News & Updates

Register online for a Priority Health Academy
Don’t miss this convenient, affordable opportunity to enhance your skills and understanding of a variety of subjects. We will again offer three academies across the state:

• Grand Rapids – Oct. 28, 2009
• Traverse City – Oct. 29, 2009
• Farmington Hills – Nov. 4, 2009

Click here for complete details – agenda, class descriptions, registration.

Code with Confidence course
Join Judy Breuker, CPC, CCS-P, CHBME, ACS, PCS, CPC-E/M, CHC, CHAP, for this class at the Priority Health Conference Center. Classes will be Mondays from 5:30 - 8:00 p.m., February 1 - April 19, 2010. This class is limited to the first 35 paid enrollees. Classes fill quickly, so register early!

ICD-10-CM class
Judy Breuker, CPC, CCS-P, CHBME, ACS, PCS, CPC-E/M, CHC, CHAP, will conduct an ICD-10 class on March 10, 2010, from 8:00 a.m. to noon at the Priority Health Conference Center. Watch our website and future newsletters for more information.

Add your website to our Find a Doctor tool
You may add your website to our Find a Doctor online search by emailing the link to your field service representative (FSR) or PAE. We’ll include this link in the Provider Information section of your practice’s page. View sample.

Terminating employee Web access
Please contact the Provider Helpline or your FSR immediately to terminate Web access for an employee in your office. We’ll inactivate his or her access to member data and your provider accounts.

Medical policy changes
Please remember to view the Recent Changes section on the left side of the online Provider Manual page for updates to medical policies and billing information.

Operational information
Coding specificity does make a difference
It’s important for providers to document each condition as specifically as possible. Correct ICD-9 coding relies on providers to clearly detail the type of condition, complications or manifestations of a condition, and outcomes from testing relating to a condition.

Documenting the specific condition also impacts the diagnosis code chosen. When documentation is generic, coders are not able to select the most specific diagnosis code. In these cases, coders may select the “unspecified” or “unknown” diagnosis code when there is a more specific diagnosis code that could be used. For example:

• Don't report unspecific anemia diagnosis (285.9) for a member with refractory anemia (238.7).
• Don't report unspecific anemia diagnosis (285.9) for agranulocytosis (288.0).

Terms such as acute or chronic may impact the diagnosis code selection and should always be documented to show the specific condition. When there are multiple forms of a given diagnosis, document and select the exact code that identifies the condition. For example:

• Avoid selecting a diagnosis for chronic bronchitis when the member actually has acute bronchitis. Two different ICD-9 codes represent these conditions.

Specifying that a condition is a manifestation or complication of another condition is imperative. This identifies that a relationship between two conditions exists, and in most cases, a different ICD-9 code or additional ICD-9 code is assigned based on the relationship between specific manifestation and complication documented.

Remember to link the two conditions with terms such as “due to,” “associated with,” and “with” to indicate that the conditions are related to one another (indicating that both conditions exist does not “link” the conditions as related). For example:

• Documenting “diabetes” as one diagnosis and “neuropathy” as another diagnosis does not clearly identify that this member has diabetes with neuropathy. The wording must be specific within the medical record.

Be specific in reporting the degree of depression for members, as there are different codes for different types.

• Patients with major depression (or major depression disorder) should be identified by reporting ICD-9 codes under range 296.20 – 296.36. Stating “depression” doesn’t indicate the most specific depressive condition.

For additional ICD-9 guidelines, please visit the CMS website for ICD-9 coding.