Where are most ICD-10-CM codes used for risk score calculation obtained from?

Where are most ICD-10-CM codes used for risk score calculation obtained from?

• A. Pharmacy records.
• B. Hospital inventories.
• C. Claims submitted by a provider.
• D. Patient interviews.

Answer: (C)

ICD-10-CM codes used for risk score calculations come from the diagnosis information included in claims submitted by providers. These claims document the conditions diagnosed during visits or encounters and are standardized for billing, which is why risk adjustment models rely on them to quantify a patient’s health burden. While pharmacy records show medications, and patient interviews or inventories may contain related information, they don’t provide the standardized diagnoses used for risk scoring. Therefore, the typical source is claims submitted by a provider.

ICD-10-CM codes used for risk score calculations come from the diagnosis information included in claims submitted by providers. These claims document the conditions diagnosed during visits or encounters and are standardized for billing, which is why risk adjustment models rely on them to quantify a patient’s health burden. While pharmacy records show medications, and patient interviews or inventories may contain related information, they don’t provide the standardized diagnoses used for risk scoring. Therefore, the typical source is claims submitted by a provider.