Provider Insider

Risk Coding

| Issue No.

We have launched a medical risk coding program to help guide providers in their efforts to tell the best patient story and appropriately document medical complexity, while meeting coding guidelines required by Medicare and commercial payers. Our program offers providers the following:

  • Individual meetings with practices tailored to the needs and areas of opportunity specific to the practice.
  • Chart audit to identify education opportunities and workflow enhancements.
  • 1-on-1 coaching.
  • Disease state coaching.
  • Rapid improvement events.
  • Workflow redesign assistance.
  • Individualized data analysis and review.

Risk coding tip: “History of Prostate Cancer” vs. “Prostate Cancer”

If your patient’s prostate cancer has been successfully treated and the patient is in remission, then you do not need to code the active diagnosis of “Prostate Cancer” (C61) to get your patient’s annual PSA level test covered. Medicare will cover the lab test as long as you do not order the “Total and Free” combination test.

For help or to schedule a clinic visit, please contact Tamara Ellis.