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
  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...