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What impact does unspecific diagnosis coding have on providers and patients?

  • Accuracy and specificity in ICD-10-CM coding and medical documentation is critical for risk adjustment. ICD-10-CM diagnosis coding is used to represent the member’s health status and establish an accurate risk score. As in all coding, ICD-10-CM diagnoses cannot be inferred from physician orders, nurse notes, or lab or diagnostic tests — they must come from the medical record documentation. Submitting an inaccurate diagnosis, or a diagnosis resulting in a different HCC, is a compliance risk. Any change in the HCC could mean you are receiving too much or too little revenue.
  • Suggested reading: "Top 10 Medicare Risk Adjustment Coding Errors" in AAPC's Knowledge Center.
  • Tip: AAPC offers a Risk Adjustment Search Tool to help you quickly search diagnosis codes or conditions to find applicable HCC reporting requirements and weights.

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