Certified Risk Adjustment Coder (CRC)

When selecting a diagnosis code, which of the following statements is true?

1. Report the default code found in the Alphabetic Index.

2. Only use codes that are found in the Tabular List.

3. Diagnosis with the highest RAF score is always first-listed.

4. Codes should be confirmed using the Tabular List before reporting.

The correct answer is: Codes should be confirmed using the Tabular List before reporting.

The statement that codes should be confirmed using the Tabular List before reporting is true because the Tabular List provides critical details about each code, including its description, any necessary additional characters, and guidelines for its use. This confirmation process ensures that the diagnosis codes accurately reflect the patient’s condition and meet all coding requirements. Using the Tabular List helps coders avoid potential errors and ensures that they are following the most current coding conventions, which can be essential for proper billing and reimbursement. It also provides necessary information about code relationships, exclusions, and other relevant instructional notes that are not found in the Alphabetic Index. This practice solidifies the validity of the coding choice and supports compliance with coding standards, ensuring that diagnoses are reported accurately.