Coding Tip Corner – September 2026

Health status is captured through ICD-10-CM diagnosis coding. While Medicare Advantage (MA) plans submit diagnosis data to CMS, the originating source of diagnosis data is provider documentation. Accurate and complete diagnosis reporting is therefore a critical compliance requirement, as it directly drives risk adjustment and funding for MA. 

Here are some tips to help you receive credit for the care you provide: 

• Address chronic conditions on an annual basis. As we enter the fourth quarter, this is a good time to ensure you have addressed all your patients’ chronic conditions for the year. 
• Document the clinical details of a diagnosis showing how it was addressed during the encounter. 
  1. Addressing conditions supports Medical Decision Making (MDM) for accurate E&M code reporting 
  2. E&M coding now rewards cognitive effort (MDM) over volume of documentation 
  3. Document how you monitored, evaluated, assessed, or treated each diagnosis during the encounter 
• Tell the full story. No credit or support for a diagnosis can be given for undocumented thoughts. 
• Report on the most specific ICD-10-CM code supported by documentation. 
  1. Avoid “unspecified” diagnosis descriptions in the EHR when more detail is clinically available 
  2. Use “other specified” diagnosis descriptions in the EHR cautiously. When selected, clearly document the specific condition represented by “other.” For example: Type 2 diabetes with other specified complication (E11.69) requires documentation identifying the specific complication. 

Accurate diagnosis documentation is not just a coding requirement. It is a direct analysis of the clinical complexity you manage daily. In Medicare Advantage, what you document determines how your MA patient’s health status is recognized, measured, and funded. 

As your patients visit, this is a great time to check that they are also compliant with any HEDIS measures they may be selected for, such as complications associated with diabetes, eye exams, kidney function, and blood pressure control. 

More Coding Tips

If you see something that you don’t understand, say something! Don’t try to guess what the provider might have meant. When records are pulled for any type of audit, the documentation must be very clear and match the code submitted.

We’d like to send a big thank you to the offices that have sent us requested records as we comply with all required audits. Unfortunately, these audits come with a strict timeframe that usually means a quick turnaround. We appreciate your help!