Monthly Archives: "August, 2015"

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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Last Chance to Correct RAPS for PY 2012

CMS notified all PACE Organizations (POs) and other risk-adjusted entities yesterday of their plans for RADV (Risk Adjustment Data Validation) audits for Payment Year 2012.  Organizations will be notified on Sept 14 if selected for an audit.  (If anyone wants to know details of the pain involved in a RADV audit, ask me…) 

RADV audits are conducted to enforce…

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New Enrollee Designation, HPMS Memo 8/14/2015

When a participant first becomes eligible for Medicare, there are no ICD9 codes on which to base a payment using the Risk Adjustment model. The reason being, that this year’s payment is based on ICD9 codes submitted from last year, and a newly enrolled participant to Medicare has no data on which to base payment. Therefore, the participant is assigned to the “New Enrollee” RA Factor Type Code. He/she will remain in that category until they have 12 months of Medicare Part…

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