By Richard Schamp, MD
CEO
Richard Schamp, MD, CEO
In our last edition, I mentioned the burgeoning new competency for physicians and other clinical providers – clinical documentation excellence. Let’s delve further into some specifics around the kinds of competence required in a risk-adjusted payment model. CMS has a process to verify that diagnosis codes reported that are relevant for payments in the HCC (Hierarchical Condition Category) model…
By George “Mike” Brett, MD
Senior Vice President of Consulting and Chief Medical Officer
George “Mike” Brett, MD
Senior Vice President of Consulting and Chief Medical Officer
In addition to demographic information and HCCs, a portion of a PACE participant’s risk score is derived from the Frailty Factor (FF). Eligible participants in PACE have the FF added to their risk score because the CMS-HCC Model…
By Amanda Piern, CRC
Risk Adjustment Coder
ICD-10-CM significantly expanded the codes available for substance use disorders (SUDs). To properly code for these disorders, the diagnosis documentation should include the type of use disorder.
The ICD-10 index includes the following use disorders:
• Alcohol use
• Amphetamine-type substance use
• Cannabis use
• Cocaine use
• Hallucinogen use
• Inhalant use
• Opioid use
• Phencyclidine use
• Sedative
• Hypnotic
• Anxiolytic use
• Stimulant use (other) (unknown)
• Substance use (other) (unknown)
In each case, the provider must document the severity of…
By Richard Schamp, MD
CEO
Richard Schamp, MD, CEO
Multiple risk adjustment models are active across the US healthcare landscape. If you are reading this, you probably already live in a risk-adjusted payment world. For example, the Centers for Medicare & Medicaid Services (CMS) uses a risk-adjusted model that pays PACE and Medicare Advantage plans based on a person’s demographics and age, with additional payments made per qualifying…
By Lynn Diorio, CCS-P, CRC
Risk Adjustment Coder
Coding for diabetes can be a daunting process. Clear and concise documentation by the provider is key in helping to ensure that the condition is captured appropriately. There are five major categories that diabetes can fall into in ICD-10: Type 1 (E10); Type 2 (E11); Diabetes due to underlying condition (E08); Drug or chemical-induced (E09); and other specified (E13).
By Jennifer Zimmerman
Client Success Specialist
The Health Insurance Claim Number (HICN) to Medicare Beneficiary Identifier (MBI) CMS initiative will take another step forward in 2018. The transition in the MARx User Interface will begin in April, and, in preparation, a MARx HICN to MBI Crosswalk File will be generated for each Plan.
In March, PACE Plans will receive an “initial” HICN to MBI Crosswalk file which will include current membership back to 2006. A monthly file will be sent thereafter to…
By Richard Schamp, MD
Chief Executive Officer
Our service to clients involves reading encounter notes for coding, auditing and training purposes. We read A LOT of notes. Sometimes we see portions of notes that are strikingly similar to previous documentation. Copy/pasting, also known as cloning, enables users to select information from one source and replicate it in another location. When doctors, nurses, or other clinicians copy/paste information but fail to update it or ensure accuracy, inaccurate information may enter the patient’s…
By Susan Trapuzzano, RN, CPC, CRC
Lymphoma is a type of blood cancer originating from the lymphatic system. Lymphomas are classified into two main categories, Hodgkin’s and non-Hodgkin’s lymphoma.
Hodgkin’s lymphoma affects the lymph nodes or extranodal lymphoid tissues, such as stomach, spleen, lung, bone and skin. Most often, this disease originates in a lymph node and spreads to adjacent nodes or to extranodal tissue via the lymphatic system. The most common symptoms are often painless, enlarged lymph nodes (neck, armpits…
By Debra L. Byble, CPC, CRC
When ICD-10-CM was implemented, it was no longer necessary to code for the difference between extrinsic or intrinsic asthma. Found in section J45 of ICD-10-CM, asthma now requires documentation of mild, medium, and severe asthma. Further documentation is needed to assign the correct code between the differences of intermittent, and persistent. The greater specificity of ICD-10-CM requires another level of detail: uncomplicated, (acute) exacerbation, and status asthmaticus.
Below are some samples of how the codes…
By Richard Schamp, MD
CEO, Capstone Performance Systems
Capstone is pleased to continue its growth and to support to PACE and other organizations providing care to vulnerable citizens. To better serve our clients, we have recently welcomed several new staff members to the Capstone team with a wealth of experience directly relevant to the needs of our clients. See the article below for more details about our new colleagues. Additionally, be on the lookout for announcements in the coming months as…
