Three tips for better risk-adjustment coding

Patient health status is one of several factors, including cost, utilization, and patient satisfaction, that are beginning to drive new models of physician payment. To help quantify the severity of illness of patient panels, more payers are relying on Hierarchical Condition Category (HCC) codes. Selecting ICD-10 codes that map to HCCs will provide a more accurate picture of patient health status and potentially have a positive effect on payment.

Specific and systematic diagnosis coding contributes greatly to accurate risk adjustment. Here are three key concepts to consider when selecting codes:

1. Choose not only the diagnosis codes that describe why the patient was seen but also codes for any chronic conditions that affected treatment choices. For example, a patient with diabetes has severe poison ivy. The physician discusses the diabetes with the patient in deciding whether to use prednisone and documents it in the assessment. The physician should report poison ivy first and diabetes second.

2. If a patient has a serious chronic condition with a manifestation or complication that has its own code, use the more specific code rather than an unspecified code.

3. Report diagnosis codes annually. Risk scores reset each year, so you must report a patient’s qualifying diagnoses every year, ideally the first time you see the patient in the calendar year.

Read the full FPM articles: “Is Your Diagnosis Coding Ready for Risk Adjustment?” and “Diagnosis Coding for Value-Based Payment: A Quick Reference Tool.”