Risk Coding

Post here your questions regarding auditing ,coding, documentation, and compliance. Also, join in on the conversation- help your fellow auditors and compliance professionals in the industry.

Moderators: Shannon DeConda, NAMAS Moderator

Post Reply
Posts: 51
Joined: Wed Aug 27, 2014 1:32 pm

Tue Dec 25, 2018 1:27 pm

I am having a difficult time understanding when I need to give credit for additional diagnosis that have been added for risk management. the dx are not addressed in the HPI or not made relevant, the dx are only in the A/P and identifying MEAT. I have noticed an higher level of care from providers. Is there a criteria in which I should be reviewing in order to give credit to these additional dx?
Posts: 9
Joined: Fri Oct 26, 2018 2:35 pm

Fri Jan 04, 2019 10:37 am

In order to bill conditions that risk adjust the documentation must show that the provider assessed the patient on that DOS for that condition. It is not enough for the provider to only list the conditions, this is the reason that a risk adjusted code should not be assigned based on the past history or problem list portion of a note. Remember that MEAT stands for monitor, evaluate, assess, treat: the documentation must show the billing provider for that condition on that DOS is actively treating the patient for that condition, it is not enough to simply know the patient has the condition.

Monitor—signs, symptoms, disease progression, disease regression
Evaluate—test results, medication effectiveness, response to treatment
Assess/Address—ordering tests, discussion, review records, counseling
Treat—medications, therapies, other modalities
Your question has been answered by: Stephanie Allard, CPC, CEMA, RHIT
Post Reply