Wiki RADV Audit Question

[ctepen]

My company has asked me to assist with a mock RADV audit, and I was wondering how to handle to following:

-Asked to validate diagnosis of Unspecified Atrial fibrillation (I48.91), which maps to HCC 96 (Specified Heart Arrhthymias)
-However, can only verify Persistent Atrial Fibrillation (I48.1), which also maps to the same HCC

Would this be allowable in a CMS RADV audit? I'm assuming so, but you know what they say about assuming things....

Thank you all so much for your knowledge and expertise!

 

[mkjames1200]

In RADV audits you are validating the HCC, not the diagnosis. If you have any diagnosis code that can be validated within the audited HCC, you should be good to go.

 

[ctepen]

In RADV audits you are validating the HCC, not the diagnosis. If you have any diagnosis code that can be validated within the audited HCC, you should be good to go.

Thank you!