HCC/RxHCC Risk Tutorial for SETMA Table of Contents - Setma.com

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As you review the Medical Decision Making criteria for a 99213 visit, you will see thatmost visits in a multi-speicality clinic will result in virtually no 99212 visits. The step from99212 and 99213 is very short. In addition, it is possible to begin seeing the correlationbetween HCC and E&M. If a patient has an HCC coefficent aggregate score above 0.75,they are certianly going to have at least one “stable chronic illnesses such as well-controlledhypertension, or diabetes,” etc. And, if either of those are not well-controlled, you quicklygo in your mangement, with proper documentation from a 99213 to a 99214.If any one of SETMA’s disease mangment tools is used effectively, the 99213 visit isreached and if two of them or used, the 99214 visit is reached. This requires that the tool beused effectively but it is an efficent process.Low Complexity (99213)As stated, the step from a 99212 to a 99213 visit is very short. The step from a 99213 to a99214 is slightly longer but still a relative short step. Again, relating E&M to theappropriate and necessary evaluation and treatment of a patient with multiple HCCs and/orRxHCCs diagnoses, which diagnoses result in a coefficient-aggregate score over 1.00, tothe Medical Decision Making criteria for a 99214 visit, shows that patients with this levelof risk will most often result in a visit with an E&M code of 99214.It should be possible, therefore, to compare an individual provider’s E&M codedistribution with the mean of his/her HCC coefficient aggregates. The higher theHCC coefficient aggregates the higher one should expect the E&M code distributionto be.44
Reviewing the Complexity of Medical Decision Making for the 99214 visit below, it is seenthat going from a 99213 to a 99214 involves the evaluation of two or more chronicconditions. Remember, all of this is dependent upon your having evaluated an adequatenumber of systems review and systems in physical examination. Whether you have or notwill be told to you by SETMA’s E&M Code calculator.Moderate Complexity (99214)Moving from 99212 to 99213 and from 99213 and 99214 in regard to Complexity ofMedical Decision Making is relatively easy. Now, however, the step from a 99214 to a99215 is a huge leap. It is possible to make this leap, as in the case of malignanthypertension with exacerbation, COPD with exacerbation, CHF with exacerbation, etc, butit will be rare.45
Page 6: To the right of the Chronic Conditi
Page 11: This button and the date beside it,
Page 15 and 16: If you have not completed an evalua
Page 17 and 18: When you click the HPI button in th
Page 19 and 20: Soon, If you use the Chronic Condit
Page 21 and 22: You can then select the specific fu
Page 23 and 24: Depressing this button launches the
Page 25 and 26: Under the title “Categories”, i
Page 27 and 28: Using the Master GP to Evaluate a C
Page 29 and 30: As you can see this displays both t
Page 31 and 32: There are two categories on this li
Page 33 and 34: If the visit in which that medicati
Page 35 and 36: We are able to report this informat
Page 37 and 38: When the IMO search engine is launc
Page 39 and 40: The following is another example of
Page 41 and 42: The last template is one which refl
Page 43: system establishes the relative ris
Page 47 and 48: The question is, “Is this because
Page 49: Summary:The correlation between HCC

HCC/RxHCC Risk Tutorial for SETMA Table of Contents - Setma.com

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