![]() The CodingIntel Guide to Hierarchical Condition Categories provides a comprehensive list of HCC and Risk Adjusted Diagnosis Coding resources available on CodingIntel.įor more about HCCs and Risk adjusted diagnosis coding, Join CodingIntel. Medical groups that are part of Accountable Care Organizations (ACOs) or that have commercial risk based contracts need to assign diagnosis codes carefully. Patient seen and noted to have “history of XXX cancer” but no current evidence of disease or current treatmentĬode indicating malignant neoplasm, starting with the letter CĬode from category Z85.-, Personal history of malignant neoplasm G45.- Transient cerebral ischemic attacks and related syndromes Patient seen in office, ED follow up for TIA Z86.73 Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits Patient seen in office, hospital follow up for stroke This brings me to a compliance issue in HCC coding. The diagnosis codes for current stroke and sequelae of a past stroke (I63, I69) do have HCC weighted scores assigned to him. Risk adjustment for history of conditionsīut would history of a stroke increase the risk score? That is, if the group has risk based contracts, does adding history of stroke increase the risk score for that patient? The answer is no. If the diabetes is listed in the problem list but not mentioned in the encounter for this date of service, I do not add it to the claim form. The diabetes affected patient care and the clinician documented that it affected patient care. If the urgent care provider says in the assessment, “I’d like to give her prednisone, but I’m not going to because of her diabetes,” then I add diabetes to the claim form. The example I use most frequently is the patient who presents to urgent care with a bad case of poison ivy. Risk Coding for Medical Practices and Outpatient Services “I have reassured him that his symptoms are not consistent with a blood clot, and there is no reason to order an ultrasound.” Or, “I think in light of his history of a stroke, we should do further testing to rule out a thrombolytic event.”Īnd while I agree with her that the history provides a clearer picture, it is the physician’s job to document a picture.ĬodingIntel has a more in-depth article about the ICD-10 and CMS risk adjustment rules in code selection. “He does have a history of stroke, and with his recent injury is at risk of a clot.” In order for me to use the past history of the stroke on the claim form, I would have had to see that the clinician mentioned it in the history of present illness. I wouldn’t assume that the physician/NP/PA was thinking about that in terms of the thigh pain after the injury, even though it is on the problem list. Problem lists, and past medical history in electronic health recordsīut, while it may be relevant to this encounter, without documentation that the clinician was thinking about this past stroke, I would not add it to the claim form. While I applaud her clinical knowledge, when selecting ICD-10 codes for office visits, follow ICD-10-rules and CMS risk adjustment guides. ![]() Coding history of CVA code as a secondary would give a clear picture.” The physician does not document this correlation, however the old CVA could affect treatment or care. There could be a correlation to a thrombosis or blood clot that the physician must consider. “However, I am a believer that although the patient is not being seen or treated for the chronic condition or history of condition, they all play a pertinent part in the patient care and overall acuity of the patient.Īn example is patient had CVA listed in the PMH and current encounter is for thigh pain without known injury. ![]() “Code all documented conditions that coexist at the time of the encounter and require or affect patient care or treatment.” She and I were in agreement that we should follow the ICD-10 guideline that states: I stated that in order to include the condition on the claim form, there should be documentation in the history of the present illness or the assessment and the plan that the condition was assessed and managed at the encounter. She was responding to an article that I wrote in which I stated the conditions listed in the past medical history should not be included on the claim form by the coder. Recently a fellow coder wrote to me about risk adjusted diagnosis coding. This post describes rules for office/outpatient coding, not facility/DRG rules.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |