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Showing posts from May, 2024

Medicare Risk Adjustment Eligible CPT/HCPCS Codes

Below are links to the list of Medicare Risk Adjustment Eligible CPT/HCPCS Codes. There are files for various years. Find the CPT code on the list to verify if those visit types are risk adjustment eligible.  Medicare Risk Adjustment Eligible CPT/HCPCS Codes outpatient inpatient skilled nursing facilities Medicare Risk Adjustment Eligible CPT/HCPCS Codes https://www.cms.gov/medicare/health-plans/medicareadvtgspecratestats/risk-adjustors-items/cpt-hcpcs Disclaimer: This guidance is to be used for an easy reference; the ICD-9-CM and ICD-10-CM code books and the Official Guidelines for Coding and Reporting are the authoritative references for accurate and complete coding. This blog may contain references or links to statutes, regulations, or other policy materials. It is not intended to take the place of either the written law or regulations.  The information presented herein is for general informational purposes only and is accurate as of the date of publication.

Diabetic conditions in V28

  These are the HCC categories in CMS-HCC V28.  CMS-HCC v28 HCC 35 Pancreas Transplant Status   HCC 36 Diabetes With Severe Acute Complications (rarely occur in outpatient setting)   HCC 37 Diabetes With Chronic Complications (higher level of severity of illness)   HCC 38 Diabetes With Glycemic, Unspecified, or No Complications   They all provide the same impact to the risk adjustment factor (RAF) score. The previous extra bump in risk adjustment factor for diabetic complications has been removed in this version.   Document linkage of diabetes to any and all manifestations.    2024 payments are based on 2023 dates of service. Disclaimer: This guidance is to be used for an easy reference; the ICD-9-CM and ICD-10-CM code books and the Official Guidelines for Coding and Reporting are the authoritative references for accurate and complete coding. This blog may contain references or links to statutes, regulations, or other policy materials. It is not intended to take the place of either t