Wiki WPS - Status of 3 Chronic Condition changing standing

[CBaer]

Just sent in an eMews from WPS

WPS Medicare Part B Legacy and MAC eNews for Thursday, March 22, 2012
********************************************************************
Status of Three Chronic or Inactive Conditions in the History of Present Illness (HPI)
Effective for dates of service April 19, 2012, and after WPS Medicare Part B will change the way we adjudicate the extended level of HPI when practitioners use the 1995 Documentation Guidelines (DG) to document their services.

The 1995 DG states: "An extended HPI consists of four or more elements of the HPI." The 1997 DG states: "An extended HPI consists of at least four elements of the HPI or the status of at least three chronic or inactive conditions." WPS Medicare Part B applied the 1997 DG statement to medical record documentation under both the 1995 and the 1997 DG based on a communication received from the Centers for Medicare&Medicaid Services (CMS) several years ago. The Comprehensive Error Rate Testing (CERT) contractor does not have that same communication and does not adjudicate documentation that way. Therefore, effective for dates of service April 19, 2012, and after, WPS Medicare Part B will no longer apply the statement from the 1997 DG to documentation when practitioners use the 1995 DG.

 

[Love Coding!]

Just sent in an eMews from WPS

WPS Medicare Part B Legacy and MAC eNews for Thursday, March 22, 2012
********************************************************************
Status of Three Chronic or Inactive Conditions in the History of Present Illness (HPI)
Effective for dates of service April 19, 2012, and after WPS Medicare Part B will change the way we adjudicate the extended level of HPI when practitioners use the 1995 Documentation Guidelines (DG) to document their services.

The 1995 DG states: "An extended HPI consists of four or more elements of the HPI." The 1997 DG states: "An extended HPI consists of at least four elements of the HPI or the status of at least three chronic or inactive conditions." WPS Medicare Part B applied the 1997 DG statement to medical record documentation under both the 1995 and the 1997 DG based on a communication received from the Centers for Medicare&Medicaid Services (CMS) several years ago. The Comprehensive Error Rate Testing (CERT) contractor does not have that same communication and does not adjudicate documentation that way. Therefore, effective for dates of service April 19, 2012, and after, WPS Medicare Part B will no longer apply the statement from the 1997 DG to documentation when practitioners use the 1995 DG.

So in a nutshell, cannot use the status of 3 chronics or inactive conditions for the HPI under the 95' guidelines...

 

[tbramhall]

WPS Change

I work for Internal Medicine clinic and we have WPS for our Medicare carriers, so this will be a change in documentation for my six providers. So starting today, I have set up a meeting with each to discuss the changes needed in their documentation; to make sure it is in place starting next week; being pro active.

 

[dyates]

I, too, work for a large internal medicine group. I'm being asked how can I document 4 of the eight elements in the HPI for stable hypertension, stable diabetes, they can get the ROS and PFSH with no problem.

Any advise is appreciated.

 

[losborn]

That is only two stable chronics - not eligible under either '97 or '95.

Lin

 

[Love Coding!]

That is only two stable chronics - not eligible under either '97 or '95.

Lin

Hi Lin,

I think what Diana was asking is how to abstract 4 elements for conditions like Hypertension and Diabetes...let me get a shot at this..

Hypertension:

How long has the patient been living with hypertension: Duration
What type of medications does the patient use for hypertension: Modifying factor
Are there any other associated symptoms along with the hypertension: Assoc. signs & symptoms
What time of the day is the hypertension mostly controlled/uncontrolled: Timing

Diabetes Mellitus

How long has the patient been living with diabetes: Duration
What type of medications does the patient use for diabetes: Modifying factor
Are there any other associated symptoms along with the diabetes: Assoc. signs & symptoms
Is the diabetes controlled or uncontrolled: Quality

I hope this helps...

 

[MISSMOUSE01]

What type of medications does the patient use for ........: needs to state if it's helping, we have been told.

 

[Captain74]

Update?

I stumbled upon this post while looking for this exact information, but did some further digging and found this had actually been updated. What a life saver.

This is from WPS:
We removed the guide from our website and are not enforcing the major change concerning the usage of the status of 3 chronic conditions for the 95 Documentation Guidelines (DG) at this time. We are currently in discussion with CMS on this issue.

From website for Illinois and Michigan:
http://www.wpsmedicare.com/part_b/training/outreach_advisory_group/_files/2012-0614-ilmi-minutes.pdf

From website for Minnesota and Wisconsin:
http://www.wpsmedicare.com/part_b/training/outreach_advisory_group/_files/2012-0612-mnwi-minutes.pdf