Is MEAT Satisfying Your RAF Hunger?



Sometimes the acronym leaves you wanting for more.

MEAT is an acronym for Monitoring, Evaluating, Addressing/Assessing, and Treatment. The coding community uses MEAT to better apply and understand an ICD-10-CM guideline that is difficult to remember … but remember you must. Failure to MEAT this guideline can and will negatively affect risk adjustment factor (RAF) scores, which ultimately amounts to decreased revenue.

A MEAT-Only Diet Can Be Risky

Risk adjustment models use ICD-10-CM codes to adjust patient premiums. However, to support an ICD-10-CM code, certain criteria must be met. The physician or other qualified healthcare professional must document the diagnosis in the patient record during a face-to-face encounter, for one. And second, the diagnosis coding must be in line with the ICD-10-CM Official Guidelines for Coding and Reporting and the American Hospital Association’s AHA Coding Clinic®.

This second criterion can be challenging because, like many coding areas, it has its own nuances. In fact, this is where the acronym MEAT originates. Another more encompassing acronym used in the industry is TAMPER™. This acronym includes MEAT plus Plan and Referral. Coders can apply MEAT or TAMPER™ to determine which conditions should be reported during a patient encounter.

The official guideline behind the acronyms reads, “Code all documented conditions that coexist at the time of the encounter/visit and require or affect patient care treatment or management.” Another official guideline that also addresses disease reporting reads, “Chronic diseases treated on an ongoing basis may be coded and reported as many times as the patient receives treatment and care for the condition(s).” This guideline only incorporates treatment, and it only applies to chronic diseases.

MEAT and TAMPER™ Fall Short for Inpatient Coding

These acronyms are more commonly used in the outpatient setting. Official inpatient guidelines state that the coder should report conditions that affect patient care in terms of requiring clinical evaluation, diagnostic procedures, treatment, extended length of hospital stay, increased nursing care, or monitoring. In fact, there is Coding Clinic® instruction indicating that if there is documentation in the medical record to indicate that the patient has a chronic condition, it should be coded. In Coding Clinic® 2007 Vol. 24, No.3, AHA states:

Chronic conditions such as, but not limited to, hypertension, Parkinson’s disease, COPD, and diabetes mellitus are chronic systemic diseases that ordinarily should be coded even in the absence of documented intervention or further evaluation. Some chronic conditions affect the patient for the rest of his or her life and almost always require some form of continuous clinical evaluation or monitoring during hospitalization, and therefore should be coded. This advice applies to inpatient coding.

This means that if a chronic condition, such as diabetes or hypertension, is listed in an inpatient admission note without further mention or management, you can report it without MEAT. In contrast, Coding Clinic® has recently stated that conditions documented in the medical history of an outpatient note, even with current medications, may not be reported unless they were “treated during the current encounter.”

Instructional Notes Sometimes Void MEAT

There are instances where MEAT falls short in the outpatient setting as well, and here is when the founding guideline must come into play.

Instance 1: According to Coding Clinic® 2018 Vol. 5, No. 4, “Obesity and morbid obesity are always clinically significant and reportable when documented by the provider.” Body mass index codes are always coded in conjunction with the obesity codes.

Instance 2: MEAT falls short when multiple coding guidelines apply, indicated with instructional notes such as “Use additional code” and “Code first.”

For example, suppose the provider is primarily evaluating the progress of chronic kidney disease (CKD) in a patient with diabetes and hypertension. All three conditions are listed in the medical history, and the drugs taken for hypertension and diabetes are listed in the medication list. Even if the conditions are just mentioned in the history of present illness or assessment section without further treatment, they should be reported. In this case, both CKD and the comorbid conditions are reported even if there is not MEAT documented for diabetes and hypertension in the encounter note. This is because there is an instructional note directing the coder to code the underlying condition(s) in addition to the renal disease.

Instance 3: MEAT falls short when applying the guideline statement, “Report the condition if it affects patient care treatment or management.” There is no MEAT capturing the effects of a disease in the patient’s treatment or management.

For example, a patient is referred to the endocrinologist because their current chronic obstructive pulmonary disease (COPD) steroid therapy is causing drug-induced diabetes. In this case, you should report secondary diabetes, in addition to COPD, since it is affecting the patient’s care.

Another example is when a provider is evaluating an injury or any other condition in a patient with dementia. The visit may focus on the injury, but if the caregiver is functioning as an independent historian or the neurological disorder is interfering with the evaluation, also report the dementia because it is affecting the patient’s care.

Remember to Hone All Your Tools

Acronyms are great tools for helping us to code. Regardless of the acronym or tool you use while assigning codes, you must know and follow official guidelines as they apply to each unique situation.


Resources:

2021 ICD-10-CM Official Guidelines for Coding and Reporting

AHA Coding Clinic® for ICD-10-CM and ICD-10-PCS: 3rd qtr 2020 p 33; 4th qtr 2018 p 77;
3rd qtr 2007 p 13

TAMPER™, IonHealthcare, https://www.ionhealthcare.com

Contract-Level Risk Adjustment Data Validation Medical Record Reviewer Guidance – In effect as of 03/20/2019.

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