Monday, August 17, 2015

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

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:

The SCAN Tools Team

Monday, August 10, 2015

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 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!

Monday, August 3, 2015


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, 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, 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 and through our email blasts.

Stacey Hernandez, CCS-P