Risk Adjustment Coding Awareness
The Coding Awareness is a series of issues to help educate providers, coders and billers on how to document and report chronic conditions. Guidance contains definitions, diagnostic criteria, treatment options, and pertinent coding tips designated for each diagnosis.
- RA Issue 1: What is Risk Adjustment (PDF)
- RA Issue 2: MEAT (PDF)
- RA Issue 3: Bipolar Disorder (PDF)
- RA Issue 4: Depression (PDF)
- RA Issue 5: ADHD (PDF)
- RA Issue 6: Behavioral Disorder (PDF)
- RA Issue 7: Autistic Disorder (PDF)
- RA Issue 8: Asthma (PDF)
- RA Issue 9: Diabetes (PDF)
- RA Issue 10: Cancer (PDF)
- RA Issue 11: Supplemental Oxygen (PDF)
- RA Issue 12: Cancer Part II (PDF)
- RA Issue 13: Colon Cancer (PDF)
- RA Issue 14: COPD (PDF)
- RA Issue 15: Smoking and Substance Abuse (PDF)
- RA Issue 16: Overweight, Obesity, and BMI (PDF)
- RA Issue 17: Monoplegia, Paraplegia, and Quadriplegia (PDF)
Documentation and Billing Examples
Contains examples of medical records showcasing support for diseases and proper coding.
- Autism Coding Tips & Billing Examples (PDF)
- Cancer Coding Tips & Billing Examples (PDF)
- Depression Coding Tips & Billing Examples (PDF)
Coding Tip Sheets
These sheets are intended to support coding and documentation education sessions with providers.
- Blood Lead Level Screening (PDF) (outlines the required lead screening timeframes, appropriate documentation including proper coding of lead screenings and defines the associated P4P/HEDIS measures)
- VFC Immunization Coding Tip (PDF) (describes the VFC immunization program and includes the CDC schedules; also includes proper coding and defines the associated P4P/HEDIS measures)
- Annual Wellness Visit (PDF) (to assist with documentation of the AWV in the patient’s chart but may be applied toward sick visits)
- Top 10 Coding Tips (PDF) (to assist with documentation and ensure proper coding of chronic diseases)
- Risk Adjustment Coding, HEDIS, and Documentation Tips (PDF) (Presentation portrays the alignment between Quality and Risk Adjustment by focusing on tips to improve clinical documentation, HEDIS measures, and chronic condition billing & coding, once on the page - scroll to bottom for training material)
- EPSDT QRG (PDF) (to assist with documentation of EPSDT visits including proper diagnosis coding and assignment for primary diagnosis)
- HEDIS Quick Reference Guide – 2019 (PDF)
Depression & Bipolar Awareness
According to many national medical associations, Depression and Bipolar Disorder are two of the most common psychological diseases. Studies report that people with these diseases often first seek help from their primary care physician but these providers may lack the tools and resources necessary to diagnose a patient accurately. Home State Health wants to bring awareness to these disorders by helping our providers with the resources, tools, and coding tips to properly diagnose and code mental illnesses to the highest specificity in the PCP office or specialist office setting.
- Patient Health Questionnaire (PHQ-9) screener (PDF): to assist in making a depression diagnosis with corresponding severity.
- Mood Disorder Questionnaire (MDQ) (PDF): provides as a good starting point for a bipolar diagnosis.
- Depression and Bipolar Disorder Helpful Coding Tips (PDF): provides clinical tools, scoring sheet, and coding tips to correctly identify the disease severity and corresponding ICD-10-CM.