Coding Guide – Risk Adjusted Diagnosis Coding for Medical Practices

Risk Adjusted Diagnosis Coding

Payment systems and reimbursements are ever-changing in healthcare and the rules of yesterday may or may not work tomorrow. This 24 page guide from CodingIntel is an introduction to risk adjustment coding and the risk adjustment factor (RAF).

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. Managers, coders and billers will find this a helpful introduction to the concept of Risk Adjustment and Hierarchical Condition Category (HCC) coding. 

This guide is essential for any practice that is thinking of joining an ACO or has diagnosis risk adjusted based contracts. Updated for 2018.

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

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Additional resources

The CodingIntel Guide to Hierarchical Condition Categories provides a comprehensive list of HCC and Risk Adjusted Diagnosis Coding resources available on CodingIntel.