At issue is what Kaiser Permanente did to obtain and report that diagnosis. Radiologists may make a note of its presence in the record if discovered during AAA screening, so the provider who ordered the test will know the patient is at risk. Most AAAs occur in people with severe aortic atherosclerosis. Yet some organizations are instructing radiologists to look for and document any aortic atherosclerosis found in imaging of the chest or abdomen. “Such cascades of care come with substantial potential for harms,” including anxiety, financial burdens, risks, and inconveniences, the article stated. 16, 2019, the Journal of the American Medical Association (JAMA) quoted studies that showed up to 52 percent of radiology and laboratory tests result in incidental findings that can lead to what JAMA called “cascades of care” - tests and treatments initiated because of the incidental findings. Every Medicare enrollee is eligible for one screening with no copay as a preventive measure. Often, the diagnosis is being reported by radiologists as an incidental finding during a Medicare ultrasound screening for abdominal aortic aneurysm (AAA). There is a hitch, though, in how aortic atherosclerosis is being diagnosed and documented these days. In the Kaiser case in California, a diagnosis of aortic atherosclerosis would generate between $2,500 and $3,000 revenue per patient per year, according to the complaint. This HCC carries a risk adjustment factor of 0.288, comparable to the factor for severe chronic kidney disease (CKD) stage 4. Atherosclerosis typically occurs with aging, so by the time patients reach the age to be eligible for Medicare, most will have at least a bit of atherosclerosis in their aorta.Īortic atherosclerosis, whether mild or severe, is reported with ICD-10-CM code I70.0 Atherosclerosis of aorta, which risk adjusts to hierarchical condition category (HCC) 108 in Medicare Advantage plans. The severity of aortic atherosclerosis ranges from early asymptomatic lesions with intimal thickening to complicated plaques with possible surface defects. When plaque buildup and hardening occur in the aorta, it is called aortic atherosclerosis, and as the disease progresses, it increases a patient’s risk of aortic dissection or aneurysm, myocardial infarction, and stroke. These deposits are called plaques, and over time, plaque buildup narrows arteries and causes them to become stiffer, making it harder for blood to flow through them. Atherosclerosis, also known as hardening of the arteries, occurs when fat, cholesterol, calcium, and other substances build up in arterial walls. It receives oxygenated blood from the left ventricle and carries it away from the heart to the rest of the body. The aorta is the largest artery in the body. At issue in this suit is the diagnosis of aortic atherosclerosis. 25, 2021, complaint against several Kaiser Permanente organizations (Case No. Department of Justice (DOJ) in San Francisco has taken aim at practices for adding incidental findings to medical records in its Oct. We are starting to see some of the long-term dangers of ambitiously mining patient data for hierarchical condition categories (HCCs). The growing prevalence of risk adjustment in healthcare has forged new processes in documentation practices that have resulted in many organizations adopting practices that bend the cast iron rules for ICD-10-CM coding. If coders disagree with suggested codes, a note taking function lets them capture their reasoning should this be challenged in the future.DOJ lawsuits may be your road map to risk adjustment compliance. With each code linked to associated text in the medical record, highlighted and presented to the user, an audit trail exists to back up each code submitted. This is where expert and technology combine in true augmented intelligence.įigure 1: Each review consists of a left-hand panel of individual results to curate, alongside a large view of the complete document with color-coded highlights 1), coders can also highlight additional text and add new codes that may have been missed – or alter NLP presented codes to ones of their choice. With the medical record presented in an easy to consume format (see fig. Having combed through lengthy medical records (often hundreds of pages long), our solution identifies conditions, codes, and risk categories and presents these to the coder to accept or reject. Our interactive interface puts facts into the hands of experts.
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