MISC 1
If a patient has documented Type 1 Diabetes (since 2010) and you see under their medications they have a prescription for insulin (Prescribed in 2010) what code would you assign for the long term insulin use ?
What is no code, as it is already implied they are using insulin due to having Type 1 diabetes!
If a patient is treated for both hypertension and Stage 3 Chronic Kidney Diseas, what would you code?
What is I12.9 and N18.3
If a patient has documented CAD, and you also notice in the PE they have a current prescription for nitro as they are having anginal symptons, what code(s) should we assign?
What is I25.119.
What is the code for Unspecified COPD
What is J44.9
What is the secondary code if they are a former smoker?
What code would you use, if it is documented in the notes that a patient has uncontrolled type 2 diabetes?
What is E11.65
If a patient has Furesomide in their medications list and also has a CKD in their problems list, are you able to code CKD and what code would you assign?
What is Yes! Lasix (furosemide) is a loop diuretic (water pill) that prevents your body from absorbing too much salt. This allows the salt to instead be passed in your urine. Lasix is used to treat fluid retention (edema) in people with congestive heart failure, liver disease, or a kidney disorder Furosemide, sold under the brand name Lasix is not a direct RX for CKD, however but Because I didn't state what stage you would code N189.
What is Evidence of, Underlying, Early, Component or Element of?
What is GOOD TO CODE!!!
If a patient has lupus in their past medical history, can we code it?
The answer is "No" per our internal guidelines lupus maps to a non HCC code.
If a patient has a documented A1C above 7.0 however he isn't on any medications for diabetes or no other mention of diabetes in the chart, what code should we assign?
What is E11.9! We should assume the doctor forgot to mention diabetes, so we can take it on good faith! Just kidding......as much as we want to code diabetes, we are not clinical and can't assign a diagnosis to a patient.
What is our goal for this Retro Season?
To accurately capture all of a member's health status using current internal and external coding guidelines.
If a provider evaluates both type 2 diabetes and bilateral neuropathy of the feet, what code should be assigned?
What is E11.42 (peripheral neuropathy)
If a patient is being seen for Emphysema and Secondary Pulmonary Hypertension is listed in the Past Medical History, can we code it?
What is No!! (Per more recent understanding of PTH, it was found to be an acute condition and thus would not be coded from a PMH alone)
What is another name for the Horizontal Body Plane?
What is Transverse! It cuts horizonatlly through the body and separates it into upper and lower sections
If a patient is documented to have type 2 diabetes, stage 4 CKD, and an AKI, what codes should be assigned?
What is E11.22, N18.4, and N17.9
How should history of alcohol dependence be coded?
What is F10.21 (alcohol dependence in remission)
When a primary malignancy is excised or eradicated from its site and there is no further treatments (of the malignancy) directed at the site, a code from what category should be coded?
What is category Z85 (Personal History Of)
If a patient has a bmi of 27 documented in the chart, but in the PE the provider states Morbid Obesity..what would you code?
What is E66.01. Because the patient has a low overall BMI, the provider has made a clinical decision that the patient still appears to be morbidly obese and we should code as such.
If the provider documents unspecified congestive heart failure in the A/P, but in the body of the note, he references the ECHO that he ordered stated Type 1 Diastolic Failure, what code would you assign?
Member is admitted to the hospital for chest pain. While in the hospital the provider thinks his chest pain may be related to lung cancer and orders a CT Scan of the chest. What could would you assign?
You would assign the code for C34.90 for lung cancer. Per coding guidelines, the member is inpatient and this is a rule out condition and may be coded as an active/working diagnosis.
What does GARR stand?
Generations Advantage Risk and Revenue.
Patient is seen at their doctors office for their yearly cancer check-up. When coding the chart you notice that the provider is still billing it as an active even though treatment was completed in 1985 and the patient has had no recurrence. How would you code this?
For retro work, you would not code the cancer :) However if we were in Patients accounts and caught this before the claim was dropped we would code Z85 Personal history and provide some education to the provider that they are putting us ask an audit risk!
If a patient was seen in the ER only, what coding rules would govern how the chart is coded?
For ER you would follow Outpatient Coding Guidelines