Level 2: Advanced Specialist

Complex Comorbidity Identification

Master advanced tier capture strategies and identify high-value coding opportunities

Learning Objectives
  • Differentiate between similar diagnoses with different tier levels (e.g., systolic vs. diastolic CHF)
  • Identify opportunities to upgrade diagnoses through physician queries
  • Recognize when multiple comorbidities can be coded from a single condition
  • Understand clinical criteria that determine tier assignment
  • Maximize tier capture while maintaining coding compliance
High-Value Tier Capture Strategies
Advanced techniques for identifying commonly missed Tier 1 opportunities

1. Diabetic Complications - Multiple Tier 1s

Don't stop at one diabetic complication. Review for:

  • E11.21 - Diabetic nephropathy (Tier 1)
  • E11.40 - Diabetic neuropathy (Tier 1)
  • E11.3x - Diabetic retinopathy (Tier 1)
  • E11.51 - Diabetic PVD (Tier 1)
  • E11.65 - Diabetic hyperglycemia (Tier 1)

💡 One diabetic patient can yield 3-5 Tier 1 comorbidities!

2. CHF Subtypes - Know the Difference

  • Tier 1: I50.2x (systolic CHF with EF less than 40%), I50.33 (acute on chronic diastolic), I50.43 (acute on chronic combined)
  • Tier 3: I50.32 (chronic diastolic CHF), I50.9 (CHF unspecified)

💡 Query for EF and acute exacerbation status to maximize tier capture

3. CKD with Etiology - Upgrade Opportunity

Stage 3 CKD (N18.3) is Tier 3, BUT:

  • E11.21 (diabetic nephropathy) - Tier 1
  • I12.9 (hypertensive CKD) - Tier 1

💡 Always query for CKD etiology in diabetic/hypertensive patients

4. Malnutrition Severity - High-Value Query

  • Tier 1: E43 (severe protein-calorie malnutrition)
  • Tier 2: E44.0 (moderate protein-calorie malnutrition)
  • Tier 3: E46 (unspecified malnutrition)

💡 Present albumin, BMI, weight loss data in query to support severity classification

5. COPD with Acute Conditions - Tier 1 Opportunities

  • Tier 1: J44.0 (COPD with acute lower respiratory infection), J44.1 (COPD with acute exacerbation)
  • Tier 3: J44.9 (COPD unspecified)

💡 Look for documentation of acute exacerbation or concurrent infection

Module Quiz
Test your knowledge of Complex Comorbidity Identification concepts

8

Questions

85%

Passing Score

~12

Minutes

Quiz Instructions:

  • Answer all 8 questions to complete the quiz
  • You must score 85% or higher to pass
  • You can navigate between questions before submitting
  • Review explanations for all questions after submission
  • Retake the quiz as many times as needed to pass