Inside This Issue Shifting from Reactive to Proactive Reinforcing Partnership –2022 ACHN Retreat Recap Coding Corner: FY 2023 Code Updates Clinical Integration News A Publication by Atlantic Coast Health Network FALL 2022
From The Executive Director
Dear Friends and Supporters,
Atlantic Coast Health Network is changing the way healthcare is delivered. We are making steady and substantial progress as a fully integrated, patient-centered, value-based network. The impact on the patient experience alone has been transformative.
At the leadership level, we are strengthening our payor partnerships to create more value for our patients and more incentives for providers. Across the care continuum, we are promoting interoperability to ensure patients have timely access to their own health information. We are also working closely with providers to ensure that our preventive care services are being utilized and coded appropriately.
With this Fall issue, we invite you to learn more about these initiatives, all of which align with our vision for ACHN—to improve the quality of care, create cost savings opportunities, and promote better outcomes. Thank you for being a trusted partner as we continue to transform the healthcare landscape.
Executive Director
Luisa Hurtado
Atlantic Coast Health Network
Shifting from Reactive to Proactive
In a value-based care system, preventive medicine has a profound influence on patient outcomes. Providers take a more proactive approach to medicine rather than focusing solely on disease intervention. As a result, patients come to understand their risk factors early on and take measures to stay healthy. Atlantic Coast Health Network is effectively driving this change—and seeing its positive impact over time.
One of the greatest benefits of preventive care involves chronic disease management. Across the nation, the burden of chronic diseases such as type 2 diabetes and heart disease is felt economically, physically and emotionally. Not only do they drive up healthcare costs, they diminishes the quality of life for patients and their families. ACHN has prioritized several strategies to identify risk and intervene before disease occurs.
Annual physicals with primary care physicians provide an important opportunity to update the medical history, detect any changes, and make a plan. Providers can assess risk factors and discuss the importance of screenings. Care managers also play an important role, identifying any social determinants that could potentially lead to chronic disease. With proper guidance, patients can take charge of their own health and keep illness at bay.
At ACHN, we have implemented several preventive programs, and we utilize metrics to measure their impact. We work closely with our payor partners to make these services accessible and affordable to our patients. By shifting from reactive to proactive, we aim to reduce the costs of healthcare and improve the health of our patient population.
The 2022 Atlantic Coast Health Network Retreat was held on August 26th at the Sonesta Fort Lauderdale Beach. Our Board of Directors, physician members and payor partners gathered together to explore new strategies to strengthen our partnerships and amplify our value. We would like to thank Florida Blue, Cigna and Oscar for their engaging and robust presentations.
Partnership 2022 ACHN Retreat
Reinforcing
Recap
Topics Included: • Network Curation and Provider Engagement • Specialty Care, Collaboration and Risk • Data Challenges and Opportunities • Patient Engagement • Patient and Provider Incentives • Outreach Models to Patients • Interoperability • Social Determinants of Health Health In Harmony. Innovation In Action. One of the top takeaways—value-based care is the future of healthcare. In the peri-pandemic era, solutions must be simple, affordable and predictable. As we accelerate towards this vision, ACHN reaffirms our commitment to our partners, our physicians and our patients.
FY 2023
ICD-10-CM Code Updates
Several updates have been made to the FY 2023 ICD-10-CM guidelines and codes. In total, there are 1,179 new codes, 288 deleted codes, and 28 revised codes. The following are a few notable updates to help ensure that you use the most appropriate code.
Chapter 5: Mental, Behavioral and Neurodevelopmental Disorders (F01 – F99)
83 new codes were added, including 69 new codes for dementia with and without psychological symptoms. This section is being expanded to include 23 codes in each category to specify severity and types of behavioral disturbance. Those codes without behavioral disturbances are not considered CCs.
New ICD-10-CM codes for dementia include:
Dementia in other diseases classified elsewhere, unspecified severity, with agitation
Dementia in other diseases classified elsewhere, mild, with agitation
Dementia in other diseases classified elsewhere, moderate, with agitation
New ICD-10-CM codes for alcohol and drug use in remission include:
Alcohol use, unspecified, in remission
Opioid use, unspecified, in remission
Cannabis use, unspecified, in remission
Sedative, hypnotic or anxiolytic use, unspecified, in remission
Cocaine use, unspecified, in remission
Other stimulant use, unspecified, in remission
Hallucinogen use, unspecified, in remission
Inhalant use, unspecified, in remission
Other psychoactive substance use, unspecified, in remission
Chapter 9: Diseases of the Circulatory System (I00-I99)
F02.811
F02.A11
F02.B11
F10.91
F11.91
F12.91
F13.91
F14.91
Nine codes added to this chapter are specific to refractory angina pectoris, all of which are classified as CCs.
Refractory angina pectoris
Atherosclerosis heart disease of native coronary artery with refractory angina pectoris
Atherosclerosis of coronary artery bypass graft(s), unspecified, with refractory angina pectoris
Atherosclerosis of autologous vein coronary artery bypass graft(s) with refractory angina pectoris
Atherosclerosis of autologous artery coronary artery bypass graft(s) with refractory angina pectoris
Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with refractory angina pectoris
Atherosclerosis of native coronary artery of transplanted heart with refractory angina pectoris
Atherosclerosis of bypass graft of coronary artery of transplanted heart with refractory angina pectoris
Atherosclerosis of other coronary artery bypass graft(s) with refractory angina pectoris
Category Z79 – Long-term Current Drug Therapy
120.2 125.112 125.702 125.712 125.722 125.732 125.752 125.762 125.792
15 new codes were added to this category including long-term current use of injectable non-insulin anti-diabetic drugs (Z79.85)
Chapter 4: Endocrine, Nutritional, and Metabolic Diseases (E00-E89)
A new guideline was added to this section.
If the patient is treated with both insulin and an injectable non-insulin anti-diabetic drug, assign the following codes.
Long-term current use of insulin
Long-term current use of injectable non-insulin anti-diabetic drugs
If the patient is treated with both oral hypoglycemic drugs and an injectable non-insulin anti-diabetic drug, assign the following codes:
Long-term current use of oral hypoglycemic drugs
Long-term current use of injectable non-insulin anti-diabetic drugs
Other updates include new codes for heart disease, injuries due to motor vehicle collisions, and new guidelines in Chapter 15 for calculating weeks of gestation.
Additional Resources
For more information, please review the ICD-10-CM Official Guidelines for Coding and Reporting. https://www.cms.gov/files/document/fy-2023-icd-10-cm-coding-guidelines.pdf
Z79.84 Z79.85
Z79.84 Z79.85
These guidelines should be used as a companion document to the official version of the ICD-10-CM as published on the NCHS website.
F15.91 F16.91 F18.91 F19.91 Coding for drug and alcohol use disorders in remission cannot be assigned without clear documentation in the medical record by the provider. The documentation must specify that the drug or alcohol disorder is in remission.
Pena, MD
Alexander Llanos, MD Richard Perryman, MD Administrators Mark Doyle Matt Muhart Nina Beauchesne Carol Toro Jim Moffett
Members Luisa Hurtado (Ex-officio) Daniel Edelman, MD Kenneth Homer, MD BOARD OF MANAGERS
in Leadership ACHN Board & Committee Membership
Physicians William
(Chair)
Non-Voting
Physicians
QUALITY & IT COMMITTEE
Physicians
Kenneth Homer, MD (Chair)
Kenneth Budowsky, MD
Brett Cohen, MD
Je-Anne Beaufort, MD
Michelle Fiorillo, DO
Jennifer Goldman, DO
Jennifer Capezzuti, MD
Administrators
Jeff Sturman
Mike Paseltiner
Non-Voting Members
Luisa Hurtado (Ex-officio)
Kenneth Homer, MD
Daniel Edelman, MD
Monica Puga
Maria Castano
FINANCE & CONTRACT COMMITTEE
Physicians
Ben Freedman, MD
Alex Llanos, MD
Nigel Spier, MD
Lav K. Goyal, MD
Fausto De La Cruz, MD
Administrators
Jeff Bross
Matt Muhart* (Interim Chair)
Ron Brandenburg
Bill Pepe
Non-Voting Members
Luisa Hurtado (Ex-officio)
Daniel Edelman, MD
Richard Ashenoff
Carol Toro
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