Because no one answered I figured I may as well just in case someone else needs this information...
Below find the following scenerio
Brief background: The client provides high quality services in support of birth, foster, and adoptive families who are caring for children with special medical needs at home. Their innovative services ensure that the physical, social, educational, recreational, healthcare, and mental health needs of medically fragile children are met. By supporting families, they prevent the institutionalization of children, precludes lengthy stays in foster care, and facilitates the timely discharge of children from hospitals where they may have lived well beyond medical need. Many of their clients have chronic medical conditions in addition to a history of mental health illness. Weâ€™ve assess their APG readiness and found the below risks as it relates to coding. Can you please review and advise of the coding decision making in response to the below questions? If you feel we need to discuss in more detail before you can respond please feel free to send me and e-mail and weâ€™ll coordinate. Thank you.
What guidelines should the client follow in coding chronic vs. acute diagnoses (i.e. patient scheduled for a preventive visit with history of cerebral palsy)) The answer to this is: The diagnosis for the visit is the primary reason for the visit. If Chronic diagnosis are addressed they should also be coded.
What determines how the diagnosis codes should be ordered? Primary reason for the vist and any additional co morbidities that effect treatment or decision making
What role does the time spent on each condition during the visit play in what diagnosis codes are included and their order? No role Time is not the deciding factor unless 50 % or more of the vist was made up of counceling and or coordination of care
What factors other than time spent influence the coding? Medical visits under APG's are reimbursed based on the diagnosis APG weight. If a procedure is part of the encounter then the visit would be reimbursed based on the procedure weight. Packaging and discounting may apply.
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