Diabetes
Most common affecting over 30 million Americans
TYPE 2 DIABETES
One of the three key metrics in Value Based Contracts
Care (CPT/HCPCS)
Quality (CPT II)
Acuity (ICD-10CM)
GSD
Glycemic Status Assessment (quality measure for pts with Diabetes)
This should be on each page of a medical record
Patient Name, Date of service
Diabetes due to underlying condition
Services must be appropriate and reasonable
Medical Necessity
KED
Kidney Health Evaluation (pts 18-85 with DM who received a kidney health eval)
M.E.A.T
Monitor
Evaluate
Assess/Address
Treat
Pt developed Diabetes due to Pesticides in the environment.
Drug or Chemical Induced Diabetes dx code E09
The primary goal of Value Based Care
To improve patient outcomes while reducing costs
EED
Eye Exam for Pts with Diabetes
Includes chronic conditions sometimes current or history of
The Problem List
Pancreas makes little or no Insulin
Type 1 Diabetes aka Juvenile Diabetes
What does Value based care emphasize over volume
Quality of care
Give one Example of a potential exclusion
Patient 66 years living in nursing home
Patient using hospice
Pt deceased
Pt has an advanced illness and frailty
True or False: When coding diabetes with complications you should always code the complication first.
False
Developed during pregnancy
GESTATIONAL DIABETES
How does Value based care benefit patients
By providing person-centered, coordinated care
If using a CPT category II code for Diabetes this must also be included in the medical record
A1C (Lab results)
What is the guideline for coding diabetes with multiple complications?
Code each complication separately