For many quality initiatives, administrative data (eg, codes reported on claims) are a primary source of information for demonstrating that a quality or performance measure was met. Payers are incentivized to demonstrate that plan members and beneficiaries receive quality care through programs like Healthcare Effectiveness Data and Information Set and rely on physicians to provide, document, and report the care associated with quality and performance measurement.

This article reviews basic coding concepts of coding to demonstrate quality, including the following:

Multiple code sets are necessary to provide evidence of the quality and value of health care services provided.

While each code set may be required to indicate quality and value of care provided, assignment is only possible when supported by documentation.

When a standardized instrument is used to determine the current status of the patient’s depression, code 96127 is reported as in example 1 but with a diagnosis code for...

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