ICD-10 Rural or Urban; It Impacts All Providers (+playlist)

This CMS video discusses the impact of ICD-10 Implementation on all providers.

For physcians and other treating clinicians, one of the most important considerations is documentation.  If you accurately and concisely document a disease, then you have the best chance of you or your coder finding an appropriate ICD-10 (or ICD-9) code.

I hope this video 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

ICD-10 Implementation Strategies for Physicians & NP Practitioners Dr. Dan D...

ICD-10 Basics MLN Connects Video

Hi all.   Did you know that CMS has a You tube channel?  I didn't either.  But they do, and have a number of ICD-10 training videos.  I'll be posting them over the next few weeks, to help you with your ICD-10 training needs. 

Health Risk Adjustment Flags

 

Health Risk Assessments (HRAs) in the Risk Adjustment Processing System Transactions

 

 

 

In the 2013  In the November 2013 Software Release, CMS acted on their stated intention to gather information on enrollee health assessments or "health risk assessments" or HRAs.  

 

The Software release provided little information, and most health plans held off publishing information until we had additional information and clarification.  On December 5, 2013, we received some clarification during a Risk Adjustment User Group Call with CMS, where no questions were taken.

 

According to the initial explanation:

 

The Risk Assessment field must contain one of the following values:

A. Diagnosis code comes from a clinical setting.

B. Diagnosis code comes from a non-clinical setting and originates in a visit where all requirements specified at 42 CFR 410.15(a) for a First Annual Wellness Visit or Subsequent Annual Wellness Visit were met.

C. Diagnosis code comes from a non-clinical setting and originates in a visit where all requirements specified at 42 CFR 410.15(a) for a First Annual Wellness Visit or Subsequent Annual Wellness Visit were not met.

 

Health Plans requested clarification from CMS on the following:

 

1)    What is a "non-clinical setting"?

2)    Are Annual Wellness Visits the only services covered by Flags/Values 'B' and 'C'?

3)     Does the providers' credential have anything to do with use of the flags?

4)     Does use of any of these flags indicate that the service will not be risk adjusted?

 

To the best of our understanding at this time, the answers to these questions are as follows:

 

1)     The patients home is the only non-clinical setting they are referring to

2)     based on 42 CFR 410.15 (a), Initial Preventive Physical Exams, the "welcome to Medicare     physical is also included.

3)      The providers' credential has nothing to do with assignment of the flags.

4)       At the present time, the use of any flag will not affect risk adjustment.  A final policy will be published in the 2015 Advance Notice in February, 2014.

 

So, to answer what falls under 'A', 'B' and 'C'?  Very simply, this:

 

A--Any risk adjustable service not done in a patients' home.

B--Any risk adjustable service which is procedure code G0402, G0438 or G0439 and is not performed in the patients' home.

C--Any risk adjustable service which is not procedure code G0402, G0438 or G0439 and is performed in the patient's home.

 

In order for health plans to accurately assign the correct indicator, it is critical that you submit the accurate place of service and procedure code on all encounters, including abbreviated format encounters.

 

We hope this helps answer some questions about the Health Risk Assessment Flags.

Remember, if you have questions about ICD-9 Coding, or have suggestions for future blog postings, contact us at coding@scanhealthplan.com.

 

 

 

 



MedLearn (CMS) Web Based Training Programs -- Free CEUs, CMEs (2 Courses) From Multiple Organizations

CMS offers a number of Web Based Training (WBT) programs which offer CEUs which should be of interest to Coders and others.  Of special interest to everyone involved in risk adjustment is a CBT on Part C and Part D Risk Adjustment.   Two of the WBTs even offer CMEs approved by the AMA:

• Safeguarding Your Medical Identity
• Avoiding Medicare Fraud and Abuse: A Roadmap for Physicians

The following organizations offer continuting education credits:

·         American Association of Medical Audit Specialists
·         American Medical Billing Association
·         California Certifying Board for Medical Assistants
·         Healthcare Billing & Management Association
·         Medical Association of Billers
·         National Academy of Ambulance Coding
·       American Association of Medical Assistants
·       AAPC

And don't forget, SCAN Health Plan also offers free Continuing Medical Education on www.SCANCME.com!

New Presentation on HCC University

There is a new presentation and quiz on HCCUniversity.com, with a corresponding quiz that you may be interested in.  The presentation covers changes to the CMS-HCC model, including things like the addition of Morbid obesity, and fibrotic lung diseases.  It also covers the deletion of previously included codes, like CKD stages I-III and polyneuropathy.  There are documentation tips for some of the new procedure codes, as well as some lessons learned from the last CMS Risk Adjustment Data Validation Study.  Finally,  there is a quiz, to help you test your knowledge of the new model and the common documentation errors that physicians encounter.  We urge you to share this  presentation and quiz with everyone involved in risk adjustment in your organization, especially physicians and physician extenders who may benefit from the documentation tips.  You can review the presentation at: http://www.hccuniversity.com/hcc-university/training-presentations/2014-cms-hcc-model/

 

If you are interested in having a webinar training session to cover the presentation, please feel free to contact us at coding@scanhealthplan.com.