• My Account
    • Login
  • Contact Us

CodingIntel

Medical coding resources for physicians and their staff. CodingIntel was founded by consultant and coding expert Betsy Nicoletti.

  • Join Today
  • What is CodingIntel
    • About
    • Become a Member
    • FAQ
  • Pricing
  • Free Resources
    • Overview
    • Blog
    • Everyday Coding Q&A
    • Newsletter
    • Can I get paid
  • Coding Library
    • Coding Guides
    • Quick Reference Sheets
    • E/M Services
    • How Physician Services Are Paid
    • Prevention & Screening
    • Care Management & Remote Monitoring
    • Surgery, Modifiers & Global
    • Diagnosis Coding
    • New & Newsworthy
    • Speciality
    • Practice Management
    • E/M Rules Archive
  • Webinars

March 29, 2023

Coding Guide – Risk Adjusted Diagnosis Coding for Medical Practices

Members, login to continue


Member Login




 



 
Forgot Password

Payment systems and reimbursement are ever-changing in healthcare and the rules of yesterday may or may not work tomorrow. Medical practices continue to hear about the switch from volume to value, and health systems and large groups have contracts in which they share risk with a payer or ACO.  The purpose of learning about this is to communicate to the payer, “just how sick the patient is,” as one physician said to me.

It is critical for clinicians and administrators to understand risk adjusted diagnosis coding, when entering into shared saving contracts. Too often, the explanations are aimed at payers and not practices.

This guide is an introduction to risk adjusted diagnosis coding. After reading this guide, clinicians will be able to focus on the specificity in diagnosis coding that not only gets a claim paid, but also communicates to payers the acuity of their patient population. Using this guide, clinicians can communicate not only how sick the patient is, but the disease burden of their entire population of patients.

This guide is essential for all practices that are part of an ACO or that have risk-based contracts.

For additional information, see the CodingIntel Guide to Hierarchical Condition Categories. It provides a comprehensive list of HCC and Risk Adjusted Diagnosis Coding resources available on CodingIntel.

Table of Contents

  • Purpose
  • Fee-for-service
  • What is risk adjustment
  • Coding and reporting guidelines
  • HCCs
  • Examples
  • Status Codes
  • Reference

Login to download this guide


Don’t have a login? Click on the link below to learn how to unlock the CodingIntel library of coding guides, webinar, and more…

Get unlimited Access to CodingIntel’s Online Library

Are you a coder, biller, administrator,
office manager or physician?

Learn more about the benefits of
a CodingIntel membership

click here!


Additional resources

  • HCC Diagnosis Coding page

Last revised March 6, 2023 - Betsy Nicoletti
Tags: HCC diagnosis coding, primary care_essential resource

CPT®️️ is a registered trademark of the American Medical Association. Copyright American Medical Association. All rights reserved.

2023 E/M reference sheets

These handy quick reference sheets included at-a-glance MDM requirements for office, hospital, nursing home and home and residence services. And, a bonus sheet with typical time for those code sets. Sign up for Betsy’s monthly newsletter to download these reference sheets and share them with your practitioners.

Sign Up Now

2023 E/M guidelines for hospital, nursing facility, home and residence services | Webinar

Effective January 1, 2023, the AMA has revised the definitions and guidelines for hospital and other E/M services, including ED visits, nursing facility services, home services, and domiciliary care codes. Also, coding for prolonged care services gets another overhaul with revised codes and guidelines. Watch this webinar about all these changes.

Watch it now

Latest Intel

Coding for hospital services | Webinar

Coding for hospital services April 20, 2023 … Read More...

CMS Split/Shared Services Rules | Reference Sheet

Download Reference Sheet Split/shared services … Read More...

Chronic Care Management | Reference Sheet

This quick reference sheet includes clinical staff … Read More...

Screening and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol Misuse | HCPCS Code G0442

The  US Preventive Services Task Force (USPSTF) … Read More...

Browse By Categories

Browse Content

  • Articles
  • Coding Guides
  • Everyday Coding Q&A
  • Videos
  • Can I Get Paid to
  • Blog
  • Webinars

Tags

behavioral health_cpt codes behavioral health_E/M services care management CMS updates Code sets and reimbursement compliance issues CPT codes for preventive services CPT updates critical care services dermatology_essential resource dermatology_procedures E/M frequency data E/M medical decision making E/M overview E/M reference sheets FQHC general surgery_diagnosis coding general surgery_E/M services general surgery_modifiers general surgery_procedures global surgery issues HCC diagnosis coding hospital inpatient/observation ICD-10 coding level of service_history level of service_MDM level of service_time medicare incident-to and shared services minor procedures modifiers newborn care office and other E/M Preventive and problem visits preventive services for medicare primary care_diagnosis coding primary care_E/M services primary care_essential resource primary care_modifiers primary care_other E/M services primary care_preventive services primary care_procedures remote physiologic monitoring screening and counseling for behavioral conditions teaching physician rules telehealth

All content on CodingIntel is copyright protected. Any resource shared within the permissions granted here may not be altered in any way, and should retain all copyright information and logos.

  • What is CodingIntel
  • FAQs
  • Terms of Use
  • Privacy Policy
  • Contact

Our mission is to provide up-to-date, simplified, citation driven resources that empower our members to gain confidence and authority in their coding role.

In 1988, CodingIntel.com founder Betsy Nicoletti started a Medical Services Organization for a rural hospital, supporting physician practice. She has been a self-employed consultant since 1998. She estimates that in the last 20 years her audience members number over 28,400 at in person events and webinars. She has had 2,500 meetings with clinical providers and reviewed over 43,000 medical notes. She knows what questions need answers and developed this resource to answer those questions. For more about Betsy visit www.betsynicoletti.com.

Copyright © 2023, CodingIntel
Privacy Policy