Time for another edition of my wildly popular “Success Codes” series. If you haven’t already, you may want to review my world-class, yet humbly simple (yes, really) explanation of RAF scoring—it’ll help you understand some of the shorthand terminology below. It’s the only one on the web written by a PCP who’s been in the trenches blocking and tackling since Medicare Advantage first arrived on the scene 20+ years ago—and done so with incredible results.
That’s probably why it’s so good—and so good for you! Now let’s get started.
Five weeks ago we discussed the simplicity of diabetes coding and how these codes affect the amount of your capitation.
If a chronic complication of diabetes is present, you want to capture at least one of the associated diagnostic codes every calendar year.
If you do, the amount of revenue the government will pay each month for the care of your patient’s diabetes will double.
Individual complications of diabetes each might increase also your risk score themselves, but all you need is one diabetes complications code to jump from “Diabetes without Complications” to “Diabetes with Complications” and the associated additional revenue.
Neurologic complications of diabetes are straightforward diagnoses to make.
The diabetes codes are in the E11.4xx ICD-10 group—based on the specific type and location of the neuropathy. The neuropathy itself is coded using G63-polyneuropathy in diseases classified elsewhere.
Take a systematic approach and the condition will never elude you.
- Once every calendar year see the patient for a routine exam.
- Ask them about any neuropathic symptoms
- Perform a full diabetic foot exam
- Vibration testing with 128 Mhz tuning fork is the best test for early clinical detection of diabetic neuropathy—do it on every patient.
If you pick up the condition, address it, document it and submit it with the appropriate code outlined below—and you’ve captured your “diabetes with risk” code for the year.
- E11.42-Type 2 Diabetes with polyneuropathy
- G63-Polyneuropathy in diseases classified elsewhere
Now you can concentrate on taking good care of your patient.
Again, the most important benefit of this workflow is not the increase in your monthly capitation, it’s the impact you can have on your patient’s disease course through early identification of complications.
That will generate far more value than even the highest RAF score.
That is the true beauty of Medicare Advantage and value-based care—you and your patient– goals truly aligned.
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