Meat Training

O ADVANTMED Where is the MEAT? RekAdustment HEDIS/ Sar Ratngs Record Rerieval Member Oureach RV Record Conralzator X ADVANTMED Where is the MEAT? Where is the M.E.A.T? * M= Monitor * E=Evaluate + A=Assess + T=Treat If your diagnosis can be supported by any of the above by being Monitored, Evaluated, Assessed, or Treated then you should be in compliance. As long as there is some relationship to your diagnosis. 2

O ADVANTMED What is MEAT? MEAT Criteria consists of the following O Anythingin the assessment would be considered as having met MEAT criteria except for specific acute diagnosis that should only appear in hospital admission (Thislist would need to be reviewed and confirmed- CVA, Fractures, PE, etc.) 0 Chronic conditions do not require MEAT (see list of chronic conditions) U MEAT is considered from ROS, PE, Assessment, or Plan ) Medications do not have to be linked by provider; however, it must be conclusive that the medication is for that condition. “For example Coumadin is prescribed and patient has both A-fib and DVT. You cannot identify whythe Coumadinis given, so you cannot assume linkage.” Laboratory or other testing does not have to be linked to be considered valid for MEAT. X &) ADVANTMED Where is the MEAT? Additional hints: * Monitoring- signs, symptoms, disease progression, disease regression Evaluating- test results, medication effectiveness, response to treatment Assessing (or Addressing) — ordering tests, discussion, review records, counseling Treating- medications, therapies, other modalities

&) ADVANTMED Where is the MEAT? Pastmedical history: Atrial Fibrillation Physical Exam: Cardio: Rhythm irregularly irregular MEAT criteria is met: Observation of the irregular heart beat is considered symptom and would be MEAT for the a-fib. PastMedical History: Neuropathyof the feet Physical Exam: Extremities: numbness and tingling bilaterally MEAT criteria is met: Numbness and tingling are common symptoms. &) ADVANTMED MEAT found in the HPI * MEAT can be found in the HPI. In the example below, provider states “ESRD started on HD” and hemodialysis status (V45.11) should be captured based on the provider’s statement Ol Coplit: ool v . murm o e i chesty e e, ERD s ). e ook dicae petesion e et e CAD, e 225 2 DES O, who s forfollow spolrpeges St vt e e admsin S s Skl st kKU S v ket ook Sedws P SO8 st &7 o g S pr——

&) ADVANTMED Where is the MEAT? Hyperlipidemia = Supporting documentation would be lipid profile ordered or medication listed next to condition. (If no linkage required check Drug.com for common lipid medications.) Osteoporosis = Dexascan ordered or medications (Boniva, Actonel, Calcium, etc. isted next tothe condition. ‘GERD = £GD Scheduled or meds (Protonix, Zantac, Tagamet, Reglan, etc.), symptoms controlledon medications. AFIB- Medications, EKG reviewed or scheduled. Major Dep ROS - Depr Improving - Diabetes- HgbA1Creviewed or ordered, review and findings of manifestation NOT present, o medications (Glucotrol, etc) Q) ADVANTMED Where is the MEAT? COPD- Spirometry, PFT (Pulmonary functions test), Chest x-ray - reviewed or ordered. Physical exam of lungs or statement of hypoxemia. HTN - Review of BP logs, medication changes or refils CKD - GFRIab results or order CAD- EXG reviewed or ordered CHF= Echo ordered or reviewed

&) ADVANTMED Common Signs and Symptoms * Congestive Heart Failure Shortness of breath (dyspnea) Fatigue and weakness Swelling (edema) in your legs, ankles and feet Rapid or irregular heartbeat Reduced ability to exercise Persistent cough or wheezing with white or pink blood-tinged phlegm Increased need to urinate at night Swelling of your abdomen (ascites) Sudden weight gain from fluid retention Lack of appetite and nausea Q) ADVANTMED Common Signs and Symptoms * Alzheimer’s and/or Dementia Look to see if provider has documented one of the following: ¥ If the patient s being accompanied by a caregiver (often mentionis made in the HPI) Repeats statements and questions over and over, not realizing that they've asked the question before Forgets conversations, appointments or events, and not remember them later Routinely misplace possessions, often putting them in illogical locations Eventually forgets the names of family members and everyday objects

&) ADVANTMED Common Signs and Symptoms * Alzheimer’sand/or Dementia (continued) Often Alzheimer’s and Dementia patients experience certain behaviors which ‘would be considered symptoms of the disease. ¥ Depression Anxiety Social withdrawal Mood swings Distrust in others Irritability and aggressiveness Changes in sleeping habits Wandering Loss of inhibitions Delusions Q) ADVANTMED Common Signs and Symptoms * GERD (Gastroesophageal Reflux Disease) Aburningsensation in your chest (heartburn), sometimes spreadingto the throat, along with a sour taste in the mouth Chest pain Difficulty swallowing (dysphagia) Dry cough Hoarseness or sore throat Regurgitation of food or sour liquid (acid reflux) Sensation of a lumpin your throat

O ADVANTMED Coding Diagnoses from PMH and Other Historical Lists There are many diagnoses in risk adjustment models that have medication therapy, where those medications are only used for those diagnoses alone, and these are often utilized to establisha diagnosis as current or valid to submit. In such cases, it is importantto be sure thatthe medication is current, and prescribed for the diagnosis to make it a current diagnosis. Medications documentedthat can be used for several different diagnoses or conditions do not help support an active diagnosis if they are not linked in some manner to the diagnosis itself Special caution s advised for those records where diagnoses appear to be continually repeated or “cutand pasted"” into each subsequent DOS and caution should be taken to only include those diagnoses which meet the TAMPER criteria above when diagnoses are listed as Historical, &) ADVANTMED Coding Diagnoses from PMH and Other Historical Lists The following diagnoses are examples that are often improperly coded as current, Many of these codes should not be reported s historical, or they may have a more specific “history of” code such as a V code that might be more accurate. » Eractures—Fractures arenot coded once they are repaired. However, compression fractures of the vertebrae are often not treated in the elderiy, and i a vertebral fracture appearsto be a current diagnosis, it may be coded. Cancers—Thereare 'history of diagnosis codes to express this, and these may or may. not risk adjust (they do for some commercial plans, but do not for CMS HCC purposes.) CVA—Codingguidelines statea CVA may not be coded once a patient s discharged for this problem, instead a history of code should be used.

&) ADVANTMED Coding Diagnoses from PMH and Other Historical Lists Myocardial Infarction—Thereis 2 specific code for old MI (412) which does risk adjustin most models. HIV—This diagnosis has no cure and could never be merely historical. Amputations—Amputated body parts are permanent. Anythingthat s listed as: repaired, resolved, fixed, or managed through prophylaxis. o Q) ADVANTMED Coding from Lists i diagnoses arelisted as current, ongoing, active, chronic, etc. they may be coded, especiallyifthereis another specific separate listing of PMH diagnoses. Conditions thatresolve and have no additional mention n the record should ot be coded unless TAMPER guidance is met Example: Chronic Problems: + Acute Pancreatitis (odritted 2002) cva (2000) Prostate CA + RATIONALE: The above lst may be titledas “Chronic conditions, but not allof the conditions listed are . The A-fibis clearly current as there is medical treatment. The acute pancreatitis appears to be may be coded as foctual, and the CVA is not only historical(one could code o nd any related residual conditions f noted) but an active CVA code cannot be coded once -t has been discharged for the CVA. CKD i clearlystillunder treatment, and prostate CA locks any t ongoing treatment that would be necessary to code a cancer as current.

&) ADVANTMED Coding from Physical Exam The exam portion of the medical record is where the provider documents the objective findings from the actual physical exam portion of the encounter with the patient. Many providers may list valid diagnoses in this section of the record and any diagnoses documented, as current should be coded appropriately. Example 1: Exam: Extremities: Good Lt. pedal pulses; Rt. Above knee amputation (2006). Rationale: In the above exam, the provider merely uses the exam portion to annotatethat there is an above the knee amputation. The code for amputation status would be appropriate to code. Example2: Exam: Appearance: Appears cachectic. Rationale: In the above exam, the provider is merely annotating an appearance and not making a diagnosisof cachexia, “Appears” is the same s “likely” which is not a diagnosis O ADVANTMED Coding from Assessment and Plan The assessment and plan portions of any record are the final portions of documentation for each encounter. The diagnoses documented in the assessment and plan should generally always be coded, with one word of caution-many providers will st tems in the assessment, which have resolved or are no longer current * Examples of assessment documentations that should not be coded Example 1: Stroke—When the patient is not having or being treated for a stroke it is improper to code this diagnosis. Example 2: Cancers—Cancers may only be coded when they are current and not current by the above definitions, as they have their own rule. Cancers must only be coded as current when there. is evidence of current treatment toward the cancer (or the patient has refused treatment, or “watchful waiting” is being followed). Special caution must be taken by the coder when reviewing records for follow up of old cancers which have resolved, been eradicated, or are no longer being actively treated and avoid coding those incorrectlyas current.