Evolution of the uses of ICD-9-CM coding: Medicare risk adjustment methodology for managed care plans

The health information management (HIM) profession is expanding to new sites and perspectives. The implementation of Medicare managed care has brought changes not only by emphasis on management of the individual's medical care and the cost of that care, but also by creating new uses for coded data. This article examines the evolution of risk adjustment methods in Medicare Managed Care. The current choice for risk adjustment is the Principal Inpatient Diagnostic Cost Groups (PIP-DCG). This article explains the health plan's submission of encounter data and how HIM can play a valuable role in data capture and improvement in data quality and reimbursement.