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AAFP Coding Flash Cards Update Includes Risk-adjusted Payment

August 12, 2016 02:26 pm Sheri Porter

Sometimes little details can make a big difference in business. Such is the case when it comes to coding, billing and keeping a family medicine practice financially sound.

[Pre-order on index card]

A long-standing Academy coding tool has been updated with important new information; family physicians can now pre-order AAFP Coding Flash Cards 2017 and expect orders to begin shipping on Sept. 19.

Members pay $54 and nonmembers pay $154 to pre-order the cards, which is $15 off the regular price for both groups.

The 2017 flash cards will help family physicians -- and their clinical and coding teams -- with accuracy and specificity in the documentation of patient care. The new card set includes

  • 2017 ICD-10 updates,
  • more than 1,200 of the ICD-10 diagnosis codes most often used by family physicians including more than 400 additional codes,
  • common CPT codes used in daily practice and
  • hierarchical condition category (HCC) codes that feature risk-adjustment indicators for payment and quality comparisons.
Story Highlights
  • Pre-order 2017 AAFP coding flash cards at a discounted price and improve the accuracy and specificity of documentation of patient care.
  • The cards include 2017 ICD-10 updates, more than 1,200 ICD-10 diagnosis codes and hierarchical condition category (HCC) codes.
  • HCC codes are a way for physicians to risk-adjust their senior patients in terms of how much expense they may generate in the future; the codes are playing an increasing role in value-based compensation.

That last bullet should hold particular interest for family physicians, according to Kenneth Adler, M.D., of Tucson, Ariz.

The HCC codes -- implemented by CMS in 2004 but just recently getting the attention they deserve -- are a way for physicians to risk-adjust their senior patients in terms of how much expense they may generate in the future, which translates to how sick they are, Adler told AAFP News.

"Physicians can no longer afford to ignore these HCC codes because they are playing an increasing role in value-based compensation. Billing correctly can make a difference -- and it can mean millions of dollars depending on the size of your organization, the size of your patient population and the type of contract an organization has with a health plan," he added.

Adler is the medical director for a large physician-owned group practice that started its own accountable care organization recently. His organization started focusing on HCC codes about three years ago when health plans starting paying physicians for providing the more detailed information.

"Basically, it's a scoring system," said Adler. Here's how it works:

Only 14 percent of ICD-10 codes have risk adjustment value, and these are separated into 79 HCC categories. Each category has a set point value. The sum of the values of the different diagnoses that qualify as HCC diagnoses -- plus a demographic value based on the patient’s age, sex, disability and location (home versus institutional) -- make up the patient’s HCC score.

"It's called an RAF (risk adjustment factor) score and 1.0 is considered the average score," said Adler. A patient with an RAF score of 2.0 is predicted to cost twice as much in the next year as a patient with a score of 1.0.

Coming Soon: FPM Primer on HCC Coding

Physicians new to HCC coding likely have a lot of questions. There's an opportunity coming soon to fill those knowledge gaps.

Watch for an article set to publish online in Family Practice Management in mid-September.

In the article titled "HCC Coding, Risk Adjustment and Physician Income: What You Need to Know," authors will review HCC coding basics, discuss risk adjustment and assess the impact these codes have on dollars paid to physicians.

"The key is to identify as many diagnoses in a particular patient as possible because the higher the score the more the health plan is reimbursed," said Adler. And depending on the contract, more and more insurers are willing to pay physicians a share of that money for doing that coding work.

"Many physicians are now involved in some sort of program where they're going to get financially rewarded if they can identify more of these codes," said Adler.

He noted that his organization encourages people to be "much more exact and specific in their diagnosing" and to be aware of those diagnoses that risk-adjust and those that don't.

For instance, renal insufficiency does not risk-adjust, but chronic kidney disease stage four does.

Specificity matters, said Adler. "A diagnosis of breast cancer has a risk adjustment value, but it's not nearly as high as if you used a diagnosis of metastatic breast cancer."

Adler has also found HCC codes helpful in identifying high-risk patients who might benefit from care management programs.

"It's one way to stratify your population and look at these patients who may benefit from additional services to keep them out of the hospital or reduce their emergency room utilizations," said Adler.

A lot of physicians view HCC coding as "just another thing they have to worry about." But family physicians should become proficient in HCC coding because correct use of the codes is good for patient care and good for practices financially, said Adler.

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