Keep M.E.A.T. on Your List for a Healthy Audit

By Jeanmarie Loria, Advize Health, LLC

If you’re reading this article, chances are you already know what HCC Coding is – but we’ll give you a refresher anyway. Hierarchical Condition Category (HCC) and Risk Adjustment Coding is a CMS-mandated payment model. This model works to identify those with chronic and other serious illnesses and prescribes a risk factor score to each patient, taking into consideration their ailments and other demographics.

With every payment model comes a specific set of audit and review requirements that must be met to maintain the integrity of the system, and this is where MEAT (Monitor, Evaluate, Assess/Address, Treat) comes in handy.

In a face to face visit M.E.A.T. maybe found in the chief complaint, history of present illness, review of systems, physical exam, assessment and/or plan.

  • Monitor – Ex. If there are there signs/symptoms for COPD, the provider may mention wheezing. For Parkinson’s disease, the provider may mention that the patient’s tremors have increased or decreased.
  • Evaluate – Ex.  For diabetes, you may see the results of an A1C test, or for Chronic Kidney Disease Stage 4; you may see the results for a GFR. The provider may document a cancer patient’s response to chemo or radiation.
  • Assess/Address – Ex.  Provider may provide counseling for diet/exercise for a patient diagnosed with morbid obesity (with a BMI of 40+).  The provider may mention that they are reviewing records from a specialist.
  • Treat – Ex. The provider may link the medication to a patient’s diagnosis to a medication, for example: “pt. is currently taking insulin for their diabetes”. Therapy is another treatment option, where a provider may note that a patient with major depression is receiving psychotherapy.

Evaluation and Management (E/M) coding and HCC coding are unique disciplines that exist on opposite ends of the coding spectrum. The singular common denominator, and most important convention to remember is abstracting documented support from the medical record as evidence of your determination of any supported codes. For E/M, this may result in a question of whether or not the provider documented an evaluation of 8 organ systems during a physical examination. The aforementioned documentation supports a comprehensive physical exam which is indicative of a level 4 or 5 procedure.

A physical exam is not the only component that computes an E/M level of service, documentation of the physical examination can be supported for high service levels. Take into consideration an assessment of the diagnosis as support for low, moderate, or high Medical Decision Making (MDM). Support for this assessed diagnosis could be found in the History of Present Illness (HPI) or physical exam. For example, utilizing HCC coding, a provider documents that chronic atrial fibrillation was assessed in an office visit note. In both cases, correct abstraction of the medical record for support is needed for proper code assignment.  The location and specificity of the supporting documentation varies between E/M and HCC coding, which results in a learning curve for coders and auditors making a transition between the two.

Another aspect of the transition from E/M to HCC includes the ICD-10-CM diagnostic guidelines. Both CPT and ICD-10 guidelines have individual complexities. In a situation that calls for HCC coding, ICD-10 diagnostic guidelines must be reviewed. It is imperative that during a HCC review, coders are mindful of code descriptions, combination codes, note exclusions, and codes detailed to the highest level of specificity. HCC coding’s emphasis on diagnosis coding contrasts E/M coding, as it is not used as often to determine the level of service for an office visit. For this reason, Evaluation and Management coders should be vigilant about refreshing their memory on diagnosis codes prior to taking on HCC assignments.

Finding a code with a HCC value and support may seem like a minor victory, but it builds the foundation for the following steps in ensuring cohesion amongst the codes that are reported as they relate to: “code also, code first” instructions, and excludes notes and other pertinent guidelines.

For many E/M coders and auditors, application of E/M guidelines becomes second nature and the need for continuous deferment to reference materials becomes unnecessary. Transitioning to HCC can be a discouraging process, as it very much requires dedication to learning new requirements. Some mitigating factors include curating a robust assortment of reference materials and cheat sheets, and keeping them close to your work station. The review of completed QA’d audits will also create a constructive environment in which new HCC auditors can thrive. Cooperation and coordination with more seasoned HCC auditors is a resource that you shouldn’t be afraid to tap into.

Of course, as with any new discipline, there are also incredible educational courses and seminars available for those interested in immersing themselves in a new specialty, including RISE West 2017 in Scottsdale, Arizona. 

Categories: Risk Adjustment
Tags: HCC coding, MEAT, Chart Documentation

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