Resources Portlet

Resources

EDUCATION & EVENTS

ENROLLMENT & CREDENTIALING

FORMS & MANUALS

PHARMACY

POLICIES & GUIDELINES

PROGRAMS & INITIATIVES

AMA/FEP Hypertension Management Project

Behavioral Health

Choosing Wisely®

Documentation & Coding

Healthcare Reform

NCQA Diabetes Recognition Program

NCQA Patient-Centered Medical Home

Opioid Management

Patient Satisfaction

Physician Performance Assessment (PPA)

Preferred Radiology Program

Radiation Therapy Management

Select Programs

Telemedicine

Urgent Care Choice

PROVIDER eSOLUTIONS

PROVIDER NETWORKS

Dynamic Rendering Portlet

Documentation & Coding

Documentation and Coding

In 2014, the federal government began reimbursing health plans based on the health of their members, similar to the way Medicare Advantage plans are reimbursed. This reimbursement is determined through a method used by the Centers for Medicare and Medicaid Services (CMS) called "risk adjustment."

Providers play an important role in the risk adjustment process because claims coding data is used to indicate the complete picture of health for plan members. This same data also enables Blue Cross and Blue Shield of Alabama to plan, analyze and design programs to help manage members' chronic conditions.

Providers can view our Documentation and Coding Improvement Initiative resources and tools below to learn more about risk adjustment and how they can provide the most accurate, complete coding and documentation possible. 

ICD-10-CM Diagnosis Code Mapping Tool

Coding for Pneumococcal Vaccines
Blue Cross and Blue Shield of Alabama benefits are set up to allow one of each Pneumococcal vaccine type in a lifetime for our members. In order for the provider to receive payment for the second vaccine, the second vaccine must be a different pneumococcal vaccine from the first vaccine and must be administered at least a year after the first.
Correctly Coding Breast, Prostate, and Other Cancers and Tumors
When selecting International Classification of Diseases, Tenth Revision (ICD-10) diagnostic codes, accuracy is important when describing the patient’s true health.
Correctly Coding Cerebrovascular Disease
When selecting International Classification of Diseases, Tenth Revision (ICD-10), diagnostic codes, accuracy is important when describing the patient’s true health.
Correctly Coding Chronic Lower Respiratory Diseases (COPD)
When selecting International Classification of Diseases, Tenth Revision (ICD-10), diagnostic codes, accuracy is important when describing the patient’s true health.
Correctly Coding Diabetes Mellitus
When selecting International Classification of Diseases, Ninth and Tenth Revisions (ICD-9 and ICD-10), diagnostic codes, accuracy is important when describing the patient’s true health.
Documentation and Coding Frequently Asked Questions
Proper Medical Documentation
Documentation is clear, detailed and accurate, providing a clear description of care. When the patient’s chronic illnesses are addressed during the visit, it is a factor in the decision-making process.
What is Risk Adjustment
Risk adjustment models organize diagnosis codes, and sometimes prescription drug claims, into discrete categories to show the overall health status of the patient.
2017 Coding Update for Drug Testing HCPCS G Codes
Blue Cross and Blue Shield of Alabama medical policy #566, Drug Testing, has undergone a major coding update for 2017.
2018 Coding Coach Coding Tips
Change Healthcare Coding Advisor's Frequently Asked Questions
Blue Cross and Blue Shield of Alabama has contracted with Change Healthcare, an independent company, to review the use of the Evaluation and Management (E&M) codes and billing of Modifier 25 for all physicians participating in the network as part of ongoing claim review activities.
Changes to Mammography Codes
CPT® Code 99080
Blue Cross and Blue Shield of Alabama encourages all vendors to receive the maximum number of diagnosis codes at the claim level without any dependencies on the number of lines/procedures. However, results from the diagnosis code exercise identified some practice management system limitations that require providers to enter multiple lines/procedures in order to submit the maximum allowed 12 diagnosis codes on professional claims, as allowed by the ASC X12 5010 Type 3 Technical Reports (TR3).
Dental Coding Coach Coding Tips
Dosage Coding Guidelines for Unlisted Drugs
Filing Instructions for Patient Clinical Information
The Filing Instructions for Patient Clinical Information document is a helpful tool that highlights coding for Body Mass Index, blood pressure and Hemoglobin A1c (HbA1c) claims filing requirements for comprehensive coding.
Guide to Closing Patient Gaps for the Diabetes Eye Exam Measure
Healthcare Effectiveness Data Information Set (HEDIS)
2018 Frequently Asked Questions
Medical Documentation Tips
The SOAP note (acronym for subjective,objective, assessment, and plan) is a method of documentation many healthcare providers use to write out notes in a patient’s chart. The length and focus of each component of a SOAP note varies depending on the specialty.
Medical Record Documentation
Documentation is the recording of pertinent facts and observations about a patients health history, including past and present illnesses, diagnostic tests, treatments and outcomes.
Modifiers
A Current Procedural Terminology/Healthcare Common Procedure Coding System (CPT/HCPCS) modifier is a twocharacter (alpha and/or numeric) code appended to a CPT/HCPCS procedure code to clarify the services or procedures being billed. The modifier indicates that the service or procedure performed has been altered by some specific circumstance but not changed in its definition or code.
National Correct Coding Initiative (NCCI)
NCCI edits define when two procedure codes may not be reported together except under special circumstances and are designed to: • Ensure the most comprehensive groups of codes are billed rather than component parts. • Identify and edit mutually exclusive codes to ensure only appropriate codes are grouped and paid.
Obstetrics Coding and Documentation Reference Guide
Pediatrics - Weight Assessment Measure Frequently Asked Questions and Answers
The HEDIS® measure Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents (WCC) is a combination measure.
Proper Use of Anesthesia Modifiers
In January 2014, Blue Cross and Blue Shield of Alabama implemented changes to guidelines for filing and processing of anesthesia claims. Modifiers are required to reflect whether a service was personally performed by the anesthesiologist or certified registered nurse anesthetist (CRNA) or whether the service was performed by the CRNA under the medical direction of an anesthesiologist.
Serogroup B Meningococcal Vaccinations
What is the Member Condition Tracker
The Member Condition Tracker identifies members who were diagnosed with one or more of eleven chronic conditions in one of the previous two calendar years who have not yet had these diagnoses documented through claims in the current year.