CHC CODING GUIDELINES QUESTIONS AND ANSWERS 2023

CHC CODING GUIDELINES QUESTIONS AND ANSWERS 2023 Diagnostic Test Provider performs the test is a face to face, Techs are not a face to face Only code from the interpretation Pathology Date of collection or Resultant Date No Commercial Plan Captures Capture for Medicare Only Telehealth Will code tele-health visits on all health plans Requires live interactive live video conferencing At a rural medical facility where the patient is at and provider is at a distant location, not a from home teleconference call Correct Beneficiary The beneficiary's name (and date of birth when available) must match throughout the medical record and with the coding tool's data entry screen. Unique Identifier Does Not Appearing On Each Page When the patient's name or unique identifier does not appear on each page of the medical record, continuity from page to page must be shown either through the flow of content or page numbers. Example: Evidence of continuity used on additional pages when the patient's name or unique identifier appears only on the first page. Page (1 of 3), (2 of 3), (3 of 3), etc. on each page Name Is Completely Different CHECK NO for medical record member match Same Name Different Birthdate Not just a typo, CHECK NO for medical record member match. Nickname or Variation If the name appears to be a nickname or other variation, CHECK YES for medical record member match. CORRECT DATA COLLECTION PERIOD The encounter's date of service (DOS) must be within the data collection period under review. The DOS is a required element and defines when the beneficiary received medical treatment from a physician, credentialed non-physician provider or medical facility. Additionally, the service must have occurred during the measurement period for valid risk adjustment coding purposes. DOS Missing or Incomplete DO NOT CODE the encounter if the DOS is missing or incomplete unless the year can be confirmed. DOS Does Not Appear On Each Page Continuity from page to page must be shown either through the flow of content or page numbers. Example: Evidence of continuity used on additional pages when the DOS appears only on the first page. Page (1 of 3), (2 of 3), (3 of 3), etc. on each page. Letter Format When the encounter is documented in letter format, the LETTER DATE CANNOT BE PRESUMED to be the DOS. Providers may at times dictate the encounter the following day or even later, at which time the letter is dated. The DOS must be clearly documented. ▪▪ Statements such as "I saw your patient today" or "patient was seen today for..." confirm that the DOS equals the letter date. Encounter Labels: DOS Dates located on encounter labels may be interpreted as the date of service for Emergency Department records or other hospital outpatient single date records. INPATIENT DOS Inpatient records must have both the admission and discharge dates documented in at least one place of the medical record (face sheet, summary, discharge orders, etc.). ENTIRE PATIENT RECORD The entire inpatient record is viewed as one encounter. ▪ The date of discharge for inpatient records should be referenced to verify the services occurred within the correct benefit year. ▪ If an enrollee was admitted to a hospital in December 2016 and discharged in January 2017, the services performed that occurred in both December 2016 and January 2017 are considered in the 2017 benefit year for calculation of enrollee risk scores and therefore not eligible for the 2016 benefit year ED DOS The Emergency Department (ED) record date of service is considered part of the inpatient date range WHEN FOLLOWED BY A DIRECT ADMISSION. Face To Face Telehealth Visit The medical record must be a face-to-face visit with an acceptable physician specialty type. Examples of Face-To-Face Visits Examples that a face-to-face visit occurred: o Patient seen today... o Patient presents today... o Discussed with patient... (confirm in person not via phone) o Reviewed with patient... (confirm in person not via phone) o Objective findings documented within the note (even without a complete exam). Not a Face-To-Face Visit Do Not Report diagnosis codes if the documentation is clearly not a face-to-face visit. Pathologist Interpretation The interpretation of the findings by a pathologist as an acceptable physician specialty is acceptable for Medicare Advantage (MA). This is an exception to the face to face requirement. o Enter the DATE OF COLLECTION as the date of service ▪ The RESULTS DATE can be used if the collection date is not present o Examples of pathology reports include the following: ▪ Pathology report from a tissue biopsy (e.g., lung biopsy, bone biopsy, etc.) ▪ Cell block report ▪ Cytopathology report of fluids/brushings ▪ Papanicolaou (PAP) smear report ▪ Chromosome analysis