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In the past few months we have seen many old friends and made many new ones at several wonderful events! Soon, we will be heading to San Francisco for the 2016 NPA Annual Conference, Oct 23-26. We look forward to seeing many of our clients and colleagues, and to co-hosting the "California Uncorked" wine tasting and dinner event!
Richard Schamp, MD
Progress Notes: Specifi city Matters !

Now that CMS has ended the one-year grace period for non-specific ICD-10 codes, providers must be diligent to avoid defaulting to non-specific diagnoses or risk losing value. Here are some tips to help your practice's compliance
  1. Always think "specificity". Your EHR may have a favorites list that includes most common codes - beware of using those that are not at the highest level of specificity.
  2. Code only the conditions addressed at each encounter, even though the patient has other chronic conditions not being addressed.
  3. Track your coding patterns. Run reports from your EHR quarterly to see which conditions are most common. Watch for codes ending in "0" or "9", which tend to be non-specific codes. Use the reports to drive training efforts.
  4. Internal auditing and monitoring. Consider a coding validation audit or even a Mock RADV audit to ascertain your level of compliance and prepare for corrective actions before you are required.
  5. Use certified coders. Most providers are not trained in coding. In Capstone audits, we frequently see errors by physicians and other providers that are both costly and non-compliant.  
Capstone provides coding services specifically tailored to PACE plans, and we are experienced with the common EMRs used in PACE.  Let us know if we can help your coding efforts in any way!
Updates to ICD-10 and Official Coding Guidelines

The multi-year freeze on changes to ICD codes ended with the launch of ICD-10 last October. We are all up to speed with ICD-10, right? Good, because on October 1, 2016, the 2017 edition became effective. Providers, coders, and billers need to be knowledgeable with these changes, as there is no grace period. Using codes that are deleted or changed will impact claims and risk adjustment. Read more here.

Code Notes: Major Depressive Disorder (MDD)

The implementation of ICD-10 has increased the specificity for many, if not all, disease processes. One such condition is Major Depressive Disorder, a commonly diagnosed condition in the PACE participant population. The correct documentation of MDD will result in a more specific and risk adjusted code, while incomplete documentation will result in an unspecified code that does not map to an HCC.

Code Notes: Fractures in ICD-10
Fracture coding is increasingly more specific in ICD-10.  As a result of this specificity, providers must document whether the fracture is traumatic or pathologic (non-traumatic). A traumatic fracture is caused by some type of accident, fall, or other kind of force. A pathologic, or non-traumatic fracture, is the break of a diseased or weakened bone (without noted trauma).  When documenting a fracture, coders must also note the site of the fracture, as well as details including "distal end" or "proximal end". Specific documentation is crucial for determining proper participant care, and for assigning proper and complete ICD-10 codes for fractures.   
Join us at NPA!

Please join 'California Uncorked' co-hosted by Capstone and CareKinesis on Sunday, Oct 23. Network with your PACE colleagues while tasting & learning about select California wines, then enjoy a delicious dinner! RSVP here.


And, we've been accepted to present three sessions this year:

    • Pharmacy Topics I - PACE Clinical Issues (10/25 @ 8am)
    • 50 Tips in 50 Minutes: A Master Class in Operational Tactics to Optimize Clinical Documentation, RAPS Data, and Risk Scores (10/25 @ 1:30pm)
    • Part D Internal Auditing and Monitoring for PACE: It's More than just a Fraud, Waste, and Abuse Policy (10/25 @ 3:30pm)

For more information and to register visit the NPA website. Hope to see you there! 

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