Which coding system is primarily used in RADV audits?

The primary coding system used in RADV audits is the International Classification of Diseases, Tenth Revision (ICD-10). This system is fundamental because it allows for accurate classification of diagnoses, which is essential for risk adjustment processes.

ICD-10 provides specific codes for a wide variety of conditions and diseases, enabling auditors to validate that the conditions coded in a patient's medical record are documented and justified. This validation process is crucial for ensuring that healthcare organizations receive appropriate reimbursements based on the severity and complexity of patient populations.

The focus of RADV audits is primarily on the diagnosis codes as these codes impact risk adjustment calculations and ultimately affect funding and reimbursement rates for healthcare plans. In contrast, while other coding systems like CPT and HCPCS are important in the broader context of healthcare coding and billing, they do not play a central role in the risk adjustment methodology specifically applied in RADV audits.