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MediSYS PM Releases Tools to Reduce Non-Specified Codes

To assist practices with the Blue Cross Blue Shield of Alabama (BCBS) ‘Complete Picture of Health Documentation and Coding Improvement Initiative‘, MediSYS PM M2 has released new tools to help reduce the number of non-specific diagnosis codes. In addition, tools to more easily include co-existing, chronic conditions to consider including on the claim are also available. Major carriers including BCBS are encouraging providers to file up to 12 diagnosis codes using diagnosis codes that are specific up to the 5th digit.

Blue Cross is now using claims data to gauge patient complexity and health status. Specificity of coding aids in planning and designing programs to manage chronic conditions.

The new approach includes:

  • Filing professional services include:
    • main reason for the episode of care
    • all co-existing, acute or chronic conditions
    • past conditions impacting clinical evaluation and therapeutic treatment
  • Filing up to 12 Diagnosis Codes
  • File diagnosis codes that are specific up to the 5th digit

Interesting statistics published by Blue Cross indicates that less than 2 diagnosis codes are being sent on claims and 44% of diagnoses received on 2012 claims were unspecified.  With the new tools available in MediSYS PM M2, clinics will have color-coded indicators and warnings to assist in submitting more complete and specific diagnoses.

For Primary Care Providers, the Blue Cross Value Based Payment Program includes a PM Software Diagnosis Exercise in which the clinic submits a test patient with 12 diagnosis.  This test is due by June 30, 2014.

For information on the new tools available, contact us at [email protected].