Time for another edition of my wildly popular “Success Codes” series. If you haven’t already, you may want to review my world-class, yet humbly simple (yes, really) explanation of RAF scoring—it’ll help you understand some of the shorthand terminology below. It’s the only one on the web written by a PCP who’s been in the trenches blocking and tackling since Medicare Advantage first arrived on the scene 20+ years ago—and done so with incredible results.
That’s probably why it’s so good—and so good for you! Now let’s get started.
Coding diabetes looks difficult and overly complex. With all those codes and complications and documentation requirements, you can never be sure you’re doing all you can to capture the risk codes you and your patients deserve.
But in reality, it’s actually pretty easy.
Yes, easy.
Here goes.
All diabetes diagnostic codes map to one of three compensation categories—called Hierarchical Condition Categories (HCCs).
Each group has its own risk-adjustment, affecting how much you’ll eventually get paid to care for the patient.
Here are the three:
- “Diabetes with acute complications.”
- These refer to hyperosmolar coma, DKA and the like—serious conditions that’ll be submitted during the normal course of treatment—Don’t worry about these codes, don’t give them another thought.
- “Diabetes with chronic complications.”
- Codes that map to this group have a much larger risk adjustment— about 0.3
- “Diabetes without complications.”
- Codes that map to this group has a small risk adjustment—about 0.15
And that’s it.
All those complications and codes—they distill into just three risk groups.
Now, your goal each year is to appropriately capture at least one diagnostic code for a chronic diabetic complication for each of your patients with diabetes. That is, of course, assuming there’s a chronic complication actually present.
In subsequent posts, I’ll name them and show you how to submit them.
Again, all you have to do is capture one complication code once a year. Submitting more complication codes does not allow you to increase your RAF score for diabetes. One RAF adjustment of 0.3, once a year is all you can get.
Sure, some individual complications from diabetes; retinopathy, neuropathy and the like, will raise your risk score themselves, independent of the diabetes with complication codes. But you’ll come across those during the routine course of treatment. We’ll cover them in future blog posts as well. The common ones are few in number and straightforward to diagnose and document.
Don’t sweat them.
One diabetes with complication code, one time, per patient, once every calendar year.
That’s it.
Once you do that, you’re fine. You’ve done the coding what you needed to do. You can now concentrate on taking good care of your patients without distraction.
One diabetes with complication code, per patient, one time, once every calendar year.
And take great care of your patients.
That’s all you need to do.
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