Recent content by rmwinder

  1. rmwinder

    The use of MEAT

    It is in my opinion. :) Where I work, it is.
  2. rmwinder

    Question Need clarification on E11.22 code DM with diabetic Chronic Kidney Disease- Add code

    However, you would code the CHF if this was an inpatient record. And even in an Outpatient setting, CHF is seldom just resolved - although if definitely can be resolved. If you have a way to query your doctor, ask if the CHF exacerbation is resolved, but do they still have CHF? If so, and if...
  3. rmwinder

    Need clarification on DM w/complication codes

    Certainly. That's why we are certified to catch those sort of things. In that scenario, you'd definitely delete the one and capture the correct one. I am in no way saying just capture everything in the A/P and be done with it. 1. If no support - Query 2. If you cannot query - if you work for a...
  4. rmwinder

    Need clarification on DM w/complication codes

    Thanks for the Coding Clinic! I actually have access to the Coding Clinics back through 2014, and I agree, the providers may not just list the Alpha-Numeric code in the diagnostic statement. In other words...they cannot just put E11.36 in the Assessment and expect that to be sufficient. But...
  5. rmwinder

    Need clarification on DM w/complication codes

    Is there any way you can supply the AHA Coding Clinic you are referring to?
  6. rmwinder

    Need clarification on DM w/complication codes

    DM is one With EMR's being the 'norm' now the following snip I've included is what you'll come across a majority of the time. What makes it acceptable is the Description column. We all know we cannot confirm a diagnosis code by the code...the alpha-numeric code itself, but the description of...
  7. rmwinder

    HCC Trump List

    Hey Amy! Yes, I believe that is what they are asking for.
  8. rmwinder

    Question HCC 140 Renal Failure

    For PY (Payment Year) 2019, See page 86 for Disease Trumping List https://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/Downloads/Announcement2019.pdf
  9. rmwinder

    Question HCC 140 Renal Failure

    Hi Myla, Yes, I am an Auditor for a large payer, working strictly in Medicare Risk Adjustment. What would you like a source for? CMS info in general, or the Hierarchy chart? Here's a link to the CMS Managed Care Info file. Chapter 7 is Risk Adjustment...
  10. rmwinder

    Need clarification on DM w/complication codes

    @Pathos as it happens, I am not entirely comfortable with my responses. I am still looking into this too. In fact, I know I had the RADV audit rules document somewhere, and was trying to find time to see if there was any further guidance in that, but I cannot find it right now. I do believe...
  11. rmwinder

    Question HCC 140 Renal Failure

    Anemia in CKD - D63.1 doesn't risk adjust, so there's no need to pick it up unless you're doing full capture. ESRD - N18.6 (HCC 136) instructs to also capture the dependence on dialysis, like you have above - Z99.2 (HCC 134) Z99.2 actually trumps N18.6. Z99.2 has no instructional note to...
  12. rmwinder

    Medicare & Naturopathic

    They aren't recognized because they don't deal in real medicine.
  13. rmwinder

    Risk Adjustment Chart Review

    Most MA plans do have record retrieval specialists too. I wonder if they could go onsite to retrieve the records?
  14. rmwinder

    HCC = Big check from Medicare?

    Sometimes your physician office may be in a contract with a Medicare Advantage company where they work in partnership to accurately capture all diagnosis codes on all their patients. Usually your office has to have a large patient membership with a particular MA plan (Cigna, UHG, Humana, etc)...
  15. rmwinder

    Need clarification on DM w/complication codes

    Just going to leave this right here! From ICD-10 guidelines in the front of everyone's book... Of course, use your best judgement. If a doctor documents a critical care code only to be used in an acute care setting, and he doesn't document the patient going right to the hospital, then, no...
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