Coding Counts

You’re Invited to the 2017 Provider and Risk Adjustment Workshop

August 1, 2017

Join us for a workshop about the relationship between Carle and Health Alliance as it relates to risk adjustment, the importance of accurate ICD-10 CM coding and documentation, population health, and the new provider education module.

2017 Provider and Risk Adjustment Workshop

Thursday, October 26

6 to 8 p.m.
Doors open at 5:30 p.m.
Carle Forum

Add this event to my Outlook Calendar.
Check your email for invites, reminders, and to RSVP.

 

Presenters Topics
James C. Leonard, MD The relationship between Carle and Health Alliance as it relates to risk adjustment, the importance of accurate ICD-10 CM coding and documentation, and what you can do to help
Robert G. Good, DO Changing healthcare outcomes through population health
Jens A. Yambert, MD Provider education module available for 2018

Documentation Counts

June 27, 2017

Using accurate diagnoses codes with supporting documentation provides a comprehensive assessment of a patient’s health status during encounters. These are some things to consider when choosing and documenting diagnosis codes:

Specificity

Accurately represent the severity of a patient’s condition with specificity in diagnosis coding.

Example: Reporting type II diabetes mellitus without complications (E11.9) for a patient diagnosed with type II diabetes mellitus with diabetic nephropathy (E11.21).

Causal Relationship

Provide better details of patients’ service needs with documentation worded to show a linked relationship between conditions and manifestation. Try using words like “with,” “due to,” and “associated with.”

Example: Reporting hemiplegia (I69.059) due to CVA that occurred 3 months ago for a patient receiving physical therapy services.

Sequelae (Late Effects)

ICD-10 gives you the opportunity to report residual conditions that occur after an acute phase of an illness is over. Use sequelae codes (previously known as late effects) to give a more accurate description of a patient’s health status.

Example: Reporting hemiplegia following non-traumatic subarachnoid hemorrhage, affecting right dominant side (I69.051), instead of unspecified hemiplegia, affecting right dominate side (G81.91).

Status Codes

Status codes are both informative and can affect the course of treatment and outcomes. We depend on the help of our provider partners to document and report the following, when applicable to a patient, in a face-to-face encounter at least once each calendar year:

  • Amputations (Z89.0-Z89.9)
  • Ostomies (Z93.0-Z93.9)
  • Dialysis status (Z99.2)
  • Respirator dependence (Z99.11)
  • Alcohol dependence in remission (F10.21)
  • Drug dependence (F19.20)

Active vs. History of Cancer

Active cancer codes (C00-D49) support a present malignancy or one previously excised, yet treatment is ongoing through adjuvant therapy, like Lupron for prostate cancer.

Active cancer documentation should state:

  • Active cancer, receiving ongoing treatment
  • Active cancer, patient declines treatment
  • No evidence of active cancer and receiving adjuvant therapy

Personal history of cancer codes (Z85.00-Z85.89) support that a patient’s malignancy no longer exists. This code series also supports that a patient is not receiving active or adjuvant treatment, but that the cancer has the potential for recurrence and requires continued monitoring and surveillance.

M.E.A.T

To create an accurate reflection of conditions in documentation, certain elements are required in order to support the diagnosis codes. Auditors from CMS and other governing entities use the acronym M.E.A.T. while looking for correct diagnosis code selection and reporting on encounters.

These elements include:

  • Monitor – Signs, symptoms, disease progression
  • Evaluate – Medications, test results
  • Assess/Address – Counseling, review of records
  • Treat – Medications, therapy

Conditions only listed on a patient’s problem list without associated M.E.A.T. do not meet the requirements for accurate coding and documentation, causing a misrepresentation of the patient’s condition, which keeps us all further away from meeting our goal of being audit proof.

 

2017, Optum 360 ICD-10-CM Expert for Physicians
2014, AAPC Risk Adjustment Predictive Modeling, Documentation, and Capture of Diagnosis Codes

Fractures

August 19, 2016

This month, we’re focusing on coding fractures to the highest specificity by defining the types of fractures and reviewing the use of the 7th alpha character in ICD-10 to identify the episode of care.

Types of Fractures Description
Open Fracture Also known as a compound fracture, this is when the bone breaks through the skin.
Closed Fracture Also known as a simple fracture, this is when the bone breaks, but there is no open wound to the skin.
Complete When the bone breaks into 2 or more parts.
Incomplete When the bone cracks, but does not break all the way through.
Stress When the fracture is a hairline crack
Displaced When the bone breaks into 2 or more parts and moves so that the 2 ends are not lined up straight.
Non-Displaced When the bone either cracks or breaks all the way through, but does not move and maintains its proper alignment.
Pathological When the fracture is caused by a disease that weakens the bones.
Routine Healing When the fracture has healed as expected in an appropriate amount of time.
Delayed Healing When an appropriate amount of time has elapsed, and the fracture has not healed, but there is still a reasonable expectation that the fracture will heal.
Nonunion When a fractured bone fails to heal after an extended recovery period. These can be a result of delayed healing.
Malunion When a fractured bone heals in an abnormal position.

Note: If documentation does not indicate the fracture as displaced or non-displaced, it should be coded as displaced. A fracture not documented as open or closed should be coded as closed.

ICD-10 includes laterality and a 7th alpha character depicting:

7th Alpha Character Description
A – Initial Patient is receiving active treatment for the fracture. Examples of active treatment include:

  • Surgical
  • Emergency room encounter
  • Evaluation
  • Treatment by a new physician
D – Subsequent Encounters for care after the patient has completed active treatment for the fracture and is receiving routine care for the fracture during the healing or recovery phase. This includes:

  • Cast changes or removal
  • Removal of internal or external fixation device
  • Medication adjustments
  • Surveillance while the fracture heals
S – Sequela Reports the after effects, late effects, and other adverse conditions that occur after the healing and recovery phase of the injury.

When reporting sequela, 2 codes are needed:

  • The specific sequela is sequenced first
  • The injury code is sequenced second with the 7th character S

Note: The 7th character “S” is only added to the injury code, not the sequela code.

 

ICD-10 Code Description
M21.751 Unequal limb length (acquired), right femur
S72.331S Displaced oblique fracture of shaft of right femur, sequela

If you have any questions, email CodingCounts@healthalliance.org.

 

ICD-10-CM Optum 2015 ICD-10-CM expert for physicians
Optum 2015 detailed instruction for appropriate ICD-10-CM coding
American Academy of Orthopedic Surgeons

Osteoporosis – With or Without Pathological Fracture

June 27, 2016

Age-Related Osteoporosis with Current Pathological Fracture

Report category M80.0 codes when a patient with age-related osteoporosis has a “fragility” fracture from a minor fall or trauma.

ICD-10 combination codes classify:

  • Type of osteoporosis
  • Site of pathological fracture
  • Laterality
  • Encounter episode
ICD-10 Code Description
M80.08XA Age-related osteoporosis with current pathological fracture, vertebra(e), initial encounter
M80.051A Age-related osteoporosis with current pathological fracture, right femur, initial encounter

When coding pathological fractures, use the seventh character A (initial episode) through the entire course of treatment for the fracture.

Age-Related Osteoporosis without Current Pathological Fracture

Report category M81.0 codes when a patient has age-related osteoporosis without a current pathological fracture.

Note: If the patient has a history of a pathological fracture that has healed, first code the osteoporosis and then the history of pathological fracture due to osteoporosis.

ICD-10 Code Description
M81.0 Age-related osteoporosis without current pathological fracture
Z87.310 Personal history of (healed) osteoporosis fracture

 

If you have any questions, email CodingCounts@healthalliance.org.

You’re Invited! Carle HIM & Health Alliance Provider Workshop

April 19, 2016

You’re Invited!

Carle HIM & Health Alliance Provider Workshop: Audits
Thursday, April 28, 6–8 p.m.

Health Alliance Risk Adjustment Revenue Management and Carle Health Information Management invite you to join us for an evening of discussion on the different types of audits facing our health systems.

Topics include:

  • Carle RAC administrator role
  • Data validation audits:
    • The hospital
    • The health plan

When: Thursday, April 28, 6–8 p.m. Doors open at 5:30 p.m. for refreshments and light snacks.

Where: The Forum at Carle Foundation Hospital

RSVP: Seats are limited. Please RSVP to CodingCounts@healthalliance.org by Friday, April 22.

 

Approved for 2.0 AMA PRA Category 1 CreditsTM

The seminar is open to all healthcare professionals who provide care, document services, code and/or bill in any of our participating provider groups and offices.

By the end of the seminar, you will be able to:

  • Describe the different types of audits presented
  • Understand the role that the Carle RAC Administrator plays within the organization
  • Understand the impact of government audits on payment at the national and Carle levels


Carle Foundation Hospital is accredited by the Illinois State Medical Society to provide continuing medical education for physicians.

Carle Foundation Hospital designates this live activity for a maximum of 2.0 AMA PRA Category 1 CreditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

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