On-Demand: 2023 ICD-10-CM Coding Updates-Presentation Slides

Presentation Slides

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This document discusses risk adjustment coding, specifically focusing on the Medicare Hierarchical Co-Existing Conditions (HCC) model. Risk adjustment is a statistical process that accounts for the health status and spending of enrollees in an insurance plan to assess health outcomes and costs. The Medicare HCC model calculates a risk factor for each member based on chronic conditions and demographics. The risk factor is used to calculate CMS payments and level the playing field for providers who treat beneficiaries of varying clinical complexity.<br /><br />The document emphasizes the importance of accurate documentation and coding to capture the complete risk profile of each patient. It provides examples of conditions that map to CMS HCCs and highlights key documentation points, such as avoiding the use of "history of" for current conditions and showing causal relationships between conditions. The document also mentions the impact of risk adjustment on Medicare payments and the need for accurate medical record documentation and coding practices.<br /><br />The document also briefly discusses the upcoming release of ICD-11 and its implementation in different countries. It provides a link to the ICD-11 reference guide for further information.<br /><br />Overall, the document serves as a guide to understanding risk adjustment coding and its significance in healthcare reimbursement.

Keywords

risk adjustment coding

Medicare Hierarchical Co-Existing Conditions (HCC) model

health outcomes

costs

chronic conditions

demographics

CMS payments

clinical complexity

accurate documentation

coding practices