Wiki Risk Adjustment Assessment question

[lmoura]

Hello,

I am a coder for our Medicare Risk Adjustment Program. If a physician assesses and codes for a condition based on the findings from an CXR, US or CT Scan does anyone know the time limits on when the dos that CXR etc. would have to be from?

For example if a physician see's his patient today for the PE and reviews a CXR from 2010 and notes a clinical finding that had not yet been diagnosed would that be compliant being that the CXR was from 4 years ago, or does the assessment need to be from a current CXR?

If anyone has any information or knows where I could get this I would greatly appreciate it.

Thank you,
Lynn M.

 

[Squiabro]

Hi Lynn,

Clinical findings from an old CXR should be reported in the PMH.

The physician should order a new CXR to verifiy if that "clinical finding" from 4 years ago is still active.

CMS allows physicians to create an addendum to medical records to reflect confirmation of a diagnosis under certain circumstances.

When in doubt, refer to Medicare Risk Adjustment Guidelines. CMS Participant Guide,2008.

Hope this helps!

Rose