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2018 CPC Practice Exam Answer Key 150 Questions With Full Rationale (HCPCS, ICD-9-CM, ICD-10, CPT Codes) Click here for more sample CPC practice exam questions with Full Rationale Answers

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Click here for more sample CPC practice exam questions and answers with full rationale

Risk Adjustment Coding- DM and complications coding.

We need clarification when coding from the following examples:
Example #1
Provider’s documentation states:
DM without complications
Hypertension with CKD III

Coding:
E11.9, I12.9, N18.3

or we should code:
E11.22, I12.9, N18.3

Example #2
Provider’s documentation states:
DM
Hypertension with CKD III

Coding:
E11.22, I12.9, N18.3
Coded as guidelines stating.

Example #3
Provider’s documentation states:
DM without complications
Polyneuropathy

Coding:
E11.42
or we should code:
E11.9, G62.9

Example #4
Provider’s documentation states:
DM
Polyneuropathy
Coding:
E11.42
Coded as guideline stating.

Guidelines:
ICD10-CM presumes cause and effect linkage between DM and certain conditions unless the physician specifically indicates the conditions are not related. Conditions that appear in the index as indented subterms under the various types of "diabetes, with" are coded as diabetic complications, even in the absence of the physician documentation explicitly linking them, unless the documentation clearly indicates these conditions are not caused by diabetes for example, by stating:
Actual nondiabetes related cause
Cause is not diabetes
Diabetes is without complications
Cause is unknown.

Any help is much appreciated.
Thank you.

Medical Billing and Coding Forum

Risk Adjustment Pay Freeze Ends

The Centers for Medicare and Medicaid Services (CMS) released a Final Rule freeing more than $ 10.4 billion to anxious payers to continue the Affordable Care Act’s (ACA) risk adjustment program. The agency had halted payments to payers while a New Mexico ruling was challenged, but in the end the activity unnerved the industry and didn’t change much. Risk Adjustment […]
AAPC Knowledge Center

Risk adjustment coding – hcc code documentation

We are a specialist office and have been researching how much documentation needs to be given within the patient’ s note to support the comorbidiitie dx codes that we are adding for risk adjustment coding . We have been told it is ok to put only the dx codes within the dx area of the note but have also been told that we need to put in further documentation stating that the patient has XXXX that is being managed by an outside physician and the condition may effect the outcome of care.

If there is any concrete documentation out there that anyone has to show what the true answer is – will you please share?

Thank you ,

Stephanie

Medical Billing and Coding Forum

Risk Adjustment

We are getting so much requests (as in 120 chart requests just for BCBS alone, another 74 for Humana) for risk adjustment.

We are a single provider office and perenially short staffed due to budget problems. I am using my weekends to submit but it feels like the vendors (ArroHealth, Cioxx, etc.) keeps on piling it on us everytime we have submitted. Anyone on the same boat?

Drowning in med records requests.

Medical Billing and Coding Forum

Risk Adjustment Coding Information

Hello, i was wondering if anyone has any specific websites, or newsletters in regards to HCC’s and Risk Adjustment Coding information that they subscribe to, that sends out periodic updates etc. If so can you please provide the link or info. I like to stay current with any and all changes and education, so i am just looking to see what everyone else uses that they think may be helpful.
Thank you

Medical Billing and Coding Forum

Include MEAT in Your Risk Adjustment Documentation

Risk adjustment helps to ensure accurate and adequate payment for Medicare Advantage (MA) patient conditions, based on expected medical costs. A patient’s health status reflects the costs associated with their healthcare needs. The more of a burden the disease is, the higher the risk adjustment score is. Healthier patients have a lower risk adjustment score. Hierarchical […]
AAPC Knowledge Center

Risk Adjustment Calculations in the Commercial Line of Business

Small group and individual markets have unique strategic opportunities for coding and operational processes. Risk adjustment is predictive modeling that assesses members’ risk for incurring medical expenses above or below the average during a defined time. Demographics and health status are used to determine health plan payments, which also can assist with care management needs. […]
AAPC Knowledge Center