At Jefferson Health Plans, we want to remind you that selecting the correct ICD-10 codes contributes to a more accurate picture of the patient’s health status, which can have a positive effect on payment and risk score.

Earlier this year, the Centers for Medicare and Medicaid Services (CMS) released the Advance Notice of Methodological Changes for CY 2024 Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies (CY 2024 Advance Notice). Jefferson Health Plans would like our providers to be aware of risk score impact and best provider practices.

We want you to know that unspecified and poor ICD-coding will be reflected in your practices risk scores. Improved medical record documentation with accurate ICD-10 diagnosis coding leads to accurate risk scores, better patient care, improved quality reporting and efficiency when responding to regulatory requirements, such as HEDIS (Healthcare Effectiveness Data and Information Set) and risk-adjusted data validation (RADV) audits.

Providers will need to be vigilant in diagnosing and documenting.

Specific diagnosis coding is the foundation of accurate risk adjustment. A few key concepts that providers should keep in mind include:

1. Select not only the diagnosis codes that describe why the patient was seen but also diagnosis codes for any chronic conditions that affect treatment choices.
   1. Example: A patient with diabetes is present with severe poison ivy. The physician discusses diabetes with the patient in deciding whether to use prednisone and documents it in the assessment. The physician should report poison ivy first and diabetes second.
2. If a patient has a serious chronic condition with a manifestation or complication that has its own code, use that code rather than the unspecified code.
3. Report diagnosis codes annually.

With the encouragement in accuracy and specificity in patient diagnosis, providers will also need to focus on patient engagement. Providers should complete an annual wellness visit (AWV) to capture the health status of the patient. Jefferson Health Plans encourages office staff to outreach to your patients to come in for annual wellness visits.

If you have any questions regarding appropriate coding and documentation, or would like education, please contact Christina Rock, Clinical Education Supervisor, via email at crock@jeffersonhealthplans.com.

Thank you for your continued support while improving the health outcomes of our members.