Coding from Risk Factors
I am an HCC coder and work for a Medicare Risk Adjustment company. We code chronic conditions for our clients for proper reimbursement. It was recently brought to our attention by our education department that we are not to abstract ICD-9 codes from Risk Factors. I was told by the previous company that I worked for that we could code from Risk Factors because the provider is stating that the patient has those conditions which puts them at risk for further complications. For example: The patient is being evaluated for chest pain, possible CAD. In Cardiac Risk Factors, the provider lists: Hypertension and Hyperlipidemia. My opinion is that the provider is listing the patient's underlying chronic conditions as part of the patient's medical history which ties into the medical decision making and final diagnosis. So, my question is: Do any of you code from Risk Factors? I would like to know your reasoning if you don't.
Arlene Andrew, CPC, CPC-I, CHCA
Certified Psychiatric Coder
University of Colorado Health