AHRQ and HealthIT.Gov Post EMR Information

The Agency for Healthcare Research and Quality (AHRQ) has posted an Electronic Health Record (EHR)  primer for physicians and hospitals.  This primer provides guidance for providers in the use of EMRs.  The AHRQ’s mission:

The Agency for Healthcare Research and Quality's (AHRQ) mission is to produce evidence to make health care safer, higher quality, more accessible, equitable, and affordable, and to work within the U.S. Department of Health and Human Services and with other partners to make sure that the evidence is understood and used.

The AHRQ primer references the Safety Assurance Factors for EHR Resilience (SAFER) guides, developed by HealthIT.gov, the official site for Health IT Information.  Because certified EHRs are part of CMS’ quality programs in FFS Medicare, the guides were developed to aid providers in the implementation and use of them.   

The SAFER guides provide  an additional resource for providers seeking information on EHRs.  The following SAFER guides are available:

·         High Priority Practice

·         Contingency Planning

·         System Interfaces

·         Computerized Provider Order Entry with Decision Support

·         Clinician Communication

·         Organizational Responsibilities

·         System Configuration

·         Patient Identification

·         Test Results Reporting and Follow Up

Finally, AHRQ has developed free CME (1 CME unit for American Board of Internal Medicine) and Medical Knowledge/Patient Safety credit (up to 45 MOC points).   There is a related CME program, The Hazards of Distraction: Ticking All the EHR Boxes available on the AHRQ site (registration required).

We hope this information is helpful.

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

Assessment;  or

Treatment

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:

evaluation

e•val•u•a•tion

[ih-val-yoo-ey-shuhn]

noun

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

Medical Records Amendments

Palmetto GBA, the Jurisdiction 1 Medicare Administrative Contractor, has published a great article on Medical Record Amendments.  We get a lot of questions about these amendments, and there's very little in writing about them.  The Palmetto article is consistent with what CMS has told Medicare Advantage plans on conference calls--that these amendments should be rare, and should be done within a few days of the original medical record entry.

You can read the article here.
Do you have coding or medical records questions? You can always submit them to us at coding@scanhealthplan.com.