Wiki How to appropriately bill when capturing additional diagnoses that you have sufficient documentation to support but were not a real focus of the appt

[ohaqmd]

I am trying to find an answer for a situation where the PCPs are dropping diagnoses with MEAT in the assessment and plan part of an outpatient visit note, but are disassociating the diagnoses from the bill. I guess my question is if this is correct, and also, if they are disassociating the diagnoses from the bill then will the RAF/HCC for those diagnoses get captured by the payers for the year? Is there a difference between claim diagnoses and billing?

I'll share an example:
A physician working in risk adjustment stated, "If during an OV (office visit) for something acute or not directly related, I will add the HCC code(s) for the year that have been flagged. I typically will say something to the effect that problem is stable, managed by specific specialty, and will follow, and I will state NOT directly discussed at visit just for clarification. I also unlink the HCC dx from billing code if not part of visit."

 

[Cls1530]

I am trying to find an answer for a situation where the PCPs are dropping diagnoses with MEAT in the assessment and plan part of an outpatient visit note, but are disassociating the diagnoses from the bill. I guess my question is if this is correct, and also, if they are disassociating the diagnoses from the bill then will the RAF/HCC for those diagnoses get captured by the payers for the year? Is there a difference between claim diagnoses and billing?

I'll share an example:
A physician working in risk adjustment stated, "If during an OV (office visit) for something acute or not directly related, I will add the HCC code(s) for the year that have been flagged. I typically will say something to the effect that problem is stable, managed by specific specialty, and will follow, and I will state NOT directly discussed at visit just for clarification. I also unlink the HCC dx from billing code if not part of visit."

If the provider is documenting that the condition is stable, then they have met the assessment in M.E.A.T.