Wiki Risk Adjustment - AWV Form

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torresreb

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I have what I hope is an easy question .. ..

AWV -

ROS:

HEENT - post nasal drip
Cardiac - intermittent chest pressure
Genitourinary - intermittent urinary blood clots

nothing about this is mentioned in the physical exam ..

assessment plans/conditions -

hypertension
diabetes
hypercholesterolemia

.... am I to code what I found in the ROS as well as the condition list? or just what is listed in the condition list?

also, there are times where what is found in the ROS is also noted in the physical exam but nothing in the condition list ... am I to code then as well?

your help would be appreciated. thank you!!
 
Hi,

I am an HCC coder. There seems to be not enough information to code these conditions. The doctor has to do something with it unless it is a status (like amputations can just be mentioned). If it is a chronic condition there should be at least one part of MEAT noted-Monitor, Evaluate, Assess/Address, Treatment. From what you posted here it doesn't look like any of these have been addressed for Diabetes, the only HCC code I see here. In this case I would address it with the doctor so they document the chronic conditions better. Just saying the patient has diabetes isn't enough for HCC credit.

Hope this helps!
 
M.E.A.T is in the guidelines for E/M services, not Risk Adjustment. If you look at the ICD-10 guidelines:

Section IV. Diagnostic Coding and Reporting Guidelines for Outpatient Services

G. ICD-10-CM code for the diagnosis, condition, problem or other reason for encounter/visit
List 1st the code for the reason for the visit (assessed/treated
List ADDITIONAL codes that describe ANY coexisting conditions (affect pt. care/Chronic conditions)

J. Code ALL documented conditions that coexist at the time of the encounter/visit, and require OR affect patient care treatment or management

K. Patients receiving diagnostic services only
Sequence first the diagnosis, condition, problem, or other reason for the outpatient services. Codes for other diagnosis (e.g. CHRONIC CONDITIONS may be sequenced as ADDITIONAL diagnosis

L. Therapeutic Services Only
Sequence first the diagnosis, condition, problem, or other reason for the outpatient services. Codes for other diagnosis (e.g. CHRONIC CONDITIONS may be sequenced as ADDITIONAL diagnosis

I have coded Risk Adjustment for 4 years. ALL Chronic Conditions need to be coded regardless if they are being treated at the time of the visit. This is how the Providers are paid, depending on how sick the patient is. If these conditions are not reported, the Provider does not get paid enough to care for these patients. If a patient has cancer of some kind, the PCP isn't typically treating it, but it does affect his MDM and patient care. All he needs to say is "followed by Oncology" stating that the cancer is still active or describe the current treatment, i.e. on Chemotherapy and/or Radiation.

Huge mistake Coders and Providers are making not coding Chronic Conditions even when they aren't being treated.
 
Thank you!

I have another question ... RxHCC vs HCC ...

does the patient have to be treated with medication in order for the RxHCC to be valid?

for instance I see that depression with anxiety 300.4 (yes still coding some ICD9 :)) is listed under RxHCC .. does this mean the patient has to be under medication treatment?

I cannot find documentation regarding the differences ... thank you again for your help I really appreciate it!
 
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