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Coding - Practice Guidelines and Tips - 2021
Documentation and Coding: Atrial Fibrillation

At Healthfirst, we are committed to helping providers accurately document and code their patients’ health records. This tip sheet will offer guidance on how to submit diagnosis code with greater specificity for coding atrial fibrillation (AFib).

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Clinical Documentation Improvement
  
Claims & Billing - Policy, Billing, or Coverage Update - 2021
New CPT® Category III Codes

Healthfirst aims to ensure that our reimbursement policy standards are compliant with state and national industry standards. The American Medical Association (AMA) has released new Category III codes, effective July 1, 2021. As of this date, Healthfirst requires prior authorization for these codes.

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Reimbursement
  
Behavioral Health and Foster Care - Practice Guidelines and Tips - 2021
Children and Family Treatment and Support Services (CFTSS) FAQs

Children and Family Treatment and Support Services are a set of six children’s health and behavioral health Medicaid State Plan services that focus on prevention, early intervention, and access to clinical treatment. With CFTSS, eligible members will have more choices in how to approach rehabilitative intervention.

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Children & Family
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2023
Reimbursement Policy: PO-RE-008v2 Venous and Arterial Thrombosis Risk Testing

A thrombosis, also known as a blood clot, occurs within blood vessels in the body.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2023
Reimbursement Policy: PO-RE-068v3 Prenatal Screening (Nongenetic)

Prenatal screening encompasses any testing done to determine the health status of the pregnant individual and/or fetus.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2023
Reimbursement Policy: PO-RE-055v2 Pancreatic Enzyme Testing for Acute Pancreatitis

Pancreatitis is an inflammation of pancreatic tissue and can be either acute or chronic. Pancreatic enzymes, including amylase, lipase, and trypsinogen can be used to monitor the relative health of the pancreatic tissue.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2023
Reimbursement Policy: PO-RE-040v2 Oral Cancer Screening and Testing

Oral cancer is defined as cancer occurring in the oral cavity between the vermilion border of the lips and the junction of the hard and soft palates or the posterior one third of the tongue.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2023
Reimbursement Policy: PO-RE-034v2 Flow Cytometry

Flow cytometry is a technique for live cell analysis that measures optical light scattering features to determine physical characteristics (Adan et al., 2017).

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2023
Reimbursement Policy: PO-RE-027v2 Cardiovascular Disease Risk Assessment

Cardiovascular risk assessment comprises the means and processes to predict the probability of developing a cardiovascular disease.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2023
Reimbursement Policy: PO-RE-063v2 General Inflammation Testing

Inflammatory response can occur due to tissue injury and/or various disorders, including arthritis, lupus, and infection.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2023
Reimbursement Policy: PO-RE-056v3 Gamma-glutamyl Transferase

Gamma-glutamyl transferase (GGT), also known as gamma-glutamyl transpeptidase (GGTP) (Singh et al., 2006; Vroon & Israili, 1990), is an enzyme that has a half-life of between fourteen and twenty-six days and is present in the cell membrane of many different tissue types, including the heart, brain, seminal vesicles, kidneys, bile duct, spleen, and gallbladder (Dillon & Miller, 2016; Dixit & Singh, 2015).

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Reimbursement Policy
  
Coding - Practice Guidelines and Tips - 2023
Documentation and Coding: Vascular Dementia

This tip sheet is intended to assist providers and coding staff with the documentation and ICD-10-CM selection on services submitted to Healthfirst—specifically for common types of vascular dementia.

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Clinical Documentation Improvement
  
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