Medical Record Documentation & Coding Tips
Provider’s Role in Risk Adjustment
Providers play a key role in risk adjustment activities for Medicare Advantage plans as each member’s health status is determined by the conditions identified and supported in medical record documentation. Review this document to learn more about the Provider’s role in risk adjustment.
ICD-10-CM Provider Training
The first section of this Provider training is a basic introduction to ICD-10-CM while the remaining five sections focus on the following common chronic conditions: chronic obstructive pulmonary disease, diabetes, rheumatoid arthritis, congestive heart failure, and major depressive disorder.
ICD-10-CM requires medical record documentation to be more specific to ensure the most appropriate code is selected. To assist with accurate diagnosis coding and billing compliance for Medicare Risk Adjustment, included are the top ten ICD-10-CM documentation and coding tips.
The ICD-10-CM Coding Reference Guide contains some of the more commonly reported conditions in Medicare Advantage Risk Adjustment. The tables within the reference guide are broken down by condition type, they include certain diagnosis (ICD-10-CM) codes and code categories along with their descriptions. Additionally, some helpful coding tips are included.
Medical Record Documentation Tips
This one page document provides medical record documentation tips for Medicare Advantage Risk Adjustment purposes. Reference these tips for documenting to the highest degree of specificity to ensure the most appropriate ICD-10-CM code is assigned.
CMS-HCC Risk Adjustment Model
These publications contain a summary of the diagnosis codes that map to the CMS-HCC Risk Adjustment Model(s). This publication includes the ICD-10-CM codes, HCC codes and category descriptions, along with the disease hierarchies.
Coding Focus publications
A useful and concise one-page publication focusing on a specific condition(s) with details regarding the clinical definition, diagnostic criteria, and relevant ICD-10-CM coding guidance with impact to CMS-HCC code(s) assignment.
These four-page coding brochures were created to guide providers through ICD-10-CM coding by giving a detailed background, specific diagnosis coding guidance, educational elements, and references for specific condition(s).
Annual Wellness Visit Fact Sheet
This Annual Wellness Visit (AWV) Fact Sheet provides details on what an AWV visit is, who can perform the AWV, who is eligible for the AWV, and more. The table of acceptable physician specialty types for Risk Adjustment data submission is also included.
Causal Relationships in ICD-10-CM
This publication contains an overview of the ICD-10-CM coding guidelines in which a causal relationship can be assumed between certain conditions.