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September 24, 2021
Summary of new code auditing changes September 2021
For claims processed on or after September 22, 2021, you may notice differences related to changes in code pairs in CCI, which includes modifier override changes; daily frequency limits; incidental, mutually exclusive and unbundled code edits; assistant surgeon eligibility; modifier to procedure compatibility; evaluation of incomplete diagnosis; global surgery pre-operative and post-operative periods as defined…
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August 18, 2021
NCQA Kidney Health Flyer Reinforces Importance of Regular Screening
Currently in its first year of implementation, the new HEDIS measure Kidney Health Evaluation for Patients With Diabetes (KED) includes this measure description: The percentage of members 18-85 years of age with diabetes (type 1 or type 2) who received kidney health evaluation, defined by an estimated glomerular filtration rate (eGFR) AND a urine albumin…
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June 23, 2021
Value-based specialty care programs: Focus on cardiology
As a means of improving health outcomes, increasing member and provider satisfaction, and reducing the high cost of care, CDPHP is investing in its network specialists by creating a number of value-based specialty care programs. The initiative, which builds on the strategies applied to our Enhanced Primary Care program, affords our specialty care providers increased…
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June 11, 2021
Code Auditing Changes Effective June 16, 2021
Quarterly, Capital District Physicians’ Health Plan, Inc. (CDPHP®) implements appropriate code auditing changes to remain current with industry standard coding updates. Updates are made to our code auditing software – Change Healthcare Technologies, LLC ClaimsXten™ – based on recommendations from a variety of sources, including the American Medical Association (AMA), Centers for Medicare and Medicaid…
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May 07, 2021
Coding Tips for Actual or Suspected Exposure to COVID-19: ICD-10 Code Z20.822
Since the COVID-19 public health emergency was declared, diagnosis codes for reporting actual or suspected exposure to COVID-19 have been updated. This article provides coding tips, based on the current official 2021 ICD-10 guidelines, for using the new ICD-10 diagnosis code Z20.822. This diagnosis code can be reported for dates of service on or after…
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March 29, 2021
First-Quarter 2021 Coding Changes Announced
Quarterly, Capital District Physicians’ Health Plan, Inc. (CDPHP®) implements appropriate code auditing changes to remain current with industry standard coding updates. Updates to Change Healthcare Technologies, LLC ClaimsXten™, our code auditing software, are based on recommendations from a variety of sources, including the American Medical Association (AMA), Centers for Medicare and Medicaid Services (CMS) Correct…
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