Toggle Menu

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.

Looking for Exhibiting Opportunities or Group Discounts?

Contact us at 844-825-1679.

Which certification is right for you?

Call 877-290-0440 or have a career counselor call you.

Which books are right for you?

Call 877-524-5027 to speak to a representative.