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June 15, 2022 Current Procedural Terminology Category II Codes (CPT-2 Codes)   WHAT ARE CPT-2 CODES: They describe the following: Clinical components, such as those typically included in evaluation, management, or other clinical services. Results from clinical laboratory or radiology tests and other procedures. Identified processes intended to address patient safety practices (such as fall risk). Services reflecting compliance with state or federal law.   PURPOSE: CPT II codes help define nati...

June 1, 2022   CAHPS - Patient Experience The Centers for Medicare & Medicaid Services (CMS) develop, implement, and administer several different patient experience surveys. One of them is the Consumer Assessment of Healthcare Providers & Systems (CAHPS). These surveys ask patients and care givers about their experiences and opinions of their health care providers, their health plan, hospitals, home health care agency, and drug plan. There are number of surveys that may pertain to your prac...

May 15, 2022 Social Determinants of Health – Why are they so important? A 28-year-old single Mom of three children while working and going to nursing school was having a tough time making ends meet. Her primary care physician referred her to two community outreach resources. Because of the awareness of social determinants of health and the actions taken by the physician, the medical profession now has a new RN. Social Determinants of Health (SDoH) are the conditions in the environments where people are ...

May 1, 2022 BLOOD PRESSURE CONTROL   DESCRIPTION: Percentage of patients 18 - 85 years of age who had a diagnosis of hypertension and whose most recent blood pressure was adequately controlled (< 140/90 mmHg) during the measurement period.   EXCLUSIONS: Patients with evidence of end stage renal disease (ESRD), dialysis or renal transplant before or during the measurement period. Patients over 81 years with frailty alone. A diagnosis of pregnancy during the measurement period. Patients aged ...

April 15, 2022 Transitions of Care – Best Practice Increasingly, health care is focusing on primary care outside of a hospital setting. Patients are vulnerable when they transition between different parts of a health care system, these care transitions threaten patient safety. Transitions of Care (TOC) are changes in the level, location, or provider of care as patients move within the health care system.(1) The consequences of poor transitions of care are multiple: (2) Patient care delays Staff stress a...

April 1, 2022 Diabetic Retinal Eye Exam HEDIS MEASURE: The percentage of members 18–75 years of age with diabetes (types 1 and 2) who had a retinal eye exam.   BACKGROUND: Diabetic retinopathy is the most frequent cause of new cases of blindness among adults aged 20–74 years in developed countries. Type 1 Diabetes Because retinopathy is estimated to take at least 5 years to develop after the onset of hyperglycemia, patients with type 1 diabetes should have an initial dilated and comprehensive eye e...

March 15, 2022 Well Child Exam vs Sports Physical Exam Background: Many students and their parents believe that a Sports Physical is equivalent to a Well Child Exam, but this couldn’t be further from the truth. The Sports Physical is designed to clear an athlete for participation in sports while the Well Exam includes much more.   Both a well-child visit and a sport physical are not needed. The child’s annual well visit covers everything he or she needs for a sport physical. A sports physical does ...

March 1, 2022 Annual Wellness Visits – Best Practice Tips Annual Wellness Visits (AWV) are underused and are a critical component of the Patient Centered Medical Home and population health management.   The AWV provides an opportunity for physicians and providers to improve the quality of care, discuss and organize a care plan, engage the patient in their care, discuss diagnoses and preventative care measures, and optimize your revenue opportunity. Despite the possible benefits to both providers an...

February 15, 2022 Combo 10 Immunizations for Patients Up to 24 Months Old Historically, immunizations have been shown to be effective in reducing morbidity and mortality caused by the pathogens they are designed against. For example, the annual morbidity from smallpox in the 20 th century was 29,000 deaths.   The annual morbidity in 2017 from smallpox was zero.   The annual morbidity from Rubella in the 20 th century averaged about 47000.   In 2017, the annual morbidity fell to 7.   ...

February 1, 2022 Ten Coding Tips for Capturing Patient Risk and Ensuring Proper Payment   Report diagnosis codes for active diagnoses each year:  HCC codes reset annually, which means that each patient’s active diagnoses must be reported every year, regardless of how long the patient has had the condition, to be counted toward the patient’s overall risk. Annual wellness visits are a good time to do this. Be specific:  Most unspecified diagnosis codes don’t risk adjust (e.g., ICD-10 code E...