Success Codes The Next Generation—Psychosis

The 21st Century Cures Act directed CMS to expand the risk-coding system to include additional mental health conditions.

 

 

We talked before that, though these changes are not revolutionary, 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.

 

 

PSYCHOSIS

 

Currently, only specific diseases with psychosis as one of their characteristics are associated with increased revenue. Examples include Schizophrenia and Bipolar disorder.

 

Starting in 2019, two new categories of diagnoses will be included other Psychoses and Personality Disorders will also be included.

 

For the purposes of risk coding you have to remember the DSM-V definition of psychosis we all had to memorize during our third-year Psych rotation—” an abnormal difficulty of the mind wherein there is a difficulty in distinguishing reality.”

 

Remember that.

 

Consider the psychotic demented patient in the nursing home, the otherwise healthy patient sundowning as an inpatient, the walk-in with the undiagnosed thought disorder.

 

Prior to 2019, none of these patients would have any diagnosis that would have counted as a risk-code.

 

That’s about to change.

 

From 2019 onward, for the most part, it won’t really matter what’s causing the psychosis, only that the psychosis itself exists.

 

If you can document that, you should be able to code it correctly—just make sure the word “psychosis” is in the diagnosis descriptor and you should be fine.

 

But if the psychosis is present and you’re not sure what’s causing it, you only need to remember one code.

 

F29—psychosis, unspecified not due to a substance or known physiologic condition.

 

That’s your fail-safe.

 

Keep that in your back pocket and use it at need.

 

And you will succeed—wildly.

 

 

 


 

 

 

Executive, administrator or clinician; here are even more specific, actionable tactics for Medicare Advantage Success.  Strategic thoughts and tactical pearls are posted every Monday and Thursday, sign up for delivery to your inbox and never miss a single one!

 

Last week’s high-value tactic.

 

Stay ahead of the managed care curve with topical weekly intelligence and immediately useful insights—and receive a value-packed free white-paper tailored specifically to your circumstance–subscribe to Value-Based Transformations today!

 

You can catch unique, high-value content including live-streams on my Professional Facebook page.

 

Collaborate with us through LinkedIn.

 

Interact with us via Twitter.

 

Like my Facebook Page.

 

Catch valuable videos and live-streams on my YouTube channel.

 

Want a high-value jumpstart?  Just published with the latest information, tools, and tactics, Medicare Advantage Mastery will set you on your way with your first 12 steps to excellent managed care performance.