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Coding (Practice Guidelines and Tips) - 2020
Documentation and Coding: Respiratory Failure

Types of respiratory failure are categorized by acute, chronic, acute-on-chronic, AND whether the patient has hypoxia, hypercapnia, or both.

Clinical Documentation Improvement

Documentation and Coding: Respiratory Failure

Coding (Practice Guidelines and Tips) - 2020
Documentation and Coding: Risk Adjustment

This tip sheet offers guidance on proper risk adjustment coding. Risk adjustment relies on correct ICD-10-CM diagnosis coding to represent the member’s health status and to establish an accurate risk score.

Clinical Documentation Improvement

Documentation and Coding: Risk Adjustment

Coding (Practice Guidelines and Tips) - 2020
Documentation and Coding: Major Depressive Disorder

Proper ICD-10 coding can provide a comprehensive view of a patient’s overall health. When coding for Major Depressive Disorder, the following components are key in documentation: Type of Disorder; Frequency of Occurrence; Level of Severity and Psychotic Symptoms.

Clinical Documentation Improvement

Documentation and Coding: Major Depressive Disorder

Coding (Practice Guidelines and Tips) - 2020
Documentation and Coding: Functional Quadriplegia

This tip sheet offers guidance on how to submit diagnosis codes for Functional Quadriplegia, which is defined as “the inability to move due to severe disability or frailty caused by another condition without physical injury or damage to the brain or spinal cord.”

Clinical Documentation Improvement

Documentation and Coding: Functional Quadriplegia

Coding (Practice Guidelines and Tips) - 2020
Documentation and Coding: Protein-Calorie Malnutrition (PCM) or Protein-Energy Malnutrition (PEM)

To accurately code a patient as Protein-Calorie Malnutrition or Protein-Energy
Malnutrition, the coder must document the diagnosis. Severity ranges from subclinical deficiencies to obvious wasting (with edema, hair loss, and skin atrophy) to starvation. Multiple organs are often impaired.

Clinical Documentation Improvement

Documentation and Coding: Protein-Calorie Malnutrition (PCM) or Protein-Energy Malnutrition (PEM)

Coding (Practice Guidelines and Tips) - 2020
Documentation and Coding: Alcohol and Drug Related Disorders

Alcohol and drug related disorders are classified according to the documented severity, which is differentiated as abuse, dependence, or use, as well as the complex of presenting symptoms.

Clinical Documentation Improvement

Documentation and Coding: Alcohol and Drug Related Disorders

Coding (Policy, Billing, or Coverage Update) - 2020
2020–2021 Seasonal Influenza Vaccine Codes

Based on the August 2020 guidance from the Centers for Disease Control and Prevention (CDC), the enclosed CPT influenza vaccine codes reflect updates to the 2019–2020 recommendations on the use of seasonal influenza vaccines in the United States from the Advisory Committee on Immunization Practices (ACIP).

Annual Flu Vaccine

Claims

1262 20 Provider Alert Adult Flu Codes v5 FINAL

Coding (General Update) - 2020
Updated RADV Audit Provider Alert October 2020

Provider alert on the upcoming RADV Audit in late 2020

Clinical Documentation Improvement

1220 20 RADV Audit Provider Alert v3 1020 FINAL

Coding (Policy, Billing, or Coverage Update) - 2020
Prior Authorization: Molecular & Genomic Testing Procedure Codes and Descriptions

Healthfirst is pleased to announce our partnership with eviCore to provide authorization services for Genetic and Molecular laboratory services requested for our members enrolled in Medicare, Medicaid, and Commercial plans for dates of service beginning January 1, 2021. Learn more here.

eviCore

Prior Authorization

Billing

Laboratory Services

Prior Authorization: Molecular & Genomic Testing Procedure Codes and Descriptions

Coding (Practice Guidelines and Tips) - 2019
Documentation and Coding Tips: Myocardial Infarction

Created December 2019

Clinical Documentation Improvement

Documentation and Coding Tips: Myocardial Infarction

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