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April 1, 2024   G-2211 Do’s and Don’ts DEFINITION: 2 Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient's single, serious, or complex condition (add-on code, list separately in addition to office E/M visit, new or established)   BACKGROUND: G2211 includes services enabling practitioners to bui...

January 15, 2024   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...

January 1, 2024 HCC RECAPTURE – WHY IT’S IMPORTANT BACKGROUND: Recapture Rate is the rate at which providers capture (code) recurring (or Chronic) HCC diagnoses on an annual basis. A standard goal is 85% recapture rate. 1 The number (and severity) of chronic conditions is a predictor of costs, which are somewhat persistent from year to year. A drop in the risk score, possibly because of failures in capturing recurring diagnoses, could lead to lower financial benchmarks. This, in turn, could result in re...

October 1, 2023   RESPIRATORY SYNCYTIAL VIRUS (RSV) BACKGROUND: Respiratory syncytial virus (RSV) is a common virus that affects the lungs, making breathing difficult. It is also more common in the spring and fall seasons. The virus is common in children under 2 years, though people of all ages can get it. Illness caused by RSV is often more severe for young and premature infants, as well as older adults with poor health. It is no longer considered a children’s disease. Each year in the U...

September 15, 2023   Making Standard of Care, The STANDARD Statin Therapy for Patients with Diabetes Statin Therapy for Patients with Cardiovascular Disease   Adults 40–75 years of age with diabetes, who do or do not have clinical atherosclerotic cardiovascular disease (ASCVD), should be started on a statin for primary and secondary prevention of ASCVD regardless of lipid status. Statin Therapy for patients with cardiovascular disease, male patients ages 21-75, and female patients ages 40-75 i...

September 1, 2023 COPD SCREENING AND TREATMENT   BACKGROUND: Chronic Obstructive Pulmonary Disease (COPD) affects around 15 million people in the U.S. and costs more than $32 billion annually. Chronic lower respiratory diseases, including COPD, are the fourth leading cause of death in the U.S. and the third leading cause of death worldwide. GOLD ( Global Initiative for Chronic Obstructive Lung Disease) 2023 defines COPD as a  heterogeneous lung condition characterized by chronic respiratory sy...

August 15, 2023   Long COVID   It has been over 3 years since the pandemic started. As we get more experience with this situation, we are able to improve our diagnoses, treatments and recommendations. Unfortunately, there still is much to be learned. Approximately 10% of individuals infected with COVID-19 developed symptoms that may be defined as “Long COVID.” Many of these symptoms are also present in other chronic conditions and typically routine imaging and blood tests come back as normal. ...

August 1, 2023   Cardiorespiratory Fitness (CRF)   Even small changes in cardiorespiratory fitness (CRF) have a considerable impact on clinical symptoms and mortality risk among individuals with or without cardiovascular disease, as observed in United States veterans study analyzed from over 93,000 U.S. veterans. The mortality risk was greatly attenuated in those who were moderate and high fit at baseline who displayed declining fitness over time. CRF is not a short-lived benefit but carries a...

July 15, 2023 COLONOSCOPY GUIDELINES FOR 2023 RECOMMENDATION: Adults who are at average risk for colorectal cancer (CRC) used to start having regular colonoscopies when they turned 50. Now the timeline has changed. The American Cancer Society and The U.S. Preventive Services Task Force recommend that colorectal cancer screenings begin at age 45. This is due to the increased death rates from CRC with Colorectal cancer expected to cause about 52,550 deaths in 2023, according to the American Cancer Society...

June 15, 2023 2023 American Diabetic Association Standard of Care Selected Updates The American Diabetes Association (ADA) provides an update to their Standards of Care (SOC) every year to include developments in research and published literature. Selected 2023 SOC updates that may change practice delivery include: Patients diagnosed with type 2 diabetes mellitus (T2DM) should be treated with a medication known to reduce cardiorenal risk (SGLT2 inhibitor, GLP-1 RA) if they have established or are at hig...