Certified Risk Adjustment Coder (CRC)

How should resolved conditions be coded?

1. Reported as current if included on the problem list

2. Reported as history of when appropriate

3. Reported as current as a secondary diagnosis, never as first-listed

4. Reported for one year after onset

The correct answer is: Reported as history of when appropriate

Resolved conditions should be coded as a history of when appropriate because this accurately reflects the patient's current health status. When a condition has been effectively treated or resolved, it is no longer active, and thus it should not be represented as a current diagnosis. Instead, documenting it as a historical condition provides important context in the patient's medical record; it indicates that the condition was once present but has since been addressed. In many coding practices, distinguishing between active and historical conditions is crucial for ensuring that healthcare professionals understand the patient's background, especially for conditions that may still have implications for future health care or risk assessment. Using “history of” coding helps maintain accurate documentation without misrepresenting the patient's present condition. This approach aligns with best practices in risk adjustment coding, where clarity and precision in the coding of patient conditions are essential for proper risk assessment and reimbursement. Properly coding resolved conditions as historical avoids confusion about the patient's current health status while preserving the relevant information about their medical history.