The 21st Century Cures Act directed CMS to expand the risk-coding system to include additional mental health conditions.
We talked before that these changes are evolutionary, not revolutionary, but they will give you the chance to gain some additional risk-based revenue.
We also discussed how important it is to start coding these conditions now even though the changes are going to be phased in over three years starting in 2019. Experience teaches that getting ahead of the curve is the key to outsized performance.
I simplified what you needed to know about risk-coding mental health conditions in this earlier blog post.
Everything there is still accurate—and it’s still great.
But starting in 2019 conditions that previously were not associated with increased revenue will now get you additional credit.
Although lots of details still need to come out, here is what you, as a clinician or the supervisor of clinicians need to know.
This is something new, but be careful.
Bipolar, antisocial, narcissistic, borderline, obsessive-compulsive.
These conditions are diagnosed in a fashion similar to Major Depression, using observational data to meet set criteria.
The definitions are set out in the Diagnostic and Statistical Manual, Volume Five (DSM-V)
They are soft diagnoses, meaning there are no objective laboratory data that can be referred to.
That means they’re going to be audit bait—big time.
And now that you know you’re going to get paid for personality disorder diagnoses, it’s going to be awfully tempting to start submitting them on your patients. Think about the patients you deal with on a daily basis—personality disorders abound.
Don’t submit these diagnosis without meeting the objective criteria set down by the DSM -V—and documenting it.
Of course, if you have a psychiatrist give your patient an Axis two diagnosis, you’re golden.
Just refer to it in your documentation. You don’t need to have the diagnosis confirmed by them every year, you just need it in the chart once—and refer to it every year when you address it during their annual visit.
In the eyes of CMS, the psychiatrist’s ability to diagnose a personality disorder is better than a prime’s
So be wary of the opportunity this new class of risk codes presents.
Because if you overuse them, if you submit them willy-nilly without the proper documentation you’ll just be giving the money back after the next recovery audit.
But use them wisely—and you will prosper.
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