Wiki Coding with MEAT or not

[princesskass16]

I have been doing RA coding for insurance companies for 4 years now. When I was originally trained, I was told to look for MEAT or TAMPER for every RA code before submitting to CMS. However, CMS also says to follow ICD 10 guidelines. In the 2017 ICD 10 guidelines, this statement was added: "Diagnosis code assignment must be based on the provider's diagnostic statement that the condition exists and is not based on clinical criteria the provider used to establish the diagnosis. Conflicting documentation must be queried."

Does this mean that we should be coding anything the provider says in his or her note and not be checking to see if the documentation meets "MEAT" requirements anymore? A lot of our providers just write diagnoses in the A/P section and don't talk about the disease whatsoever.

I am just getting very confused now on what to do. Thanks!

 

[FerenczK@aetna.com]

Coding with MEAT-

I think you are misinterpreting the ICD guidelines. What this means is that you cannot code based solely on the clinical information. Example, you cannot code diabetes based on a recorded HgA1C value, or CHF/CM based on an ejection fraction. The provider must document the condition, it is not for you or me, as coders, to decipher and interpret clinical data and assign a diagnosis.

 

[mitchellde]

in my experience you need to be careful about pulling the diagnosis listed in the A/P section. Many time those are codes and descriptions pulled there by the EHR from previous notes creating a problem list and not diagnosis rendered by the provider at that encounter. I always verify that the provider addressed that issue before I code it.