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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. 

Documentation and Coding FAQs

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.
2017 Coding Coach Coding Tips
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.
2016 Coding Coach Coding Tips
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.
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).
Dosage Coding Guidelines for Unlisted Drugs
Guide to Closing Patient Gaps for the Diabetes Eye Exam Measure
Healthcare Effectiveness Data Information Set (HEDIS)
2019 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.
Obstetrics Coding and Documentation Reference Guide