COVID-19 POA Indicators – February 2021 Coding Tip

COVID-19 is a complex disease with a wide spectrum of clinical patterns. COVID-19 was initially viewed as primarily a respiratory disease, but is now recognized as a complex disorder affecting many body systems. Coding professionals need to be knowledgeable of the testing of COVID-19 (e.g., diagnostic and antibody tests) and the COVID-19 disease processes (e.g.,…

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The Structure of ICD-11

The eleventh version of the International Classification of Diseases (ICD-11) is structured very differently than previous ICD versions. At the core of this difference is the ICD-11 Foundation component and the ability to define a linearization. The Foundation is the underlying structure of ICD-11. It is a large data base that includes all ICD concepts,…

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FY21 E/M Office Visit MDM Part 2: Amount/Complexity of Data Reviewed

UASI is on the front lines actively working with our clients to help them comply with the biggest change in evaluation and management (E/M) coding since 1997. The new office visit E/M code levels are assigned based on either medical decision making (MDM) or total time. The complex MDM rules make it really easy to…

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FY21 E/M Office Visit MDM Part 1: Number and Complexity of Problems

UASI is on the front lines actively working with our clients to help them comply with the biggest change in evaluation and management (E/M) coding since 1997. The new office visit E/M code levels are assigned based on either medical decision making (MDM) or total time. The complex MDM rules make it really easy to…

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The Importance of Calculating Accurate RAF Scores

The risk adjustment factor (RAF) score is the risk score assigned to each patient in a risk adjustment payment model. Risk Adjustment Models account for multiple factors to calculate a RAF score which is the combination of both the demographic risk score and the disease risk score. Demographic Risk Score: The patient’s age and whether…

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Risk Adjustment Factor Basics

Risk adjustment provides a way for the Centers for Medicare & Medicaid Services (CMS) to pay health plans for the risk of the beneficiaries they enroll. By risk adjusting payments, CMS can make different payments for patients based on expected costs. Risk Adjustment Models are predictive, based on actuarial data that forecasts the cost of…

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Monthly CDI Scenario Discussion – February 2021

UASI Solutions

Topic: Outpatient CDI: Diabetes with Chronic Complication Office Visit 6/8/2020: 87-year old Caucasian female who lives with her son being evaluated today for diabetes. Her son reports elevated blood sugars in the past 4 weeks. Starting from yesterday the readings are 272, 172, 202, 242, and 198. These are on a daily basis in the morning….

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