Apply MEAT to Support Chronic Condition Coding
Question: A Medicare Advantage patient presents for a routine follow-up visit. The provider documents type 2 diabetes mellitus, CKD stage 3a, and COPD on the problem list. The note also states: “A1C reviewed; diabetes is stable on metformin. eGFR remains consistent with CKD stage 3a; avoid nephrotoxic medications and repeat CMP in 3 months.” COPD is listed in history, but there aren’t any symptoms discussed, and no treatment plan is documented. Which diagnoses should I report for risk adjustment, and how does monitor, evaluate, assess/address, and treat (MEAT) affect the decision? Idaho Subscriber Answer: You may report the diabetes and chronic kidney disease (CKD) diagnoses if the documentation supports the assigned ICD-10-CM codes, but you should not report chronic obstructive pulmonary disease (COPD) from this encounter for risk adjustment unless additional documentation supports it. MEAT helps coders identify whether the provider actively considered the condition instead of merely listing it. The record does not need to contain all four MEAT elements for every diagnosis, but it should include enough encounter-specific evidence to support the reported condition. In this scenario, the diabetes documentation supports MEAT because the provider reviewed the A1C, which can reflect blood sugar levels over time; evaluated the condition as stable; and continued metformin. The CKD documentation also supports MEAT because the provider evaluated kidney function, assessed the stage, addressed medication risk, and ordered follow-up labs, like the comprehensive metabolic panel (CMP). However, according to the documentation you’ve shared, COPD appears only as a carried-forward problem-list item; the provider did not document current symptoms, disease status, medication management, counseling, testing, or a plan related to COPD during this encounter. Generally, a diagnosis needs to be more than a “problem-list” condition to count for risk adjustment. Documentation should show that the condition required or affected patient care, treatment, or management during the visit. In such cases, coders should look for evidence such as lab review, medication effectiveness, disease status, ordered tests, counseling, referrals, or a treatment plan. If the note is unclear and the condition may have affected care, follow your organization’s query policy instead of assuming the diagnosis is reportable. Rachel Dorrell, MA, MS, CPC-A, CPPM, Production Editor, AAPC
