SMORGASBOARD
Also called "Qualified Providers", they are the only ones who may document and code a high-risk condition and have the RAF score count.
What is a Physician & Advanced Care Practitioners or Providers?
Although studies have shown it to be present on over 40% of thoracic and abdominal imaging studies in patients over 65, this condition is often not documented or coded
What is atherosclerosis of the aorta?
Coding conditions that a patient does not have may land you there
What is jail, prison, or court?
Often incorrectly coded as 'weight loss' or 'failure to thrive', this condition carries significant risk for elderly patients with low protein stores
What is malnutrition, or protein calorie malnutrition?
Along with RAF scores, these metrics account for the vast majority of Medicare Advantage premium
What is Quality, HEDIS, or STARS?
Surgically created 'holes' for breathing and elimination, they all risk adjust
What are ostomies?
A Fib, A Flutter, and MAT will all risk adjust, but if these conditions are unspecified you get nothing
What are arrhythmia's?
Often coded incorrectly as 'history of depression', this code describes patients who have had one or more major depressive episodes in the past but who are doing fine now
What is major depression in remission?
DAILY DOUBLE!!!
Step on a crack and you break your mother's back, but if she's just old it may be that she has this high-risk condition
What is an osteoporotic fracture, or a compression fracture?
Easy to document, this measure may be assessed using a simple scale of 1-10
What is pain? What is a pain assessment?
A morbid obesity code may used for a patient with a BMI between 35 & 39 if they have two of these
What are co-morbid conditions?
It's the code you must use to describe the prostate cancer patient who has had a total prostatectomy and has no evidence of the disease
What is a history of prostate cancer?
Since it is intended to used for atherosclerotic conditions outside the brain, neck, and heart - this code should be not be used to describe carotid artery disease, even though it risk adjusts
What is atherosclerosis, unspecified
Purple spots he said were because he bruised easily, but they have a RAF of 0.218
What is senile purpura, or hemorrahagic non-thrombocytopenic purpura?
DAILY DOUBLE!!!
The threshold at which diabetes is considered poorly controlled, patients with numbers over this value will hurt your STARS score
What is an HA1c over 9.0?
DAILY DOUBLE!!!!
Along with arteries in the neck, atherosclerosis in these two organs are the only atherosclerotic conditions that do NOT count toward RAF.
What are the brain and heart?
A code that is often documented but not coded; it occurs when a patient develops an oxygen requirement as a result of a pulmonary condition
What is respiratory failure?
He suffered with Sick Sinus Syndrome for weeks, but once the pacemaker was placed he felt great and his cardiologist knew not to use this code from now on.
What is Sick Sinus Syndrome?
Often presenting with sudden cramping, abdominal pain, an urgent desire to defecate, and passage of bloody diarrhea, this high-risk condition is the same category as a peripheral artery disease
What is ischemic colitis?
After a hospitalization it's the time within which a PCP's office must contact the patient to schedule an appointment
Every condition that has a risk adjustment factor is placed into one of these
What are Hierarchical Condition Categories?
An incidental finding on a CBC is all you need to code this condition
What is thrombocytopenia?
Paresthesias that develop as a result of chemotherapy will risk adjust, but doctors often use this code instead which does not risk adjust
What is unspecified polyneuropathy?
Affecting 8% of elderly patients, CMS did not consider this condition "high risk" until 2019, but don't tell this to your patients who have it. They probably won't remember what and HCC is anyway.
What is Alzheimer's disease, dementia, or vascular dementia?
Along with glycemic control, retinopathy screening, and blood pressure management it's an important part of 'Comprehensive Diabetes Care'
What is nephropathy screening?