University HealthCare Alliance

July 07, 2020

Optum Insider | Chronic Conditions Need a Yearly Evaluation

Specific documentation and coding clearly depict the level of disease severity, comorbidities, underlying disease, and other factors that contribute to the level of complexity for the patient encounter.

Per the ICD-10-CM official guidelines for coding and reporting: Code all documented conditions that coexist at the time of the encounter/visit, and require or affect patient care, treatment, or management.

Payment from Centers for Medicare & Medicaid Services (CMS) is based on the overall health status of the Medicare Advantage member.
Diagnosis codes are some of the criteria used for determining the severity of illness, risk, and resource utilization. Diagnostic coding influences the “level of risk” in determining CPT® code assignment.  All conditions that affect the composite picture of the patient’s health status need to be recorded at least once per year.