Understanding Distinct Roles, Responsibilities, and Qualifications in Healthcare Documentation Two critical functions are often misunderstood or conflated: medical coding and clinical validation. While both are essential to accurate documentation, appropriate reimbursement, and regulatory compliance, they are fundamentally different disciplines that require distinct skill sets, credentials, and areas of expertise. Confusing these roles—or allowing one professional […]
Diagnosis coding
Diagnosis coding establishes the medical necessity for a service, and can be the source of denials. Accurate and specific diagnosis coding is also important for groups that are part of ACO or have risk-contracts in communicating the acuity of a panel of patients.
Depression Coding and Hierarchical Condition Coding (HCC)
Introduction | Depression coding in HCC In fee-for-service medicine: Diagnosis coding establishes the medical necessity for a service. At times, it may be the reason for a denial, particularly for diagnostic tests or procedures. Services with national or local coverage policies often have specific diagnosis codes that are required for payment. In V28 of HCC, […]
HCC Coding for Medical Practices | Webinar
Recorded March 19th, 2026
1 CEU expires 3/30/27
Risk adjustment coding is a hot topic for Medicare Advantage Organizations and medical practices with risk-based contracts. It’s one of the pillars of payment for Value Based Care. At this webinar, participants will learn how Hierarchical Condition Categories work based on ICD-10-CM rules.
Diabetes Coding in Hierarchical Condition Coding (HCC)
Diabetes is a common chronic condition, included in three distinct HCC categories Patients often have more than one chronic condition of the disease; page down for a Q&A related to how multiple conditions do–and don’t–affect the risk score CodingIntel members can download our guide to Risk Adjusted Diagnosis Coding for Medical Practices for more explanation and […]
Compliance Issues in ICD-10 Coding for Risk Based Contracts and HCCs
How to be a great HCC coder? Know ICD-10-CM Official Guidelines for Coding and Reporting During an encounter: Code conditions assessed and managed. If treatment of an acute or chronic problem is affected by an ongoing condition, note that, and add the ongoing condition to the claim form. If the condition has a manifestation or […]
Coding Guide – Risk Adjusted Diagnosis Coding for Medical Practices
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).
Coding for Hypertension in the HCC System | Reference Sheet
This quick reference sheet simplifies coding for hypertension in the HCC system. A must-have resource for clinicians who see patients with hypertension.
Diagnosis Coding for Suspected Cancer
Diagnosis coding for possible malignancy When coding for a suspected or possible condition in the outpatient setting, follow the guidelines in Section IV. Diagnostic Coding and Reporting Guidelines for Outpatient Services. “H. Uncertain Diagnosis Do not code diagnoses documented as “probable,” “suspected,” “questionable,” “rule out,” “compatible with,” or “working diagnosis” or other similar terms indicating […]
Top Denied High-Value Inpatient ICD-10-CM categories of 2025 | Webinar
Recorded February 19th, 2026
1 CEU Expires 2-28-2027
Guest presenter Dr. Amarin “Ty” Alexander
This presentation will cover frequently denied ICD-10-CM codes in Inpatient Hospital claims from 2025. Clinical validation considerations and relevant ICD-10-CM Guidelines will be highlighted from the payer perspective.
Diabetes Coding in V28
This quick reference sheet simplifies coding for diabetes in the HCC system. A must-have resource for clinicians who see patients with diabetes.
ICD-10-CM Update | Webinar
Recorded September 25th, 2025
1 CEU expires 9/30/26
Guest Presenter Shannon McCall of HCPro
ICD-10-CM updates are here and effective starting October 1, 2025. This webinar will describe changes to the all-important ICD-10-CM Official Guidelines for Coding and Reporting.
Aftercare and Follow-Up: ICD-10-CM Coding
Aftercare visit codes are assigned in situations in which the initial treatment of a disease has been performed but the patient requires continued care during the healing or recovery phase, or for the long-term consequences of the disease. ICD-10-CM makes two important points about the use of aftercare codes in the final chapter. The aftercare […]
Diagnosis Coding for Intentional Self-Harm
Another discussion of codes that use placeholder xxxA (or xxx with another 7th character) One of the most searched terms on CodingIntel is xxxA. Experienced diagnosis coders recognize the placeholder digits “xxx” and the 7th character extender A. When we pulled the list of ICD-10-CM codes that have xxxA in them, some relate to self-harm […]
Diagnosis Coding For a Fall (or Other Injury)
When a patient presents for an injury after a fall, practitioners may be tempted to search for the word “fall” and select the first diagnosis that they find. Perhaps, they find the code W06.xxxA “fall from a bed” or even W19.xxxA “unspecified fall”. They select the code, close the encounter, and move on to the […]
ICD-10-CM Chapter Specific Guidelines – Chapters 17–20
The ICD-10-CM Official Guidelines for Coding and Reporting sets the precedent of rules that all diagnostic coders must abide by. Section I.C. covers the chapter-specific guidelines. These offer detailed information about various conditions that require more thorough reporting guidance than the general guidelines provide. Reading the guidelines in their entirety is incredibly important, but this […]
ICD-10-CM Chapter Specific Guidelines – Chapters 14–16
The ICD-10-CM Official Guidelines for Coding and Reporting sets the precedent of rules that all diagnostic coders must abide by. Section I.C. covers the chapter-specific guidelines. These offer detailed information about various conditions that require more thorough reporting guidance than the general guidelines provide. Reading the guidelines in their entirety is incredibly important, but this […]
ICD-10-CM Chapter Specific Guidelines – Chapters 11–13
The ICD-10-CM Official Guidelines for Coding and Reporting sets the precedent of rules that all diagnostic coders must abide by. Section I.C. covers the chapter-specific guidelines. These offer detailed information about various conditions that require more thorough reporting guidance than the general guidelines provide. Reading the guidelines in their entirety is incredibly important, but this […]
DRG Red Flags: A Payor Perspective | Webinar
Recorded November 21st, 2024
Guest Presenter Dr. Amarin “Ty” Alexander
Inpatient DRG coding is based on diagnosis coding. Learn how payers use coding summaries. This webinar describes Present on Admission (POA) conditions that invite scrutiny and why short Length of Stay (LOS) with one Major Complication and Comorbidity (MCC) might raise red flags.
ICD-10-CM Chapter Specific Guidelines – Chapters 7–10
Section I.C of the ICD-10-CM Official Guidelines for Coding and Reporting, titled “Chapter Specific Guidelines,” contains 22 chapters. These chapters offer detailed guidance on specific codes and code ranges in the ICD-10-CM manual. This article is part of a series that will delve into each of the chapters in Section I.C to delineate coding protocols […]
ICD-10-CM Chapter Specific Guidelines – Chapters 4–6
Section I.C of the ICD-10-CM Official Guidelines for Coding and Reporting, titled “Chapter Specific Guidelines,” contains 22 chapters. These chapters offer detailed guidance on specific codes and code ranges in the ICD-10-CM manual. This article is part of a series that will delve into each of the chapters in Section I.C to delineate coding protocols […]
ICD-10-CM Chapter Specific Guidelines – Chapters 1–3
Section I.C of the ICD-10-CM Official Guidelines for Coding and Reporting, titled “Chapter Specific Guidelines,” contains 22 chapters. These chapters offer detailed guidance on specific codes and code ranges in the ICD-10-CM manual. This article is part of a series that will delve into each of the chapters in Section I.C to delineate coding protocols […]