Coding Tip Corner – August 2026

As you know, CMS is moving forward with an enormous number of audits. This means the likelihood of your records being selected for review is greater than in previous years. That’s why it’s so important to follow all current coding guidelines and requirements. 

The purpose of a CMS Risk Adjustment Data Validation (RADV) audit is to ensure that the diagnosis codes submitted by healthcare plans are fully supported by the patient’s current medical record documentation. 

One common issue we continue to see is cerebrovascular accidents (CVAs, commonly referred to as strokes) being coded as active conditions years after the original event. As you know, it is highly unlikely that the CVA itself occurred during the office visit. 

Although you cannot go back and change what has already been submitted, it is important to code CVAs accurately going forward. Once a patient has been transferred from an acute care setting to rehabilitation or home for continued stroke care, the condition should be coded as either an acute stroke or a sequela, as appropriate. There is no time limit for reporting stroke sequelae (category I69). However, there is a strict limitation on reporting a stroke from category I63 once the acute phase has ended. 

Strong collaboration between providers and coders is essential in the office setting. We certainly recognize that there are only so many hours in the day, but consider exploring workflows that allow coders to query providers when documentation or coding concerns are identified. 

If your office has developed an effective provider-coder collaboration process and would like to share what is working for your team, please email Mary Feltovich at mfeltovich@htanc.com.