Medicare Record Documentation and Coding Tips | Providers – Amerigroup

Medicare Advantage

Medical Record Documentation & Coding Tips

The ICD-10-CM Provider Training consists of six sections focusing on ICD-10-CM documentation and coding tips. The first section 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.

Speaking ICD-10-CM

Speaking ICD-10-CM was produced to help learn the terminology for the new diagnosis code set. These are one-page summaries containing the ICD-9-CM to ICD-10-CM code crosswalk for specific conditions including a detailed comparison of diagnosis code selections and/or relevant coding guidance.

Coding Focus publications

The Coding Focus provides everything you need to know about specific clinical diagnoses. These publications contain the definition, diagnostic criteria, treatment options and relevant coding guidance for each designated diagnosis.

ICD-10-CM provides a greater level of specificity with over 71,000 diagnosis codes from which to select. This 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, see the following for the top ten ICD 10 CM documentation and 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.

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 additional information on the following illnesses/diagnoses:

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.

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.

Coding Reference Guide

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.