📚 Today’s HEDIS® Reviewer & Coding Academy Discussion

Lanette Woods · 2026-10-06T18:06:08.974Z

🩺 HEDIS® + ICD-10-CM Challenge: Code vs. Clinical Evidence A member has the following documented in the medical record: Diagnosis: Type 2 diabetes mellitus with diabetic chronic kidney disease ICD-10-CM: E11.22 The medical record also states the member has Stage 3 chronic kidney disease (CKD). 💬 Discussion Questions: 🔎 As a medical coder , is E11.22 the only code you would expect to see, or is an additional ICD-10-CM code needed to identify the CKD stage? 📋 As a HEDIS® reviewer , would the diagnosis codes alone be enough to determine that the member meets the numerator for a kidney-related HEDIS® measure? 🧠 Bonus: What clinical documentation or test results would you look for in the chart? 👇 Drop your answers in the comments! Let’s see how our coders and HEDIS® reviewers approach the same medical record differently. 💡 Academy Tip: A diagnosis code can tell you what condition is documented—but HEDIS® compliance depends on the requirements of the specific measure.

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📚 Today’s HEDIS® Reviewer & Coding Academy Challenge!