Take a Deep Dive Into Substance Use Disorders

Approved by the AAPC for 4 hours of CEU:

This program meets AAPC guidelines for 4.0 CEUs. Can be split between Core A, CRC, CEMC, CHONC, CANPC, CDEO, CPCO and CPMA after successful completion of post-test for continuing education units.

Overview:

When is it appropriate to code for opioid dependence versus long time use?

What documentation is needed to support a diagnosis of alcoholism in remission? 

Should I code sedative dependence for all of my patients taking a sleeping medication?

Is it appropriate to code cannabis abuse when the medical record states recreational marijuana use? 

These are some of the most frequently asked questions by physicians and coders. 

This course takes a deep dive into the classification, screening, coding and documentation of the four most frequently coded substances: alcohol, cannabis, opioids and sedatives and substance-induced disorders. 

Register now - Course is FREE until August 1, 2020


Key Objectives:

Substance Use Disorders

• Introduction
• Brief history of Substance Use
• Important Definitions

Classification of Substance Use Disorders

• Introduction to DSM
• Brief History of the DSM
• Drugs of Abuse
• Substance-Induced Disorders

Screening, Brief Intervention and Referral for Treatment

• SBIRT
• AUDIT
• CAGE
• CAGE-AID
• DSAT-10
• SMAST-G

Coding for Substance Use Disorders

• AHA Coding Clinic
• ICD-10 Coding for Substance Use Disorders
• Alcohol Use Disorders
• Cannabis Use Disorders
• Opioid Use Disorders
• Sedative, Hypnotic, or Anxiolytic Use Disorders

Coding for Substance-Induced Disorders

• Substance-Induced Anxiety Disorders
• Substance-Induced Bipolar and Related Disorders
• Substance-Induced Depressive Disorders
• Substance-Induced Neurocognitive Disorders
• Substance-Induced Sexual Dysfunctions
• Substance-Induced Sleep Disorders

Clinical Documentation Improvement for Substance Use Disorders

• Ten Tips for Success
• Clinical Documentation Examples

Quality Measures for Substance Use Disorders

• 2020 HEDIS Codes
• 2020 CMS QM

View the course on ERM365

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Are you looking for the best education available in risk adjustment, value-based payments and/or CDI?

Good News - You have found it!

Join us for a day of risk adjustment, catch up with colleagues over lunch, and get the best tools in the industry for FREE!

Do you need CMEs or CEUs? We have that too!

All Workshops are approved by the American Medical Association, American Academy of Family Practice and the American Academy of Professional Coders.

Register your team ( 3 or more) today to save 10% on any 2020 Workshop!

Take advantage of Early Bird pricing and Save $100!

Overview:

• Vast changes are coming to the way we purchase healthcare.
• What should your team be doing now to be successful in the world of value-based payments? 
• How do HCCs impact benchmarks and quality scores?
• Review the CMS-HCC Model V24 for risk adjustment in 2020 and 2021. 
• Discuss the importance of managing HCCs year over year. What resources are available from CMS to help? 
• Take a deep dive into the 20 most common HCCs per Medpac data. 
• Common GAPS in claims and encounter data that lead to inaccurate risk scores. 

Download the Agenda Here

Who Should Attend?

-Providers - MDs, DOs, PAs, and NPs

-Medical Directors - Medicare Advantage, ACOs, CPC+ and Medicaid

-Hospitals and Academic Medical Centers

-Medical Coders, Billers and CDI Specialists

-Executive Leaders, Administrators, Directors and Managers

-MSO and IPA Teams

-Rural Health Centers, FQHCs and Community Health Centers

-Health Alliance Members and Medical Society Members

-Medicare, Medicare Advantage, Medicaid and Commercial Plans

  

Each Attendee will Receive ($130):

 - Color copy of the presentation

 - CME from AAFP and AMA

 - CEU from AAPC

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Please email Kameron Gifford

Early Bird Pricing and Group Discounts

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Arm Your Team For Combat This Risk Adjustment Season!

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2020 CMS-HCC Quick Coder 2020 CMS-HCC Coding Cards - 12 Pack 2020 CMS ICD-10 to HCC Mappings 2020 Medicare Coding Essentials Visit ERM365 or ERM Consulting to learn more.

Pulmonary Hypertension - HCC 85

What is Pulmonary Hypertension?

Pulmonary hypertension, defined as a mean pulmonary arterial pressure greater than 25 mm Hg at rest or greater than 30 mm Hg during exercise, is often characterized by a progressive and sustained increase in pulmonary vascular resistance that eventually may lead to right ventricular failure.

Types of Pulmonary Hypertension

Pulmonary arterial hypertension (PAH): 

This type of PH is caused by the changes in the walls of the small arteries of the lungs.

Pulmonary venous hypertension (PVH): 

This type of PH is caused by problems related to the left side of the heart such as heart valve disease, congestive heart failure and cardiomyopathy.

Other conditions that contribute to the development of PH

• Aortic valve disease
• Chronic obstructive pulmonary disease “COPD”: a group of lung diseases that block airflow and make it difficult to breathe.
• Congenital heart disease
• Liver cirrhosis: a disease that occurs when healthy cells in the liver are damaged and replaced by scar tissue, usually as a result of alcohol abuse or chronic hepatitis.
• Autoimmune disease: a condition in which your immune system mistakenly attacks your body (e.g. lupus, rheumatoid arthritis and scleroderma).
• Mitral valve disease
• Pulmonary fibrosis: a type of lung disease that occurs when lung tissue becomes damaged and scarred.
• Sickle cell disease: a condition in which there aren't enough healthy red blood cells to carry adequate oxygen throughout your body.
• Obstructive sleep apnea: a condition in which your breathing abruptly stops and starts while sleeping.

Symptoms of Pulmonary Hypertension

The signs and symptoms of pulmonary hypertension in its early stages might not be noticeable for months or even years. As the disease progresses, symptoms become worse and begin to show. Various symptoms include:

•          Abdominal bloating
•         Shortness of breath during routine activity
•         Fatigue
•         Heart palpitations: when you feel like your heart is racing, pounding or fluttering.
•         Heart arrhythmias
•         Chest pain
•         Decreased appetite
•         Pain in your right side of the abdomen
•         Rapid heart rate (tachycardia) of more than 100 beats per minute.
•         Lightheadedness/Fainting
•         Swelling in your ankles, legs and abdomen
•         Bluish lips or skin (cyanosis)

Classification of Pulmonary Hypertension

The cause of pulmonary hypertension is classified by the World Health Organization into five groups.


Group 1- Pulmonary arterial hypertension: This grouping is caused by:

• Certain drugs
• Conditions that affect veins and small blood vessels of the lungs.
• Congenital heart disease
• Autoimmune disease (e.g. lupus, rheumatoid arthritis and scleroderma) is a condition in which your immune system mistakenly attacks your body.
• Genetic tests
• HIV infection
• Liver disease
• Sickle cell disease
• Unknown cause

Group 2- Pulmonary hypertension caused by left-sided heart disease: This grouping is caused by:

• Aortic valve disease
• Cardiomyopathy
• Congestive heart failure
• Mitral valve disease

Group 3- Pulmonary hypertension caused by lung disease: This grouping is caused by:

• Chronic obstructive pulmonary disease (COPD)
• Interstitial lung disease
• Long-term exposure to high altitudes
• Sleep apnea and other sleep disorders

Group 4- Pulmonary hypertension caused by chronic blood clots: This grouping is caused by:

• Chronic blood clots in the lungs or general clotting disorders.

Group 5- Pulmonary hypertension associated with other conditions that have unclear reasons why the pulmonary hypertension occurs: This grouping is caused by:

• Blood disorders such as polycythemia vera and essential thrombocythemia.
• Metabolic disorders such as thyroid and glycogen storage diseases.
• Systemic disorders such as sarcoidosis and vasculitis.
• Tumors pressing against pulmonary arteries.

Patients with pulmonary hypertension are normally classified into 4 symptom-based (functional) classes also described by the World Health Organization.

• Class I: Patients in this category show no limitation of physical activity. Ordinary physical activity does not cause fatigue, palpitation or shortness of breath.
• Class II: Patients in this category show slight limitation of physical activity. No symptoms at rest.
• Class III: Patients in this category show great limitation of physical activity. No symptoms at rest.
• Class IV: Patients in this category are unable to carry on any physical activity without discomfort. There are symptoms at rest.

Risk Adjustment / HCC Coding FAQs

Question:

If both pulmonary hypertension and heart failure are coded, will both diagnoses be added to the patient’s risk score? 


Answer: 

No, both diagnoses map to HCC 85. Each 

HCC category is only added to the risk score once.  

HCC Category	Description	Community       Non-Dual, Aged	Community            FB Dual, Aged
HCC 85	CHF	0.331	0.371

There are a total of 61 ICD-10 codes included in HCC 85. See the complete list below. 

ICD-10 Description     
A36.81 Diphtheritic cardiomyopathy
B33.24 Viral cardiomyopathy
I09.81 Rheumatic heart failure
I11.0 Hypertensive heart disease with heart failure
I13.0 Hypertensive heart and CKD with HF and stage 1 through 4 CKD
I13.2 Hypertensive heart and CKD with HF and with stage 5 CKD, or ESRD
I26.01 Septic pulmonary embolism with acute cor pulmonale
I26.02 Saddle embolus of pulmonary artery with acute cor pulmonale
I26.09 Other pulmonary embolism with acute cor pulmonale
I27.0 Primary pulmonary hypertension
I27.1 Kyphoscoliotic heart disease
I27.20 Pulmonary hypertension, unspecified
I27.21 Secondary pulmonary arterial hypertension
I27.22 Pulmonary hypertension due to left heart disease
I27.23 Pulmonary hypertension due to lung diseases and hypoxia
I27.24 Chronic thromboembolic pulmonary hypertension
I27.29 Other secondary pulmonary hypertension
I27.81 Cor pulmonale (chronic)
I27.83 Eisenmenger's syndrome
I27.89 Other specified pulmonary heart diseases
I27.9 Pulmonary heart disease, unspecified
I28.0 Arteriovenous fistula of pulmonary vessels
I28.1 Aneurysm of pulmonary artery
I28.8 Other diseases of pulmonary vessels
I28.9 Disease of pulmonary vessels, unspecified
I42.0 Dilated cardiomyopathy
I42.1 Obstructive hypertrophic cardiomyopathy
I42.2 Other hypertrophic cardiomyopathy
I42.3 Endomyocardial (eosinophilic) disease
I42.4 Endocardial fibroelastosis
I42.5 Other restrictive cardiomyopathy
I42.6 Alcoholic cardiomyopathy
I42.7 Cardiomyopathy due to drug and external agent
I42.8 Other cardiomyopathies
I42.9 Cardiomyopathy, unspecified
I43    Cardiomyopathy in diseases classified elsewhere
I50.1 Left ventricular failure, unspecified
I50.20 Unspecified systolic (congestive) heart failure
I50.21 Acute systolic (congestive) heart failure
I50.22 Chronic systolic (congestive) heart failure
I50.23 Acute on chronic systolic (congestive) heart failure
I50.30 Unspecified diastolic (congestive) heart failure
I50.31 Acute diastolic (congestive) heart failure
I50.32 Chronic diastolic (congestive) heart failure
I50.33 Acute on chronic diastolic (congestive) heart failure
I50.40 Unspecified combined systolic (congestive) and diastolic (congestive) heart failure
I50.41 Acute combined systolic (congestive) and diastolic (congestive) heart failure
I50.42 Chronic combined systolic (congestive) and diastolic (congestive) heart failure
I50.43 Acute on chronic combined systolic (congestive) and diastolic (congestive) heart failure
I50.810 Right heart failure, unspecified
I50.811 Acute right heart failure
I50.812 Chronic right heart failure
I50.813 Acute on chronic right heart failure
I50.814 Right heart failure due to left heart failure
I50.82 Biventricular heart failure
I50.83 High output heart failure
I50.84 End stage heart failure
I50.89 Other heart failure
I50.9 Heart failure, unspecified
I51.4 Myocarditis, unspecified
I51.5 Myocardial degeneration

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CMS Issues ABN Update

Are you using the most current ABN?

A new Fee-for-Service Advanced Beneficiary Notification of Non-coverage (ABN) form is now effective, with an expiration date of June 30, 2023. The use of the old ABN (version 03/2020) will be considered invalid after Aug. 31, 2020.

What’s Changed in the ABN?

Guidelines for dual eligible beneficiaries (patients with both Medicare and Medicaid coverage) have been added to the ABN form instructions. The changes were necessary to comply with billing prohibitions for patients in a Qualified Medicare Beneficiary (QMB) program. The QMB program helps pay Part A, Part B, or both program premiums, deductibles, coinsurance, and copayments.

Special Instructions Apply

Patients in a QMB program cannot be charged for Medicare cost sharing for covered Parts A and B services, nor can they elect to pay Medicare cost sharing. As such, special instructions apply when a provider issues an ABN to a dual eligible beneficiary:

Dually eligible beneficiaries must be instructed to check Option Box 1 on the ABN in order for a claim to be submitted for Medicare adjudication.

Strike through Option Box 1 as provided below:

□ OPTION 1. I want the D. [service or supply] listed above. You may ask to be paid now, but I also want Medicare billed for an official decision on payment, which is sent to me on a Medicare Summary Notice (MSN). I understand that if Medicare doesn’t pay, I am responsible for payment, but I can appeal to Medicare by following the directions on the MSN.

If Medicare denies a claim where an ABN was needed in order to transfer financial liability to the patient, the claim may be crossed over to Medicaid or submitted by the provider for adjudication based on state Medicaid coverage and payment policy.

Once the claim is adjudicated by both Medicare and Medicaid, providers may only charge the patient in the following circumstances:

If the patient has QMB coverage without full Medicaid coverage, the ABN could allow the provider to shift financial liability to the patient per Medicare policy.

If the patient has full Medicaid coverage and Medicaid denies the claim (or will not pay because the provider does not participate in Medicaid), the ABN could allow the provider to shift financial liability to the patient per Medicare policy, subject to any state laws that limit beneficiary liability.
These instructions should only be used when the ABN is used to transfer potential financial liability to the beneficiary and not in voluntary instances.

Find Out More About ABNs

More information on dual eligible beneficiaries may be found on the CMS website. Guidelines for issuing the ABN can be found beginning in Section 50 in the Medicare Claims Processing Manual, Pub. 100-4, Chapter 30. The revised ABN form may be downloaded from the CMS website.


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Read more from the AAPC Blog

CMS-HCC to ICD-10 Mappings for 2021

CMS has released the initial ICD-10 Mappings and Software for 2021. 

 – The V24 (HCC) Model includes 9,757 ICD-10 Codes 

 – The V05 (RxHCC) Model includes 4,381 ICD-10 Codes

Click on a file below to download.

2021 Initial ICD-10-CM Mappings xlsx

2021 Initial ICD-10-CM Mappings csv

Download the 2021 Initial Model Software from CMS

Visit ERM365 to learn more. 

CMS Innovation Center COVID-19 Flexibilities

Centers for Medicare & Medicaid Services (CMS) has announced flexibilities and adjustments for current and future alternative payment models administered by the Center for Medicare and Medicaid Innovation (CMMI) to accommodate relevant participants, providers and stakeholders during the COVID-19 public health emergency. While CMS announced that additional details regarding model-specific flexibilities will be released on a rolling basis, CMS leadership authored a blog post and released a table that outlines the models and changes applicable to relevant models.

CMS has utilized existing flexibilities built into current bundled payment models, as well as aligned its additional adjustments with COVID-19 public health emergency flexibilities available on a Medicare fee for service basis. CMS also aimed to adjust financial methodology for performance-based rewards and repayment obligations during the public health emergency to accomplish the following:

• Encourage continued participation in CMMI alternative payment models and ensure higher quality outcomes.
• Create equity and consistency across models.
• Reduce risk for model participants and the Medicare and Medicaid programs.

For example, certain models exclude COVID-19 cases or may reduce exposure for downside risk during the public health emergency. Other flexibilities offered by CMS involve quality reporting changes, including extending deadlines or implementing exceptions. Lastly, CMS announced adjustments to certain model timelines due to COVID-19. CMMI will extend timelines for certain existing models and delay starts for upcoming models.

A full version of the table outlining CMMI flexibilities is available here, which addresses the following models:

• Bundled Payments for Care Improvement Advanced Model.
• Comprehensive ESRD Care Model.
• Comprehensive Care for Joint Replacement Model.
• Direct Contracting Model.
• Emergency Triage, Treat and Transport Model.
• Oncology Care Model.
• Home Health Value-Based Purchasing Model.
• Independence at Home.
• Integrated Care for Kids Model.
• Kidney Care Choices.
• Maternal Opioid Misuse Model.
• Medicare Choices Model.
• Medicare Diabetes Prevention Program Expanded Model.
• Primary Care First Model.
• Medicare ACO Track 1+ Model.
• Next Generation ACO.

Additionally, in separate guidance, CMS published flexibilities in response to COVID-19 for the Medicare Shared Savings Program, available here.

Visit the Innovation Center