Risk adjustment practices consider chronic diseases as predictors of future healthcare needs and expenses. Detailed documentation and compliant diagnosis coding are critical for proper risk adjustment.


Risk Adjustment Documentation & Coding provides:

  • Risk-adjustment parameters to improve documentation related to severity of illness and chronic diseases.
  • Code abstraction guidelines and best practices recommendations to improve diagnostic coding accuracy without causing financial harm to the practice or health facility.


The impact of risk-adjustment coding — also called hierarchical condition category (HCC) coding — on a practice should not be underestimated:

  • More than 75 million Americans are enrolled in risk-adjusted insurance plans. This population represents more than 20% of those insured in the United States.
  • Insurance risk pools under the Affordable Care Act include risk adjustment.
  • CMS has proposed expanding audits on risk adjustment coding.


Meticulous diagnostic documentation and coding is key to accurate risk-adjustment reporting.




  • Five chapters delivering an overview of risk adjustment, common administrative errors, best practices, an alphabetized, topical review of clinical documentation improvement and coding for risk-adjustment, and guidance for development of internal risk-adjustment coding policies.
  • Three appendices offering mappings, tabular information, and documentation and abstraction training tools for coders and physicians that include an alphanumeric mapping of ICD-10-CM codes that risk-adjust to HCCs and RxHCCs for Medicare Advantage plans.
  • Learning and design features:
    • Vocabulary terms highlighted within the text and conveniently defined at the bottom of the page
    • “Advice/Alert Notes” that highlight important coding and documentation advice from federal regulatory sources
    • “Sidebars” that provide derivative story and additional information
    • “Coding Tips” that guide coders with practical advice from sources like AHA’s Coding Clinic and cautionary notes about conflicts and exceptions
    • “Clinical Examples” that underscore key documentation issues for risk-adjustment
    • "Clinical Coding Examples" that provide snippets or full encounter notes and codes to illustrate risk-adjustment coding and documentation concepts
    • “Documentation tips” that highlight recommendations to physicians regarding what should be included in the medical record or how ICD-10-CM may classify specific terms
    • “Examples” that explain difficult concepts and promote understanding of those concepts as they relate to a section
    • “FYI” call outs that provide quick facts
    • “Abstract & Code It!” exercises that test diagnosis abstraction and coding skills (exclusive to Chapter 4)
  • Extensive end-of-chapter “Evaluate Your Understanding” sections that include multiple-choice questions, true-or-false questions, audit exercises, and Internet-based exercises
  • Two downloadable course tests and slide presentations for each chapter
  • Exclusive content for academic educators: A test bank containing 100 questions and a mock risk-adjustment certification exam with 150 questions.



Risk Adjustment Documentation & Coding OP287018

SKU: OP287018