Anthem Blue Cross and Blue Shield appropriate coding helps provide a comprehensive picture of patients’ health and services provided

As the physician of our members who have Affordable Care Act (ACA) health plans, you play a vital role in the success of this initiative and our compliance with ACA requirements. When members visit your practice or office, we encourage you to document all of the members’ health conditions, especially chronic diseases. As a result, there is ongoing documentation to indicate that these conditions are being assessed and managed. Ensuring proper coding on the claim is to the greatest level of specificity can help reduce the number of medical chart requests in the future.

Ensure all codes captured in your electronic medical record (EMR) system are included on the claim and not being truncated by your claims software management system. For example, some EMR systems may capture up to 12 diagnosis codes. However, a claim system may only have the ability of capturing four. If your claim system is truncating some of your codes, please work with your vendor/clearing house to ensure all codes are being captured.

Best practices and documenting guidelines: Use clear terminology.

Include a brief statement that updates the status of each diagnosis. For example, use words such as continue, increase, add, name of medication treating the condition, refer to, return to center, follow up, and so on. This informs the coder the condition is current. Include orders for each condition if applicable.

For every medication refilled, document a diagnosis and address it in the progress note. Chronic conditions should be evaluated at least once per year.

Use the words history of to mean the condition no longer exists. For example: Document the patient has diabetes and hypertension rather than the patient has a history of diabetes and hypertension.

Please see forms and guides for a more comprehensive Commercial Risk Adjustment coding brochure.

Contact our Commercial Risk Adjustment Network Education representative if you have any questions:

For providers in	Commercial Risk Adjustment Network Education representative
California, Colorado, and Nevada	Martha.Bendot@anthem.com
Indiana, Missouri, Wisconsin, Ohio, and Kentucky	Mary.Swanson@anthem.com
New York, Maine, New Hampshire, Connecticut, Georgia, and Virginia	Alicia.Estrada-Hoare@anthem.com

Thank you for your continued efforts with our Commercial Risk Adjustment Program.