Donna Garrett asked:
On page 115 in our CRC text it refers to 2008 RA Participant Guide. I downloaded that just to see what it was all about. It has a loooooong list of CPT codes that risk adjust and a few HCPCS codes that risk adjust. What a helpful list! Wonder if they have a list for ICD risk adjust? However; just wondering here; I thought risk adjustment only dealt with diagnosis codes and not procedure codes. Any comments please? Thanks.
Donna
Answer:
Tiffany Baca wrote:
Hi Donna; CPT and HCPCS codes do not RA; only ICD-10 codes risk adjust. CMS publishes every year a list of CPT/HCPCS codes that are allowed to determine diagnosis (ICD-10) risk adjustment codes. For example; an office visit is coded as 99213 and the patient has a diagnosis of hypertension and CAD; you would just capture the hypertension (I10) and CAD (I25.10).
CMS also publishes every year a list of ICD-10 codes that risk adjust that you can find on www.CMS.gov which is known as HCC and RxHCC Mappings.
Here is the link to the 2018 ICD-10 codes that risk adjust https://www.cms.gov/Medicare/Health...=1&DLEntries=10&DLSort=0&DLSortDir=descending
You will want to select "2018 Midyear Final ICD-10 Mappings."
On page 115 in our CRC text it refers to 2008 RA Participant Guide. I downloaded that just to see what it was all about. It has a loooooong list of CPT codes that risk adjust and a few HCPCS codes that risk adjust. What a helpful list! Wonder if they have a list for ICD risk adjust? However; just wondering here; I thought risk adjustment only dealt with diagnosis codes and not procedure codes. Any comments please? Thanks.
Donna
Answer:
Tiffany Baca wrote:
Hi Donna; CPT and HCPCS codes do not RA; only ICD-10 codes risk adjust. CMS publishes every year a list of CPT/HCPCS codes that are allowed to determine diagnosis (ICD-10) risk adjustment codes. For example; an office visit is coded as 99213 and the patient has a diagnosis of hypertension and CAD; you would just capture the hypertension (I10) and CAD (I25.10).
CMS also publishes every year a list of ICD-10 codes that risk adjust that you can find on www.CMS.gov which is known as HCC and RxHCC Mappings.
Here is the link to the 2018 ICD-10 codes that risk adjust https://www.cms.gov/Medicare/Health...=1&DLEntries=10&DLSort=0&DLSortDir=descending
You will want to select "2018 Midyear Final ICD-10 Mappings."