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.
Last week we discussed the simplicity of diabetes coding and how they affect the amount of your capitation.
The upshot?
If a chronic complication of diabetes is present, you want to capture at least one of the associated diagnostic codes every calendar.
And the most common of these is diabetic angiopathy (E11.5x). It’s also the one that is most commonly missed.
Always check your patient’s plain films for the presence of atherosclerotic changes in their peripheral arteries. If present, document appropriately and submit the code—even if you have to use an addendum.
Does your patient with diabetes have a slow healing wound? Even with normal arterial dopplers if you can establish a connection with their diabetic angiopathy, you should do it. Just make sure you document your assessment of the causation clearly.
“wound healing more slowly than expected due to diabetic angiopathy despite normal ABI.” That’s all you need.
Once the data works its way through the system, taking a few moments in documentation will increase your monthly capitation by 45%.
45%!
Warning!
Don’t do imaging as a fishing expedition just looking for angiopathic changes just so you can capture the code—it’s bad care and fraud plain and simple.
But, if the atherosclerotic changes are there, even as an incidental finding and you can tie it to their diabetes, then the “diabetes with angiopathy” code isn’t just acceptable, it’s accurate.
And it’s this accuracy that will set you apart from your peers with your success.
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