Exercise this option to support higher CPT® codes when needed.
In their paper arguing for longer “routine” primary care visits, Dr. Mark Linzer and colleagues describe “[a] 78-year-old widow with hypertension, osteoarthritis, a recent stroke, elevated cholesterol, and a 50-pack-year smoking history [who] comes to her primary care provider for a mild cough and weight loss.”
Patients don’t always visit you for the reasons they most need to visit you.
So how do you handle documenting and coding chronic conditions in fully accurate, regulatory compliant, revenue-generating ways during an established patient visit?
Chronic Conditions: Increasingly Common and Costly
The HHS defines chronic conditions as “conditions that last a year or more and require ongoing medical attention and/or limit activities of daily living.”
About two-thirds of Medicare beneficiaries live with multiple chronic conditions, compared to one-quarter of the U.S. population generally. The five chronic conditions most commonly found among Medicare beneficiaries (according to the 2012 edition of CMS’ chronic conditions chartbook) are:
- high blood pressure (58%)
- high cholesterol (45%)
- heart disease (31%)
- arthritis (29%)
- diabetes (28%)
Common chronic conditions that should always be coded include hypertension, congestive heart failure, asthma, emphysema, COPD, Parkinson’s disease, and diabetes mellitus.
Coding chronic conditions is key to not only your patient’s care but also your practice’s revenue. “Approximately 71% of the total health care spending in the United States is associated with care for the Americans with more than one chronic condition,” the CDC reports. “Among Medicare fee-for-service beneficiaries, people with multiple chronic conditions account for 93% of total Medicare spending.”
Only thorough documentation meeting CMS guidelines will ensure you see the share of that spending you deserve for treating patients with chronic conditions. “If critical information is not documented during each patient encounter with the chronically ill,” coding expert Valerie Fernandez wrote for ICD10monitor, “a physician will lose revenue.”
Using Extended HPI to Document Chronic Conditions
Your most reliable tool for documenting and coding your established patients’ chronic conditions is the extended history of the present illness (HPI).
Under CMS’ 1997 E/M services guidelines, you may document an extended HPI by noting the status of three or more chronic conditions to support higher levels of care for established patients and the higher CPT® codes associated with that care. (In 2013, CMS expanded this option, allowing it to satisfy HPI documentation whether providers followed the 1995 guidelines or the 1997 guidelines.)
“The key to this option is the status,” coding and billing expert Rebecca Caux-Harry wrote for 3M Health Information Systems. “A provider can’t point to a problem list as satisfying the HPI requirement, as the problem list doesn’t usually document the status of each issue.”
That’s why, as Dr. Alexander Stemer stresses in his MDCodePro video lectures, “language counts.”
Naming the chronic condition isn’t enough. You must also describe it. The history you document should “paint the picture” of the patient’s complexity and risk, and chronic conditions play a big part in what that picture ultimately looks like.
“Controlled” and “uncontrolled” are appropriate statuses for most chronic conditions, but they don’t exhaust all your options. “If it’s ‘new,’ always say that,” Dr. Stemer advises, “as that descriptor significantly impacts scoring. If the problem is ‘acute,’ ‘severe,’ or ‘worsening,’ state that. If your patient’s asthma attack is severe, record ‘acute bronchospasm, severe, persistent.’ If a problem interferes with function, such as severe arthritis preventing stair climbing, record ‘no longer able to climb stairs,’ or ‘unable to shop for food.’”
“Saying it at the beginning of the visit,” Dr. Stemer teaches, “helps your scoring at the end.”
Meet CMS Coding Guidelines for Chronic Conditions with MDCodePro
Showing you how to efficiently and effectively incorporate an extended HPI into your professional routine is only one way the MDCodePro system can help you better document all your patient visits, including those “routine” ones, like the visit Dr. Linzer described, that you soon realize aren’t.
When you put the method we show you into practice, you may sometimes have more documentation than the CPT® code your established patient’s visit requires, but you’ll never have less.
The number of chronic conditions today’s patients face means you should probably be submitting higher CPT® codes more of the time. Be ready to support those claims with MDCodePro. Sign up for your subscription now.