to download it on the Announcements and Documents Page.

For an easy to read summary of the notice, you can download the CMS Press Release.

CMS plans to completely phase in the new CMS-HCC model, with no blend.

In addition, CMS is proposing that they will calculate 2016 MA and Part D risk scores by blending two separate risk scores.  One risk score would be calculated using 2015 diagnoses from the Risk Adjustment Processing System (RAPS) and Fee-For-Service (FFS) data, and another separate risk score would be calculated using 2015 diagnoses from the Encounter Data System (EDS) and FFS.  CMS would then blend these two risk scores, weighting the risk score from RAPS and FFS by 90% and weighting the risk score from EDS and FFS by 10%.  This will make the subission of all encounter data more important than ever before.

CMS has decided not to disallow services performed in the home setting, but health plans still must report services performed in the home.

We suggest you review the CMS documents, and download the final rule, which will likely be released late in the afternoon of April 6, 2015.

Can You Code From a Problem List?

Today we posted a collections of documents from CMS. These documents were Questions and Answers from a series of CMS Risk Adjustment  User Group Calls.  Among the answers is a question we get very frequently--Is it okay to code from a problem list?  To find out, check out the CMS User Group Q and A's on HCC University.