The importance of complete coding by physicians
Dr. Marcia Naveh of Matrix Medical Management has a very readable article on the issues surrounding Medicare Risk Management in the January, 2008 issue of Managed Care magazine.
At the end of the day, it all comes down to regular, complete, and specific diagnostic coding by the physician.
posted by Michael Duffy at 12:56 PM
3 Comments:
What an asinine point of view. The problem is physicians? With a silly out look like this, it is no wonder these problems don't go away.
Hello! No duh!
You based a payment scheme on diagnosis codes, and the outcome relies on the coding. No amount of actuarial flim-flam is going to make that go away.
But Anonymous has missed the point if they feel that the problem is the physicians. Who, by the way, are trained to practice medicine, and that does not make them expert, professional coders. That would be me! Their documentation, now that's another issue and they should be held accountable there.
This article referenced is readable, that part is accurate. I absolutely love that the graph used to illustrate poor physician coding has coronary artery disease as one of the examples. If you look at the HCC codes allowed as risk adjusted in Chapter 7, Disease of CV System of the ICD-9-CM code book, you will see that there are four, count them four HCC codes that describe the patient’s chronic CAD (angina and old MI). Otherwise, without an acute event in the year or CHF, no risk adjustment will be allowed for a patient that has say ischemic cardiomyopathy 414.8, or history of CABG V45.81, history of PTCA/stents V45.82. I could keep going, but you get the idea, if you know anything about coding that is. And Cardiologists, they think this is totally nuts! They have documented and coded four or five codes that describe the extent of the patient’s CAD, but hey they don’t have angina or an old MI, so no risk adjustment for you! Instead of the soup Nazi, it’s the code Nazi. Dementia? Not risk adjusted, so Parkinsonism with dementia 331.82, no HCC vs. Parkinsonism 332.0, HCC 73 Parkinson’s and Huntington’s Diseases. Just one of the many inconsistencies in this payment scheme that I have, BTW, pointed out many times to anyone at CMS that I could get to listen. I once, in an attempt to get one of them to grasp the nonsense of this “risk adjustment” scheme, pointed out that from what we know publicly about Ronald Regan’s medical condition, he would be deemed “health”. But hey, he was rich so the rest of us can, as Dick Cheney so delicacy puts it, “go f ourselves”.
I'm sick to death of the BS pushed out by MDs, PhDs, and other high level folks with their heads up their ass prostilizing about how to maximize recovery and payment under this, what could have been a reasonable idea based on the original research, but as usual #u@ked by CMS in some vain attempt to stay within budget. Been there, done that under the DRG scheme. Remember HCA and the others? Guess not. Have you heard of a CIA? Apparently not. Instead of all the brain power, time, and money being poured into figuring out ways to, let’s speak the truth here, once again game the system and suck out the most profit possible; why don’t you take all that clout and use it to work for a more equitable system?
Oh, but that’s a different blog right? Healthcare payment reform, where we take the profit motive out of our health and sickness.
Thanks for the opportunity to vent from one of the voices lost in the wilderness.
Susan Proctor, RHIT, CCS
Nice article.
A better strategy can be to mark suspects before going for retrospective audits by evaluating the performance of physician. Some good suspecting mechanisms can be used to see which physician is not doing coding correctly and what common mistakes are by the physicians. This way plans can perform a targeted retrospective audit in place of full population audit.
At the same time keep educating physician to reduce losses for future
Thank you,
Sajid Ali
Storan Technologies Inc., a Medicare Risk Adjustment Company
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