Medicare Advantage medical record documentation and coding resources
Amerigroup Community Care is committed to helping providers offer quality care and services to the members in our network. The resources on this page provide guidance and instructions to help providers serve members with Medicare Advantage plans.
Providers play a key role in risk adjustment activities for Medicare Advantage plans as each member’s health status is determined by the conditions identified and supported in medical record documentation. Review this document to learn more about the Provider’s role in risk adjustment.
ICD-10-CM requires medical record documentation to be more specific to ensure the most appropriate code is selected. To assist with accurate diagnosis coding and billing compliance for Medicare Risk Adjustment, included are the top ten ICD-10-CM documentation and coding tips.
The ICD-10-CM Coding Reference Guide contains some of the more commonly reported conditions in Medicare Advantage Risk Adjustment. The tables within the reference guide are broken down by condition type, they include certain diagnosis (ICD-10-CM) codes and code categories along with their descriptions. Additionally, some helpful coding tips are included.
This one-page document provides medical record documentation tips for Medicare Advantage Risk Adjustment purposes. Reference these tips for documenting to the highest degree of specificity to ensure the most appropriate ICD-10-CM code is assigned.
These publications contain a summary of the diagnosis codes that map to the CMS-HCC Risk Adjustment Model(s). This publication includes the ICD-10-CM codes, HCC codes and category descriptions, along with the disease hierarchies.
A useful and concise one-page publication focusing on a specific condition(s) with details regarding the clinical definition, diagnostic criteria, and relevant ICD-10-CM coding guidance with impact to CMS-HCC code(s) assignment.
- Alcohol Use Disorder
- Aortic Ectasia
- Atrial Fibrillation
- Bipolar Disorder
- Breast Cancer
- Cerebral Hemorrhage
- Chronic Bronchitis
- Chronic Kidney Disease (CKD)
- Chronic Obstructive Pulmonary Disease (COPD)
- Colon Cancer
- Compression Fractures
- Congestive Heart Failure
- Coronary Artery Disease
- Deep Vein Thrombosis (DVT)
- Diabetes Mellitus with Neurological Complications
- Diabetes Mellitus with Ophthalmic Complications
- Diabetes Uncontrolled
- Diabetic Renal Disease
- End Stage Liver Disease
- Heart Failure
- Human Immunodeficiency Virus (HIV)
- Hypertension (HTN)
- Lung Cancer
- Major Depressive Disorder
- Malignant Neoplasm of Prostate
- Morbid Obesity
- Myocardial Infarction
- Opioid Use Disorder
- Personality Disorders
- Respirator Dependence
- Rheumatoid Arthritis
- Sedative, Hypnotic or Anxiolytic Use Disorder
- Seizure Disorder
- Senile Purpura
- Sick Sinus Syndrome
- Unstable Angina
- Venous Ulcers
- Viral Hepatitis
These four-page coding brochures were created to guide providers through ICD-10-CM coding by giving a detailed background, specific diagnosis coding guidance, educational elements, and references for specific condition(s).
This Annual Wellness Visit (AWV) Fact Sheet provides details on what an AWV visit is, who can perform the AWV, who is eligible for the AWV, and more. The table of acceptable physician specialty types for Risk Adjustment data submission is also included.
This publication contains an overview of the ICD-10-CM coding guidelines in which a causal relationship can be assumed between certain conditions.