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 terminologies 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.
Hematologic conditions are black and white—and that makes them audit proof.
They also are conditions that, if they’re coded at all, are only coded by a careful prime.
Often chronic illnesses with capitation adjustments present year-after-year. These conditions are associated with increased payments far in excess of what a good clinician needs to take care of them.
They’ll provide an excellent buffer for your risk pool when times turn bad.
Just don’t fake it, only code them when you have the lab in hand.
- Chronic leukemias in remission—various codes RAF 0.7
- Coagulation defect—Various codes RAF 0.3
- Sickle cell trait D57.3. RAF 1.4!
- Neutropenia D70.9 RAF 0.62
- Agranulocytosis due to chemo D70.1 RAF 0.62
- Thrombocytosis D47.3 RAF 0.3
- Thrombocytopenia if not chemo-induced D69.6 RAF 0.3
- Pancytopenia D61.818 RAF 0.62
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- Chronic leukemias in remission—various codes
- Chronic leukemias are lifelong illnesses that are never considered “cured”
- Coagulation defect—various codes e.g. D66.0 Factor VIII
- Most specific defects are associated with risk codes
- Once identified, address yearly, document and submit
- Sickle cell trait D57.3
- Often buried in the medical record
- Test for it if indicated, address it if needed every year
- CBCs
- A common source of incidental findings that still require additional evaluation and follow up
- Neutropenia D70.9
- Agranulocytosis due to chemo D70.1
- Thrombocytosis D47.3
- Thrombocytopenia D69.6
- Can only be coded if not secondary to chemotherapy
- Pancytopenia D618.18
- Can be coded even if secondary to chemotherapy D617.10
- A common source of incidental findings that still require additional evaluation and follow up
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