ICD 10 Coding Basics
What does ICD-10 stand for?
What is International Classification of Diseases 10th revision
What does HCC stand for?
What is Hierarchical Condition Category
What does "Risk Score" refer to in risk adjustment?
What is A risk score is a numerical value assigned to a patient based on their dx, age and other factors, used to estimate the patient's healthcare cost and risk level
What happens if a medical coder submits an incorrect dx code for risk adjustment purposes?
What is it can result in underpayment or overpayment which can lead to audits or legal consequences.
What is the ICD-10 code reporting requirement for risk adjustment?
What is the code must be supported by documentation in the patient's medical record.
Which ICD 10 code is used for Type 2 DM w/o complications?
What is E11.9
Which HCC code is associated with congestive heart failure?
What is HCC 85?
What is the purpose of risk adjustment in healthcare?
What is to ensure that insurance providers receive appropriate compensation for the care of patients with higher medical needs.
Which of these is an example of "upcoding" in risk adjustment: Using a more severe diagnosis than the patients condition, or using a less severe diagnosis than the patient's condition?
What is Using a more severe diagnosis than the patients condition
What is the difference between a primary and a secondary diagnosis?
What is The primary diagnosis is the main condition treated or investigated during the encounter, while secondary diagnosis are additional conditions that affect the treatment.
How does HCC coding affect risk adjustment?
What is It helps determine the patients risk level, impacting the health plan's payment rates by identifying patients with higher healthcare needs.
True or False: Risk adjustment coding only applies to Medicare Advantage plans.
What is False? (Risk adjustment is used in several programs, including Medicare Advantage Plans, Medicaid and some commercial health insurance plans.
What is a common consequence of missing a dx that qualifies for risk adjustment?
What is the patients risk score may be inaccurately low, leading to underpayment for the care provided.
How often should risk adjustment diagnoses be updated in patient records?
What is The diagnosis should be updated at least once annually during the patient's visit to ensure accurate risk adjustment coding for the year.
What code would you use for hypertension stage 1?
Which of the following conditions in not included in the HCC coding system: Chronic Obstructive Pulmonary Disease, Asthma or Hyperlipidemia?
What is Asthma? (It is not an HCC condition for risk adjustment purposes, whereas COPD and hyperlipidemia are.
What is the "CMS-HCC" model?
What is The CMD-HCC model is the risk adjustment model used by the Centers for Medicare & Medicaid Services to calculate risk scores for Medicare Advantage enrollees.
Which of the following is an example of "down coding" in risk adjustment?
A.) Missing a diagnosis
B.) Reporting a condition as less severe than it is
C.) Reporting a condition as more severe than it is
What is
B.) Reporting a condition as less severe than it is.
What is the best practice for ensuring accurate risk adjustment coding?
What is Reviewing documentation thoroughly, verifying codes against the patients medical history, and ensuring codes are submitted based on the most accurate and complete diagnosis information.