Tuesday, September 7, 2010


Welcome to the new SCAN blog! We have added moderated comments to the new blog, so that you can join the conversation. Guidelines for posting are posted, and we hope that you’ll read them, and add to discussion. Because your comments need to be reviewed prior to posting, there may be a delay of up to a day before you see them.

We see this as a great opportunity for everyone to share their Medicare Advantage Risk Adjustment (RA) knowledge, ask questions, and further discussions on topics of interest to all of us involved in Risk Adjustment.

If you have ideas for future postings, have found a great resource, or want to know where to find information, let us know here.

Look for our next RA topic related posting in a few days…and please, join in!

The SCAN Risk Adjustment Team


  1. Hi Stacey,

    I hope this is the right spot to ask questions. I am currently trying to help one of our providers. He wants to bill 425.9, secondary cardiomyopathy NOS. What type of documentation is needed to support this billed code?

    Thank you,

  2. I'm happy to answer your question here--but the best place to post coding/Risk Adjustment Questions is at Coding@SCANHealthplan.com. We usually handle questions in 2-3 days, and most of the questions end up on our Ask A Coder page on HCCUniversity.com.

    When educating physicians and other clinicians on coding, it's important that we give them factual information, and not lead them, or tell them "document these words".

    Coding can't start from the place of what to bill, it must start from what's wrong with the patient, and the clinician's documentation.

    The physician must identify the disease that the patient has as specifically as possible. If the cardiomyopathy is secondary to another disease, he should indicate that other disease whenever possible. Then he must determine if there is a code that represents that condition. For example, if the cardiomyopathy is secondary to alcoholism, then the correct code is 425.5, and that's the code he should use. If the cardiomyopathy is secondary to an unstated cause--secondary cardiomyopathy with no further description, the correct code is 425.9. In general, we as coders want to avoid "NOS" codes when we can. Most often, if a disease is noted to be "secondary to" another disease, the physician will know what the causative disease actually is.

    Physicians should always be encouraged to be more specific in their documentation whenever possible. Usually, this can be accomplished without a large amount of additional documentaiton.

    I hope this helps.