Certified Risk Adjustment Coder (CRC)

Which medical record should be used for a RADV audit if CMS is requesting validation for diabetes mellitus with neuropathy?

1. Chart #1: DOS 1/1/20XX—Diagnoses: DM, PVD

2. Chart #2: DOS 4/2/20XX—Diagnoses: DM with neurologic manifestations, polyneuropathy, CKD

3. Chart #3: DOS 7/7/20XX—Diagnoses: DM with neurologic manifestations

4. Chart #4: DOS 9/9/20XX—Diagnosis: DM, HTN

The correct answer is: Chart #2: DOS 4/2/20XX—Diagnoses: DM with neurologic manifestations, polyneuropathy, CKD

The correct choice is based on the specificity and clarity of the diagnoses documented in the medical record. In the context of a Risk Adjustment Data Validation (RADV) audit, it is essential to provide detailed evidence of the specific condition being audited—in this case, diabetes mellitus with neuropathy. Chart #2 includes a precise diagnosis of "DM with neurologic manifestations, polyneuropathy, CKD." This documentation clearly indicates that the patient suffers from diabetes mellitus along with neurological complications and provides a specific mention of polyneuropathy, which directly correlates with the auditor's request for validation of diabetes mellitus with neuropathy. The inclusion of chronic kidney disease (CKD) adds context but does not detract from the primary focus on the neuropathy associated with diabetes. The other charts do not provide the same level of specificity regarding neuropathy. For instance, Chart #1 only indicates diabetes mellitus and peripheral vascular disease without mentioning any neurologic implications. Chart #3 mentions neurologic manifestations but does not specify the type or nature of the neuropathy, making it less suitable for validating the specific condition of diabetes with neuropathy. Chart #4 lists diabetes and hypertension but lacks any reference to neuropathy entirely. Thus, Chart #2 is the most appropriate choice