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Risk Adjustment

PW_E180972
 
ICD-10-CM Provider Training  
The ICD-10-CM Provider Training consists of six sections focusing on ICD-10-CM documentation and coding tips. The first section is a basic introduction to ICD-10-CM while the remaining five sections focus on the following common chronic conditions: chronic obstructive pulmonary disease, diabetes, rheumatoid arthritis, congestive heart failure, and major depressive disorder.  
ICD-10-CM Provider Training
Desk Reference ICD-10 Companion Crosswalk
 
Speaking ICD-10-CM  
Speaking ICD-10-CM was produced to help learn the lingo for the new diagnosis code set. These are one page summaries containing the ICD-9-CM to ICD-10-CM code crosswalk for specific condition(s) including a detailed comparison of diagnosis code selection(s) and/or relevant coding guidance.  
Speaking ICD-10-CM Vol 1, Issue 1: Chronic Obstructive Pulmonary Disease (COPD)
Speaking ICD-10-CM Vol 1, Issue 2: Atrial Fibrillation (Afib)
Speaking ICD-10-CM Vol 1, Issue 3: Rheumatoid Arthritis with Polyneuropathy
Speaking ICD-10-CM Vol 1, Issue 4: Sepsis
Speaking ICD-10-CM Vol 1, Issue 5: Urosepsis
Speaking ICD-10-CM Vol 1, Issue 6: Cerebral Artery Occlusion with Infarct
Speaking ICD-10-CM Vol 1, Issue 7: Acute Myocardial Infarction (AMI)
Speaking ICD-10-CM Vol 1, Issue 8: Acute Respiratory Failure
Speaking ICD-10-CM Vol 1, Issue 9: Weakness due to CVA
Speaking ICD-10-CM Vol 1, Issue 10: Depression
Speaking ICD-10-CM Vol 1, Issue 11: Human Immunodeficiency Virus (HIV)
Speaking ICD-10-CM Vol 1, Issue 12: Psychoactive Substance Use, Abuse and Dependence
Speaking ICD-10-CM Vol 1, Issue 13: Status of Below Knee Amputation
Speaking ICD-10-CM Vol 2, Issue 1: Hypertensive Heart and CKD
Speaking ICD-10-CM Vol 2, Issue 2: Malnutrition
Speaking ICD-10-CM Vol 2, Issue 3: Chronic Kidney Disease (CKD)
Speaking ICD-10-CM Vol 2, Issue 4: Deep Vein Thrombosis (DVT)
Speaking ICD-10-CM Vol 2, Issue 5: Chronic Obstructive Pulmonary Disease (COPD)
Speaking ICD-10-CM Vol 2, Issue 6: Compression Fractures
Speaking ICD-10-CM Vol 2, Issue 7: Lower Limb Amputation Status
Speaking ICD-10-CM Vol 2, Issue 8: Viral Hepatitis
Speaking ICD-10-CM Vol 2, Issue 9: Cerebral Hemorrhage
Speaking ICD-10-CM Vol 2, Issue 10: Stroke
Speaking ICD-10-CM Vol 2, Issue 11: Major Depressive Disorder
Speaking ICD-10-CM Vol 2, Issue 12: Neoplasms
 
Coding Focus Publications  
The Coding Focus provides everything you need to know about specific clinical diagnoses! This publication contains the definition, diagnostic criteria, treatment options, and relevant coding guidance for each designated diagnosis.  
Coding Focus Vol 2, Issue 1: Diabetes with Renal Disease
Coding Focus Vol 2, Issue 2: Respirator Dependence
Coding Focus Vol 2, Issue 3: Aortic Ectasia
Coding Focus Vol 2, Issue 4: Tachycardia
Coding Focus Vol 2, Issue 5: Coronary Artery Disease
Coding Focus Vol 2, Issue 6: Diabetes Uncontrolled
Coding Focus Vol 3, Issue 1: Hypertension (HTN)
Coding Focus Vol 3, Issue 2: Malnutrition
Coding Focus Vol 3, Issue 3: Chronic Kidney Disease (CKD)
Coding Focus Vol 3, Issue 4: Deep Vein Thrombosis (DVT)
Coding Focus Vol 3, Issue 5: Chronic Obstructive Pulmonary Disease (COPD)
Coding Focus Vol 3, Issue 6: Compression Fractures
Coding Focus Vol 3, Issue 7: Lower Limb Amputation Status
Coding Focus Vol 3, Issue 8: Viral Hepatitis
Coding Focus Vol 3, Issue 9: Cerebral Hemorrhage
Coding Focus Vol 3, Issue 10: Stroke
Coding Focus Vol 3, Issue 11: Major Depressive Disorder
Coding Focus Vol 3, Issue 12: Neoplasms
Coding Focus Vol 4, Issue 1: HIV
Coding Focus Vol 4, Issue 2: Morbid Obesity
Coding Focus Vol 4, Issue 3: Congestive Heart Failure
Coding Focus Vol 4, Issue 4: Schizophrenia
Coding Focus Vol4, Issue5: Bipolar
Coding Focus Vol4, Issue6: Alcohol Use Disorder
 
Top Ten ICD-10-CM Tips  
ICD-10-CM provides a greater level of specificity with over 71,000 diagnosis codes to select from. This requires medical record documentation to be more specific to ensure the most appropriate code is selected. To assist with accurate diagnosis coding and billing compliance for Medicare Risk Adjustment, included are the top ten ICD-10-CM documentation and coding tips. Additionally, you will find a publication that contains a summary of the diagnosis codes that map to the 2017 CMS-HCC Risk Adjustment Model. This publication includes the ICD-10-CM codes, HCC codes and category descriptions, along with the disease hierarchies.  
Top Ten ICD-10-CM Tips
2017 CMS-HCC Risk Adjustment Model
 
Provider’s Role in Risk Adjustment  
Providers play a key role in Risk Adjustment activities for Medicare Advantage plans as each member’s health status is determined by the conditions identified and supported in medical record documentation. Review this document to learn more about the Provider’s Role in Risk Adjustment.  
Provider’s Role in Risk Adjustment
 
Coding Brochures  
These four page coding brochures were created to guide providers through ICD-10-CM coding by giving a detailed background, specific diagnosis coding guidance, educational elements, and references for additional information on the following illnesses/diagnoses:  
Circulatory
Chronic Kidney Disease
Diabetes Mellitus
Hypertension
Mental, Behavioral & Neurodevelopmental Disorders
Neoplasms
Fractures
Respiratory
 
Annual Wellness Visit Fact Sheet  
This Annual Wellness Visit (AWV) Fact Sheet provides details on what an AWV visit is, who can perform the AWV, who is eligible for the AWV, and more. The table of acceptable physician specialty types for Risk Adjustment data submission is also included.  
Annual Wellness Visit Fact Sheet
 
Medical Record Documentation Tips 
This one page document provides medical record documentation tips for Medicare Advantage Risk Adjustment purposes. Reference these tips for documenting to the highest degree of specificity to ensure the most appropriate ICD-10-CM code is assigned. 
Medicare Record Documentation Tips
© 2017 BlueCross BlueShield of Georgia
Blue Cross and Blue Shield of Georgia, Inc. and Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. are independent licensees of the Blue Cross and Blue Shield Association. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.