John C. Stolze
John C. Stolze has joined Capstone Performance Systems as Senior Vice President of Business Success. Stolze brings to Capstone an in-depth understanding of the operations side of PACE, accountable care organizations (ACOs) and physician groups with a strong suit in value-based care. He most recently served as director of operations and population health for St. Anthony’s Physician Organization in…
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…
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…