Ciox Aetna 2019 Mra Hcc Guidelines
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- 1.What is the Project scope for the CIOX Aetna 2019 MRA ?
- A.
2017-18 & 2019 till date, HCC, Rxhcc One per year HCC coding rule.
- B.
2019 till date with HCC and Rx HCC, Each Visit HCC coding rule.
- C.
2018-2019 till date , HCC and Rx HCC. Each Visit HCC coding rule.
- D.
None of above
- 2.Patient is here for the cardio f/u. his bp is normal. He is on calcium channel blocker for her heart disease. PMH/Pl: - HTN, Hyperlipidemia, Hypercholesterolemia, Hypertryglecridemia, ASCVD, DVT, GERD, CHF. Vitals normal PE: - Constitutional: - Smile face, alert and oriented. HENT – normal, Cardio- continue aspirin for CAD. RRR normal. Extremities: - Edema present. Assessment: - DVT before 2 weeks ago patient went to Ed that time. Cont. lab order for ECHO, Lipid profile. LDL 90, HDL110.
- A.
I10, E78.5, I2510,K219,I82409.
- B.
I119,i509,E785,I2510,K219,I82409
- C.
I110,E785,I509,I2510,K21.9
- D.
I110,I509,E78.2,I2510,K21.9,
- 3.Acute condition ( As per CIOX Cross walk list) I65.23 ( occlusion and stenosis of carotid artery Bilateral) is valid to code directly from the assessment with the provider attention. True or false ?
- A.
True
- B.
False
- 4.Chronic condition which are present under the CC will be coded directly submittal without requiring any kind of MEAT/TEMPER or support in the visit?
- A.
True
- B.
False
- 5.For the Medication we can use WebMed But, Provider linkage for all the medication of the disease condition is required. is this statement is True or False ?
- A.
True
- B.
False
- 6.Each discharge summary will be coded with the D/S dos only, And in between document will be coded with the A/D and D/S date range.
- A.
True
- B.
False
- 7.C.C Patient appointment for the Injection. HPI: - patient for the Vitamin B injection. PMH: - HTN, CAD, HLD, CHF, Prior MI 1885. Vitals: - BP 180/90, Ht 120Cm, Wt 145 Lbs, BMI 39.9 PE: - Not recorded Procedure: - Vitamin B injection is administered on the patient left side of the thigh by IV route by Mohmmad Devlekar RN. Electronically signed by Roket Baba M.D on 02-02-2019. Is this visit is valid to code or not ?
- A.
Yes , It is valid to code.
- B.
No, It is not valid to code.
- 8.Age related cataract is valid to Link with the DM?
- A.
True
- B.
False
- 9.Visit dos is 02/02/2019 and provider signature on 06/28/2019. (electronically singed by xyz M.D on 06-28-2019) is this statement is going under as __?
- A.
No valid provider signature ( EMR sign issue)
- B.
Valid Provider signature ( Completed EMR sign)
- 10.BMI = 40 or more then 40, Present under the vitals section is valid to code directly without requiring any extra support. Is this statement being true or false?
- A.
True
- B.
False
- 11.C.C - Patient is here for the cancer past surgery f/u. HPI – Mr Nanda is here for the f/u of the breast ca surgery f/u. here surgery for the Right breast ca – Lumpectomy was done before the 1 month ago. Now, she is here for the f/u. PE – All systems are normal. Assessment: - right sided breast cancer. Mammogram for the breast cancer is ordered. Cont. on Chemotherapy. Plan - NAD (No evidence for the disease is present). Electronically signed by XXRAI MD on current date. Can we code BREAST CA as VALID or SKIP the condition ?
- A.
Code the Condition.
- B.
Do not Code, Skip the condition.
- 12.Patient past medical History of condition is HTN, HLD, CKD, DM, GERD, OA, RA, Dementia, Ulcer. Can we code the Chronic condition from above mention list? or we going to skip those condition as it is marked as HX (History of ) condition without any kind of Support/MEAT/TEMPER?
- A.
Skip It as it is marked as HX of Statement without any Support. No evidence is present that condition is Active or not.
- B.
Code the condition as it is mention under the past medical history of , We have guideline that chronic condition from PMH go as valid directly no required any support.
- 13.Type 1 -insulin dependent diabetes mellitus is mention under the assessment . So, it is valid to code it as E10.9 and Z79.4, If provider not document insulin under the medication list not in the entire visit. Is this statement being true or false ?
- A.
True
- B.
False
- 14.What is the chart rejection process please select the below suitable option?
- A.
Missing of patient second identifier in the visit.
- B.
A date of service is not mention clearly.
- C.
Entire record with the missing of the patient DOB and Miss match of the Patient First and last Name, Multiple patient data on valid SOAP format.
- D.
All of the Above.
- 15.Select the best option for the Rejection Reason for the coding from the Medical Record.
- A.
Face sheet/ cover sheet only in entire chart.
- B.
In competed notes no 2/3 key component are present no valid SOAP note present in ENTIRE record.
- C.
Labs/ Imaging reports only.
- D.
All of the Above.
- 16.EYE report Note – Patient is here for the Eye exam. OS: - No PDR present OU: - Positive for ARND, +1 NC. OD: - No DR present. Assessment: - PVD – I73.9, Vitreous hemorrhage, Hypertensive Retinopathy. It is valid to code I73.9 from Above case? True or False ?
- A.
True
- B.
False
- 17.He has suspected MI in 2000, As CIOX MI is fall under the Chronic list and Also, OLD MI is fall under the status condition code .So, It is valid to code it as I25.2, True or False ?
- A.
True
- B.
False
- 18.PMH: - HX of DM, HTN, HLD. Code the Note. All are the chronic condition found under the CIOX Cross walk.
- A.
Z86.39, I10, E78.5
- B.
I10, E78.5
- C.
E11.9 with Chronic no support found, I10,E785.
- 19.DOS:- 12/31/17 Patient is here for the change the medication for HTN. Patient also has High Chol. Patient suffering from the CKD stage 3 from past 2 years. PMH – HTN, CHF, DM, GERD Medication – Insulin pump, Tums (Prilosec Proton Pump inhi.), Lisinopril. Furosemide, Digoxin, Losartan. Assessment: - patient is stable on HTN, CHF, GERD and CKD stage 3 to 4. EMR singed by UUir E APN on 01/01/2018. Select appropriate option.
- A.
I13.0, N18.4, E11.22, K21.9, I50.9, Z79.4
- B.
I13.0, N18.3, E11.22, K21.9, I50.9, Z79.4
- C.
I13.0, N18.3, E11.22, K21.9, Z79.4
- D.
I13.0, N18.4, E11.22, K21.9, Z79.4
- E.
None of the above.
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