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  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...
  16. rmwinder

    Need clarification on DM w/complication codes

    I agree with you... of course, one would not assign a breast cancer code if it were in the A/P without further support, such as continued treatment. I was operating on the fact that the original poster's record had a FBS report and instructions to continue Levemir. So there's no question that...
  17. rmwinder

    Diagnosis Coding help

    Hi, about a year late...:) M46 is a category for "Other Inflammatory Spondylopathies", and it looks like that is what one is supposed to select when following the ICD-10 index path. However, we wouldn't select a code from M46 unless we had the verbiage of 'inflammatory'. Since it appears you...
  18. rmwinder

    Wiki facet arthropathy

    bhavana... I fell into that trap too. :) However, unless there is a specific type of arthritis, Coding Clinic 2016, 4th quarter, instructs us to default to "osteoarthritis", M19.--. M46 category is Inflammatory spondylopathy category...which we couldn't select from unless the physician...
  19. rmwinder

    Diabetes with Manifestation

    I'm an HCC coder and we've been taught that, yes, pick up the 250.50 and if the manifestation isn't stated, you don't have to code it. Your instincts are correct that the record said DM w/ ophthalmologic (sp?) manifestations - you code just that. That came up soooo many times. We had meetings...
  20. rmwinder

    DX documentation

    No, no, no... The opposite is true. The doctor has to state in words what is wrong. You, as the coder, picks the correct code. He may write down the wrong code. This is a recurring theme I've been noticing. I looked up some backup for it the last time. Can't remember where I found it, but it...
  21. rmwinder

    Need additional Dx?

    I think you are correct to use this category since the instructional note says this category will also be used to classify bacterial infections of unspecified nature or site. And that is indeed what you are dealing with. However, you didn't mention if your documentation noted a group of strep...
  22. rmwinder

    Wiki GIST-gastrointestinal tumor DX on path/44120

    A GIST tumor is a sarcoma and as such is definitely malignant. But, since this thread is so old, I'm sure that doesn't help you anymore! Hopefully, anyone seeing it in the future will benefit.
  23. rmwinder

    DRG's in ASC's

    I'd call Oklahoma WC if I were you and get some clarification, because DRG's are strictly inpatient related. They are Diagnosis Related Group's. In other words if an inpatient has a certain diagnosis upon discharge, the hospital is paid a set amount, according to the DRG assigned by the coder...
  24. rmwinder

    Follow up for resolved condition

    What about V67.59 and thrush as an additional code if you feel like you need to??
  25. rmwinder

    Fracture Diagnosis

    Well you can't pay any attention to the verbiage "likely to...". So you would have to just use 'scaphoid fracture' and also not use 'indeterminate age', and since it isn't open (otherwise doc wouldn't have to 'rule out' - which is a no-no for outpatient coding).. you'd probably use 814.01. If...
  26. rmwinder

    Wiki DX code for AKI (Acute Kidney Injury)

    Just an FYI for you... It seems that "Acute Kidney Injury" is new terminology approved by the National Kidney Foundation instead of using "acute renal failure". Don't know why they wanted that - which has no diagnosis code attached to it. It was creating a lot of havoc w/ our coders, too...
  27. rmwinder

    HTN - urgency

    When doctors say 'hypertensive urgency', they usually just mean that the hypertension has caused or is the problem. Urgency or Crisis, etc. are just non-essential modifiers. Things doctors say, that have no bearing on the code. So you just code hypertension, malignant, benign or unspecified...
  28. rmwinder

    Wiki COPD Diagnosis

    If all you have is COPD w/ exacerbation, and that's the only description you have (exacerbation), no mention of bronchitis or emphysema or asthma, it is 491.21. To get any other diagnosis, you'd need clarification on it, you'd have to query the physician as to exactly the type of COPD.
  29. rmwinder

    status post vs history

    Also, you might check w/ your state quality review board or whatever it's called in your state - the entity contracted w/ Medicare to ensure correct coding. Here in Alabama it's AQAF - Alabama Quality Assurance Foundation. AQAF has told us (facility coders) that whenever someone has had a...
  30. rmwinder

    thoracic syrnix

    That is exactly the correct code. I had the same question last month. A syrinx is a syringomyelia. If you work for a facility and use 3M encoder, you get nothing if you type syrinx... So I had to ask my nurse/guru supervisor. She was perplexed as to why the encoder would not take "syrinx"...
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