Resource ICD-10-CM 2022 Updates

2022 ICD-10-CM coding guideline changes

• 2022 POA Exempt Codes (ZIP)
• 2022 Conversion Table - Updated 08/27/2021 (ZIP)
• 2022 Code Descriptions in Tabular Order (ZIP)
• 2022 Addendum (ZIP)
• 2022 Code Tables, Tabular and Index (ZIP)
• FY 2022 ICD-10-CM Coding Guidelines (PDF)

CMS Data Location: Each year, CMS posts all of the 2022 ICD-10-CM coding guideline changes on its website in six separate downloadable ZIP files:

• 2022 POA Exempt Codes (ZIP): CMS description of POA Exempt Codes
• 2022 Conversion Table – Updated 08/27/2021 (ZIP)
• 2022 Code Descriptions in Tabular Order (ZIP)
• 2022 Addendum (ZIP)
• 2022 Code Tables, Tabular and Index (ZIP)
• FY 2022 ICD-10-CM Coding Guidelines (PDF)
• Note: Zip files are a way to condense large amounts of data into smaller file sizes to be accessed more quickly.

Download the Data: You must download each ZIP file separately. Follow these three steps for each ZIP file you want to download:

• Click on the file you want to download
• A “Save As” window should pop up asking you where you’d like to save the file to download.
• Choose the folder you’d like to download the data into and click the “Save” button at the bottom right of the window.

Extract the Data: Each downloaded 2022 ICD-10-CM coding guideline file will save in a folder of your choosing and have a ZIP extension. This indicates that you must extract the condensed information from the folder to access it. Follow these steps to decompress the data so you can access the data:

• Click on the ZIP folder you downloaded. You should see an “Extract All” button at the top right of the window that opens.
• Click the “Extract All” button. This will take you to a “Select a Destination and Extract Files” window. The folder you choose will be where the data is extracted into.
• Click on the “Browse” button to choose your folder, and then click the “Extract” button at the bottom of the window to decompress the files

Format: Each extracted folder usually contains multiple files. Typically, each file name is available in both XLSX (Excel) and TXT (Text) formats. If you are not utilizing Excel, try accessing the data in the TXT format. To do this, go to your preferred program, choose “Open” from the file menu, and then select the TXT file. This will convert the data into the file format for the program you are utilizing. Then you will need to save the file in the new format.

2022 ICD-10-CM | CMS

COVID-19 Update In response to the ongoing national emergency concerning COVID-19, the Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics (NCHS) is implementing 3 new diagnosis codes, Z28.310, Z28.311 and Z28.39, into the International Classification of...

www.cms.gov

DRG

https://www.cms.gov/files/zip/fy202...factors-and-geometric-and-arithmetic-mean.zip

ICD-10-CM/PCS MS-DRG v38.1 Definitions Manual

 

[TashaM_12627]

Hi Lori! How will the new guidelines affect RAF scores and HCC/Risk Adjustment? Are there any resources that talk about this?

Thanks!

 

[Lori]

Most physicians are aware of new models of payment, including accountable care organizations (ACOs), bundled payments, and value-based purchasing, that are increasingly shifting financial risk to providers. However, many physicians may be unaware of how essential accurate coding is under these models to characterize risk, enhance shared savings, and provide patient-centered care.

HCCs are derived from ICD codes via retrospective review of claims data. ICD codes are factored into the algorithm regardless of site of service (inpatient or outpatient), provider type (physician or extender), or order of diagnosis (primary or secondary). An ICD code maps to exactly one HCC, but not all ICD codes map to an HCC. Approximately 10,000 ICD-10 codes map to an HCC, but this is just 14 percent of the approximately 69,000 diagnosis codes.3 The CMS-HCC model focuses on chronic health conditions likely to affect long-term health expenditures and purposefully excludes non-diagnostic diagnoses (e.g., a diagnosis of abdominal pain), clinically insignificant diagnoses (e.g., a sprain), or diagnoses that are definitively treated (e.g., acute appendicitis).

HCC Coding, Risk Adjustment, and Physician Income: What You Need to Know

Accurate coding drives accurate risk adjustment, which will increasingly affect your bottom line.

www.aafp.org

https://bok.ahima.org/doc?oid=302516#.YpZDW5PMJQI

HCC codes are additive, and some have multipliers. Population complexity/severity affects payment in many Medicare contracts. RAF is used for benchmarking for quality and safety. RAF enables identification and stratification for patient management.

A RAF score, or risk adjustment factor score, is a medical risk adjustment model used by the Centers for Medicare & Medicaid Services (CMS) and insurance companies to represent a patient's health status. RAF scores are used to predict the cost for a healthcare organization to care for a patient.

Individual scores/weights are assigned to patient demographics and HCCs and then added together to calculate the total risk adjustment factor (RAF) score. RAF scores are then multiplied by the published denominator to derive an expected annual expenditure.

Please see these CCO threads:

HCC-Hierarchical Condition Categories

Risk Adjustment

Education:

• Overview of the HCC/risk adjustment factor (RAF) methodology.
• Review of criteria to identify reportable conditions (e.g., MEAT or TAMPER™).
• A refresher of the ICD-10-CM Official Guidelines for Coding and Reporting with a focus on risk adjustment coding and where correct coding is most impactful in the applicable HCC model.
• Education for the appropriate interpretation and use of AHA Coding Clinic advice.
• Familiarity with clinical indicators (e.g., testing, treatment, medications) for chronic conditions to recognize the current nature and/or presentation of the condition.
• Practice analyzing clinical documentation to recognize when documentation meets criteria for assignment of chronic secondary diagnosis codes.
• Review of audit requirements to ensure understanding of the monitoring processes employed by CMS for validation of code abstractions.

CCO RA/HCC Course:

Certified Risk Adjustment Coder (CRC™) Course - Exam Prep

Learn Risk Adjustment and Pass the CRC™ Exam with our Full CRC Course. Coaching, Exam Prep and 9 Months Access Included.

www.cco.us

 

[TashaM_12627]

Thank you!!! This was extremely helpful!