Hi Jeyasri

I read the book
Risk Adjustment Documentation and Coding by Sheri Poe Bernard by AMA .Excellent resource and also reading the the
Healthcare Business journal has good articles. But things I know about risk adjustment coding is when the provider gives you clear detailed dx codes ensure use the dx matches because amost dx have risk adjustmnt codes linked with DRG codes for inpatient reimbursements. Also if pt has particular medical problems ensure add on end of claim proper supported Z dx codes listed since in medical documentation.Add this in med record Smoking current or past HO dx Z87 or F17 or Z72 especially if pt. has heart or respiratory conditions. DRg for these disease are such as: Quadriplegias G82or G81, Long term drug use block Z79 for DM , Cancer, or Cardiac patients and Residual Weakness one side of body after stroke dx I69 and Amputations block Z89 , Cardiac Pacemakers Z95, HIV B20, Kidney Dialysis and BMI dx Z68 and E66 together on same claim from notes in record. Be familiar with the Chronic Conditions listed in medical documentation of the pt. They are DM, COPD, Depression,RA Arthritis, MS, Parkinson Ds., CHF, Hemipholia D66 and Atrial Fibril. Some ds that do not risk adjust are Anemia, Glasglow Coma Scales, IBS, R symptoms dx codes used for heart attack , BMI less than 30% do not risk adjust, and Mental Retardation and dx R06.03
Here are some elderly patient illness tracked by CMS and Medicare.... HLD, CKD, Hypothyrodism,DJD or Osteoarth, HTN, DM, COPD, Depression, Heart Ds.
Also if someone has Forever Ds add it on the claim too if in documentation
Errors to watch on medical record are missing signatures and credentials, correct dates of service, wrong data, be aware of cloning notes, miss list of dx assessments, describe treatment given, labs or xray orders and reason or medical necessity, evidence of MEAT or SOAP guide used in documentation, do not code illness no longer have unless it is history code in which provider should date when pt last had it. Provider not create own medical abbreviations but follow standards set, medical coders should follow sequencing rules with Dx and CPT codes, understand Excludes 1 Rules and integral coding. Unspec. dx can be used for inpatient admissions whereas Unspecfic dx should not be used for outpatient settings. However sometimes unsec dx are used in outpatient settings because cannot be helped. The providers clear documentation will help you assign proper dx. codes which is the key to Risk Adjustment.
Oh yes another thing to remember the dx combination codes such as: UTI dx N39.0 add infection code B95-B97, DM E11 with manifestation codes of nerve damage or eye problems,, Cardiac Arrest I46 differ types give the reason, CHF I50 and HTN I11.9 code together if listed, BMI% and Z68 with matching percentage, CHKD and Anemia, Osteomyelitis dx M86 with dx infection of dx B95-B97.
Well I hope I helped you understand the Risk Adjustment coding a bit more.
Lady T
