New Specialties Approved for Risk Adjustment

Effective January 2012, the following CMS Physician Specialties are approved for risk adjustment submission:

• 21   Electrophysiology
• 23   Sports Medicine
• C0  Sleep Medicine

CMS has indicated that they will publish a complete specialty listing soon. When the listing is published, we'll post it to the Tools section of HCCUniversity.com

Coding BMI

We often receive questions about when certain conditions can be coded.  Most often, the questions are about whether or not anything (everything) a physician or physician extender writes down can be coded. Almost always, the answer is that the condition must be:

• Documented
• Supported by the history, physical examination or clinical condition of the patient

When it comes to secondary diagnoses, they must meet the definition of a reportable additional diagnosis per coding guidelines.  From the Coding Guidelines: "As with all other secondary diagnosis codes, the BMI and pressure ulcer stage codes should only be assigned when they meet the definition of a reportable additional diagnosis (see Section III, Reporting Additional Diagnoses)."

According to Coding Clinic, 2Q 2010 the associated diagnosis (such as overweight, obesity, or underweight) must be documented by the provider.  If no associated diagnosis is documented, then the recorded BMI cannot be coded.

Free CME for Physicians

Did you know that your can earn free category 1 Continuing Medical Education from Medicare?   The Medicare Learning Network (MLN) offers free CME for an online course in conjunction with the Office of the Inspector General  (OIG).   You can get more information on their course, Avoiding Medicare Fraud and Abuse: A Roadmap for Physicians.  Learn more about it here.

Update on Diagnosis Codes Instead of a Diagnosis

A couple of weeks ago, we published information on a Q 1 2012 Coding Clinic ruling on physicians using a diagnosis code in lieu of a written diagnosis.  This has led to some questions, so we wanted to provide additional information.

Coding Clinic was asked about physicians choosing a diagnosis code in an EMR vs. using a written diagnosis--but this advice applies to handwritten or dictated notes as well.  One important point that Coding Clinic made relates to something we see frequently--physicians just picking the diagnosis code and short descriptor of the code and using it as an assessment.  Coding Clinic said:

"...it is not appropriate for providers to list the code number or select a code number from a list of codes in place of a written diagnostic statement. ICD-9-CM is a statistical classification, per se, it is not a diagnosis. "  (emphasis added).

Here's an example that we see frequently as an assessment:

250.40--Diabetes with renal manifestations

As you can see, this is not a diagnosis, but a category of diseases, or in ICD-9 terms, a statistical classification.

The clinician is responsible for providing a diagnosis, so they may need to add to the short descriptor of a diagnosis code in the EMR.  For example:

250.40--Diabetes with renal manifestations - CKD 4 due to DM

This provides an actual assessment (diagnosis) of the patient's condition, that allows correct coding.

EMRs can be tremendous time savers, but physicians and clinicians must ensure that they meet coding and documentation requirements.

Proposed 1 Year Delay in ICD-10 Implementation

On Tuesday, April 17, 2012, the Department of Health and Human Services published a proposed rule, entitled " Administrative Simplification: Adoption of a Standard for a Unique Health Plan Identifier; Addition to the National Provider Identifier Requirements; and a Change to the Compliance Date for ICD–10–CM and ICD–10–PCS Medical Data Code Sets"

The proposed rule can be downloaded at: http://www.gpo.gov/fdsys/pkg/FR-2012-04-17/pdf/2012-8718.pdf

In addition to a proposed delay in the compliance date for ICD-10 (to October 1, 2014), there are proposals for a Unique Health Plan Identifier, and an identifier for entities that currently cannot obtain an NPI.

Comments on the proposed rule are being accepted until May 17, 2012 at 5:00pm EST.

Code Numbers Instead of a Narrative Diagnosis

All too often, we see a diagnosis code written in the medical record, in lieu of a narrative diagnosis.  In those instances, we cannot code what has been written for two important reasons:

• Coding is done based on the narrative documentation in the medical record--with no narrative, no coding can take place
• There's no way of telling if the diagnosis code in the chart is correct (i.e., what the provider meant to code)

We get this question at least once a year--and sometimes it leads to lively exchanges.  Thankfully, Coding Clinic, Q1 2012, has decided to address it.  Their answer, in part reads:

"There are regulatory and accreditation directives that require providers to supply documentation in order to support code assignment. Providers need to have the ability to specifically document the patient's diagnosis, condition, and/or problem. Therefore, it is not appropriate for providers to list the code number or select a code number from a list of codes in place of a written diagnosis."

So--the next time you're asked if a provider can just write the code in the chart--you'll know where to point them for clear guidance.

Keeping Up with What's New in Medicare

The Medicare program is massive, and ever changing.  Changes come out several times a year--Part A changes around September, Part B changes in January.  Add that to changes in ICD-9 and CPT, changes in your commercial business--it's all a bit much.

How can you keep up with all these changes? The CMS website is difficult to navigate--and finding things is complicated. 

But, one great place to bookmark and visit frequently is the Medlearn Matters webpage.  This page has educational materials about new Medicare programs and coverage. It's a great way to keep up with what's new in Medicare.  https://www.cms.gov/MLNProducts/

In addition, there's a Medlearns Product Catalog, that allows you to order certain printed matter.  You can view the catalog at https://www.cms.gov/MLNProducts/downloads/MLNCatalog.pdf

You can learn about EHR incentives, the annual wellness exam, and even take online training courses, some of which have CEUs for coders.

Although you won't find everything there--you will find a lot of information about new and changed programs on the Medlearn Home page.