Yearly Archives: "2015"

Substance Use Disorder

As I have discussed before, DSM 5 was released last year and contains some new concepts. There is no longer a category of Substance Abuse or Substance Dependence. (The term “substance” referring to alcohol, cannabis, opioids – prescribed or illicit – and benzodiazepines to name a few). Now, in its place, DSM 5 combines abuse and dependence into one category known as “Substance Use Disorder.” While both abuse and dependence have unique definable characteristics, my sense was that DSM…

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Get the Coding Edge with ICD-10 & Initial, Subsequent, and Sequela Encounters

Since ICD-10 implementation there have been quite a few changes in the world of coding and documenting. One in particular would be the usage of Initial, Subsequent, and Sequela, requiring us to append a seventh character for injuries and most external causes reported.

The seventh character indicates “A” for initial encounter, “D” for subsequent encounter, and “S” for sequela of an encounter. You…

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DSM 5 Terminology
As we all become comfortable with ICD10, we need to also be aware of changes in the latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM) released by the American Psychiatric Association in 2013. The latest iteration called DSM 5 introduces new terminology for a number of conditions we see in PACE
For example, the word “dementia” is being phased out and replaced with “Major (or Minor) Neurocognitive Impairment”. Minor Cognitive impairment implies evidence of…

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Health Outcome Survey – Modified (HOS-M)
In early October CMS released the memo titled “HEDIS HOS CAHPS Reporting Requirements for 2016 FINAL”. This memo reaffirms the CMS requirement for PACE plans to participate in the annual HOS-M survey. Plans must contract with the survey vendor NCQA, no later than January 15, 2016. All plans will be receiving correspondence from NCQA shortly.
This important survey takes place annually and the survey results will create the frailty factor used in the following calendar year. This is rare…

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NPA Conference Welcome Message from Dr Schamp

Hello friend, and welcome to the 2015 NPA Annual Conference!

If you are reading this, then you are already aware of  mobile conference app, powered by Whova and sponsored by Capstone Performance Systems. The app is an innovation designed to reduce paper and bring the conference experience directly to your mobile device to get the most current event updates, follow the schedule of sessions and activities, network with other attendees, and more to make the most of your conference experience. Read More

New Enrollment and Disenrollment requirements for Plans in CY2016

In early September CMS released the updated “CY 2016 MA Enrollment and Disenrollment Guidance” One major change this year is the transitioning of responsibility for good cause reinstatement requests directly to plans. In the HPMS memo released on 08/19/15 titled “Revisions to Good Cause Process” CMS defined the changes and requirements. The update CMS released to the Enrollment and Disenrollment process helps to frame the changes. With 2016 right around the corner now is a great time…

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Medical Coder
in Careers

Location: Pittsburgh PA

Capstone Performance Systems is seeking a Professional Remote Medical Coder who will apply his or her technical and specialized expertise to help healthcare programs remain compliant with government regulations while identifying opportunities for increased financial success. (more…)

Diabetes Coding in ICD-10

Diabetic coding in ICD-10 has changed significantly from ICD-9. The requirement for documenting the type of diabetes and linking it to any complications still exist. However, in ICD-10, there are very few diabetic codes that require an additional code for the manifestation. Those that do require an additional code are diabetes with CKD and diabetes with a foot ulcer.

ICD-9 and ICD-10 guidelines for coding diabetes require the provider to document diabetes and the complication, ensuring the documentation states a…

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