November 2018

‘Annual Visit’ Campaign Continues, Proper Coding is Crucial

In August 2018, we launched a preventive care awareness campaign to remind our members of the importance of scheduling annual visits for routine physical exams. This campaign is still in progress and, this month, we are focused on encouraging members with asthma to see their health care providers.

We know you already see a lot of patients and, since this annual visit campaign may increase patient traffic to your office, we wanted to take this opportunity to emphasize again the importance of careful medical record documentation.

Careful documentation is critical for proper assignment of ICD-10-CM/PCS codes. To help ensure that claims are properly billed and appropriate benefits are applied, your documentation should paint a clear and complete picture of each patient’s condition, with sufficient detail to support diagnoses and treatment.

As you know, medical record data is also used to help create provider report cards and show meaningful use in electronic health records. Potential patients may use provider profiles and other online comparison tools to choose where to go for care.

Clinical documentation improvement tools and services are widely available. Regardless of whether your organization or office has implemented a clinical documentation improvement (CDI) program, the following CDI basics may be used to help support accurate ICD-10 coding on your claims:

1. Lay the groundwork by outlining a complete history.
2. Go below the surface by highlighting potential red flags and risk factors.
3. Include progress notes to illustrate how the patient was monitored and evaluated.
4. Put the pieces together with details on why decisions were made.
5. Focus on teamwork between medical, coding and billing staff.

Careful medical record documentation for each patient at every visit will help ensure your claims accurately reflect the care and services you give to our members.

Thank you for your efforts to support our members’ health and wellness at their annual exams and all other appointments.

This material is for educational purposes only and is not intended to be a definitive source for what codes should be used for submitting claims. Health care providers are instructed to submit claims using the most appropriate codes based upon the medical record documentation and coding guidelines and reference materials.