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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.

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Clinical Documentation Improvement
  
Coding - Practice Guidelines and Tips - 2021
Documentation and Coding: Morbid Obesity

To accurately code a patient as morbidly obese, the provider must document the patient’s obesity in the medical record. Per 2020 ICD-10-CM Guidelines, “BMI codes should only be assigned when there is an associated, reportable diagnosis (such as morbid obesity). Do not assign BMI codes during pregnancy.”

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Clinical Documentation Improvement
  
Education Events & Patient Care Resources - General Update - 2020
USPSTF Recommendation on HIV Screening and PrEP

New York State is seeking to increase the number of eligible individuals taking advantage of PrEP from 32,000 at the end of 2018 to 65,000 by the end of 2020.

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Sexual Health
  
Education Events & Patient Care Resources - Practice Guidelines and Tips - 2020
PrEP to Prevent HIV and Promote Sexual Health

NYS strongly endorses PrEP as an effective, evidence-based biomedical intervention that is a pillar of primary prevention for individuals at high risk of HIV acquisition, emphasizing the importance of prescribing PrEP in conjunction with counseling on safer sex and safer injection practices.

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Sexual Health
  
Education Events & Patient Care Resources - Practice Guidelines and Tips - 2020
PrEP Recommended ICD-10-CM Codes

The International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) coding system does not designate specific billing codes for PrEP or PEP related services. The New York State Department of Health and the New York City Department of Health and Mental Hygiene recommend the use of the following ICD-10-CM codes for PrEP and PEP related outpatient services.

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Sexual Health
  
Education Events & Patient Care Resources - General Update - 2020
PrEP Awareness Week

The theme of PrEP Aware Week, 2020 is: “This is Why I PrEP”. The theme recognizes that PrEP is an individualized approach to HIV prevention and sexual health. “This is Why I PrEP” provides a broad umbrella for reaching all New Yorkers with tailored messages about PrEP that will speak to them as individuals and members of different, overlapping, diverse communities.

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Sexual Health
  
Education Events & Patient Care Resources - Practice Guidelines and Tips - 2020
Developmental and Behavioral Health Screening in Pediatrics: Best Practices and Challenges

October 17, 2020 This CME activity is designed to provide general pediatricians and family practitioners with the most up-to-date guidance on developmental and behavioral screening practices. The event addressed strategies that general pediatricians and family practitioners can use to implement this guidance in their offices and the challenges they and the families in their care may face.

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Provider Events
  
Coding - Policy, Billing, or Coverage Update - 2021
Documentation and Coding: CVA with Sequelae

Codes in this category describe the type of stroke and the sequelae (late effects) caused by the stroke. Documentation should clearly state whether a neurological deficit is directly related to cerebrovascular disease or a cerebrovascular accident.

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Clinical Documentation Improvement
  
Coding - Policy, Billing, or Coverage Update - 2021
Documentation and Coding: Medical Decision Making (MDM)

This tip sheet is intended to assist providers and coding staff with the documentation and ICD-10-CM selection on services submitted to Healthfirst. It provides information from industry sources about proper coding practice.

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Clinical Documentation Improvement
  
Coding - Practice Guidelines and Tips - 2021
1765 20 Documentation and Coding Guide Anemia v5 FINAL

This tip sheet will offer guidance on how to submit diagnosis codes with greater specificity for coding Anemia Associated with Malignancy, Chemotherapy, or Immunotherapy. Created February 2021.

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Clinical Documentation Improvement
  
Claims & Billing - Policy, Billing, or Coverage Update - 2021
Policy for Medical Record Documentation Standards

Effective February 1, 2021, consistent with Centers for Medicare & Medicaid Services (CMS) guidelines and the Healthfirst Provider Manual, Healthfirst will require the medical record documentation standards outlined within this document.

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Medical Record Reviews
  
Behavioral Health and Foster Care - Practice Guidelines and Tips - 2021
Foster Care and Initial Health Assessments

Effective July 1, 2021, children/youth placed in foster care, including those in direct placement foster care and those in the care of Voluntary Foster Care Agencies statewide, will be mandatorily enrolled in Medicaid Managed Care unless they are otherwise exempt or excluded from enrollment. As such, these individuals may present Healthfirst insurance.

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Foster Care
  
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