The PULSE of The Physician Alliance
Friday, April 26, 2019
Diabetic education materials help improve care and metrics
More than 30 million Americans have diabetes, almost 10 percent of the population. One of the challenges of living with diabetes is risk of eye disease.

Diabetic retinopathy is the most common cause of vision loss among diabetics, although all forms of diabetic eye disease have the potential to cause vision loss and blindness. Early detection, treatment and continued follow up can help protect against vision loss.

This is a HEDIS quality metric that TPA needs to improve. The Physician Alliance created an education poster about diabetic eye exams to promote this important screening to patients. TPA practices are encouraged to post in their exam rooms and waiting areas to stimulate conversations with patients (posters can be downloaded or an online order can be submitted ). Additional diabetes-related materials are also available here .

*Sources: Centers for Disease Control & Prevention; National Eye Institute; American Diabetes Association
New metrics targeted for decreased utilization
The Physician Alliance participates in Blue Cross Blue Shield of Michigan's Resource Stewardship Initiative . This helps promote the use of evidence-based medicine and decrease the medical procedures and tests identified as over-utilized.

TPA selected measures to improve in 2019 based on physician performance in the organization. Lower metrics indicate a higher quality score. The selected measures include:
  • Decrease imaging for low back pain
  • Decrease annual vitamin D testing
  • Decrease routine annual Pap tests in women 30-65 years of age
  • Decrease HPV testing, alone or in combination with Pap tests for cervical cancer, in women younger than 30 years old

Education materials related to each measure will be available for practice use in communicating with patients and found on TPA's website .
The Physician Alliance announces Service Excellence Awards
The Physician Alliance recently announced practices receiving a Service Excellence Award in Care Coordination and Quality Improvement . These awards were created to recognize collaboration between specialty practices and patient centered medical home primary care practices to improve care coordination and quality.

A complete list of practices earning a 4-star rating or above Service Excellence Award in Care Coordination and practices earning a Service Excellence Award in Quality Improvement can be found here . Congratulations to these practices earning a Service Excellence Award! Thank you for your commitment to improving patient care!

Questions regarding the Service Excellence Awards should be directed to your practice resource team member.
Coding Corner: Coding for Cancer: History of Cancer vs Active Cancer
Accurate diagnostic coding plays a crucial role in identifying the disease burden of the patient population, determining a risk adjusted cost of care score, improving revenue and more. The new Coding Corner will provide tips to help improve diagnostic coding.

ICD-10-CM coding guidelines* state in Section I.C.2.m.

“When a primary malignancy has been excised but further treatment, such as an additional surgery for the malignancy, radiation therapy or chemotherapy is directed to that site, the primary malignancy code should be used until treatment is completed.”

“When a primary malignancy has been previously excised or eradicated from its site, there is no further treatment (of the malignancy) directed to that site, and there is no evidence of any existing primary malignancy at that site, a code from category Z85 , Personal history of malignant neoplasm, should be used to indicate the former site of the malignancy.”

Documentation must clearly indicate that the cancer was either not treated or is being actively treated, including with adjunct therapy. Forms of active treatment include:
  • Current hormonal therapy
  • Active surveillance
  • Refusal of or is too frail for treatment

The exception to the rules occurs when coding multiple myeloma and leukemia. These diagnoses have “in remission” codes that physicians should use once treatment is completed and the patient achieves remission. For example, when a patient diagnosed with acute myeloblastic leukemia, treated with chemotherapy, and successfully achieved remission returns to the office for a visit and has no evidence of recurrence, the code for acute myeloblastic leukemia in remission ( C92.01 ) should be used.

*To ensure best coding practices, please refer to ICD-10-CM Official Guidelines for Coding and Reporting FY 2019 (October 1, 2018 – September 30,2019)

Source: Ethica provides hands on, face to face assistance to helps practices with accurate diagnostic coding. Visit or call (586) 498-3587 to learn more and to schedule a consultation.
News You Can Use
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The Pulse is the bi-weekly e-newsletter from The Physician Alliance, one of Michigan's largest physician organizations serving more than 2,200 primary care and specialty physicians. - (586) 498-3555