By Debbie Ploschnitznig, CRN-C
Degenerative disc disease (DDD) describes the symptoms of pain and possibly radiating weakness or numbness stemming from a degenerated disc in the spine. Simply put, degenerative disc disease occurs when an intervertebral disc loses its integrity, eventually causing pain. The condition is most often caused by age-related deterioration of the spine. (more…)
By Richard Schamp, MD, CEO
PACE organizations are accustomed to receiving final reconciliation of the prior year’s Part C and Part D payments in July. This reconciliation is reflected in the Monthly Membership Report (MMR) and typically includes a positive true-up payment, especially if retrospective reviews were done in timely fashion. However, this year the PY2016 reconciliation is delayed until October, as CMS communicated during their April CMS Risk Adjustment EDS & RAPS User Group presentation. The delay is due to…
We have been describing multiple aspects of risk adjustment compliance in our newsletters, along with helpful tips on documentation and coding. CMS requires PACE, Medicare Advantage and similar organizations to submit all relevant diagnosis codes at least once yearly. A “relevant” code is one that impacts Part C or Part D payment. Failure to submit all relevant codes is an important compliance issue. To help our clients with the dual challenges…
By Richard Schamp, MD
CEO, Capstone Performance Systems
Definitions
Nephropathy refers to any disease of the kidney. In common clinical parlance, the term is modified by an etiology referring to one of over a dozen types, such as analgesic nephropathy, gouty nephropathy or most commonly, diabetic nephropathy. Chronic Kidney Disease (CKD) is defined by GFR (Glomerular Filtration Rate) less than 60 ml/min per 1.73 m2 and/or kidney damage for three or more months. The presence of albuminuria is most commonly used to…
It is unlikely that a clinician would overlook properly documenting a patient with neurologic quadriplegia resulting from a cervical spine injury. However, somewhat less obvious might be functional quadriplegia that results from a patient’s severe weakness. This condition is the inability to move due to disability or frailty caused by another medical condition but not from direct physical injury or damage to the brain or spinal cord (ACP Hospitalist Coding…
By Jan Deyber, CRN-C, and Tiffany Brookshire, BSN, CRN-C
We often see inconsistency in medical records regarding diagnoses as current or historical. Documenting “history of” when referencing a patient’s past medical background is a longstanding practice. Providers may intend a “present perfect” tense – a condition that started in the past and continues in the present. However, in the world of diagnosis coding, “history of” indicates a past (or past perfect) tense; in other words, a condition that no longer…
by Richard Schamp, MD, Chief Executive Officer
When documenting in the medical record, providers should take care to capture their thoughts and findings as completely as possible. Best practice is to document the patient encounter at the time, or shortly afterwards. Inevitably, situations require some changes in the medical record, of which four types are recognized. (more…)
by Katina Yablinsky, CRN-C
In October 2016, there was an update to the ICD-10 coding guidelines that allows a coder more flexibility in assigning certain codes. Previously, the guidelines stipulated that if two conditions are related to each other, the provider needs to document their relationship for them to be coded as such. (more…)
On Target recognizes a client who is showing process improvement from putting Capstone’s processes and advice into action.
Pain points
ICD-10 was the tipping point. CMS’s implementation of the new edition of the coding system was the point of no return for Senior Total Life Care (STLC), a PACE organization serving 175 participants in a rural area less than 20 miles outside of Charlotte, North Carolina. (more…)
by Richard Schamp, M.D., C.M.D., C.H.C.Q.M., Chief Executive Officer
Several times in 2016, my comments in this column have emphasized elements related to corporate compliance with regulations and rules governing documentation and coding. As 2016 comes to a close, I wish to share two key messages from a recent compliance and auditing conference.
Listening to presentations from several prominent healthcare lawyers, I was reminded of the priority (which we have mentioned repeatedly here) for all healthcare organizations, especially health plans, to have…