Coding

Health Plus’s coding team is an integral part of the Quality Improvement (QI) Department. The coding team works closely with the QI clinical team to continually monitor, evaluate and improve the quality of health care received byour members. We also analyze medical record data and compare this with the claims data ensuring accuracy in the information reported to us.

The coding team engages in QI program activities that are consistent with QARR and HEDIS reporting requirements. (Please refer to our Quality Improvement tab for further details regarding QARR and HEDIS.)

We perform periodic chart reviews to ensure that the Health Plus providers that we serve are compliant with various federal, state and local regulatory agencies. The core chart review activities that the coding teams engage in are as follows:

• Appropriate Testing for Children with Pharyngitis
• Chlamydia Screening
• Appropriate Monitoring for Patients on Persistent Medication
• Well Child 0-15 Months
• Well Child 3-6 Years Old
• Well Adolescent
• Hierarchical Condition Category (HCC) Medicare Risk Adjustment

Performing chart reviews has afforded us the opportunity to work closely with our providers to identify coding inaccuracies and promote provider coding education and training initiatives.

Below is some coding literature which provides documentation and coding tips that address the various chart review activities that we engage in. Please note that coding literature contains CPT, HCPCS and ICD-9-CM code information. Please check our link periodically for various coding updates and tips. Also, please be sure to review our quarterly Health Plus provider news bulletin for various coding topics. Should you have an interest in coordinating coding education and training or have suggestions on coding topics that you would like to see in the provider bulletin, please contact your Provider Relations Associate, the Health Plus Provider Care Center (1-800-450- 8753), or e-mail us at: providers@healthplus-ny.org.

CPT copyright 2010 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

CODING RESOURCES

• 2011 ICD-9-CM Code Changes - ( PDF, 107 KB )
• E&M 1997 Guidelines - ( PDF, 129 KB)
• H1N1 Provider Notice - ( PDF, 93.3 KB)
• ICD-10 Readiness - ( PDF, 850 KB)
• Medicaid EHR Incentive Q&A - ( PDF, 247 KB)
• Medicare Incentive Payments Tip Sheet - ( PDF, 232 KB)
• Modifier 25 Coding Tips - ( PDF, 51.3 KB )
• Vaccine Adm Overview 2010 - ( PDF, 91.7 KB)
• Wax Removal Tips - ( PDF, 57.7 KB)