Drug Search

Quickly locate diagnosis codes associated with specific medications using a curated drug-to-code lookup. Identify risk-adjustable conditions linked to prescriptions and improve coding specificity based on drug data.

Example Use Case:

While reviewing a chart, a medication like Digoxin is mentioned, but no cardiac diagnosis is clearly stated. The coder uses the Drug Search feature to confirm that Digoxin is linked to conditions such as atrial fibrillation and heart failure, helping guide accurate diagnosis code selection.

Side-by-Side View

Cross-check codes in real time with a dynamic view of Index and Tabular references. See all inclusions, exclusions and official guidance side-by-side for faster, more accurate coding.

Example Use Case:

A coding specialist is validating a code during a QA review. They use the Side-by-Side View to instantly see both the index entry and tabular rules, along with inclusions, exclusions and instructional notes all at once, eliminating the need to flip between screens or books.

AHA Coding Clinic Access

Boost compliance and accuracy with direct links to coding clinic indicators and guidance from the AHA’s official Coding Clinic, included at no additional cost.

Example Use Case:

A question arises about whether a certain code combination is valid. Instead of searching manually, the user clicks a coding clinic indicator next to the code to view the AHA's official guidance directly within the Encoder platform, confirming compliance without leaving the interface.

Year Toggle

Instantly switch between ICD-10 code sets from 2017 to the current year. Ideal for retrospective audits or projects requiring multi-year data validation.

Example Use Case:

A compliance auditor is reviewing a claim from 2020 and needs to confirm the code validity and logic based on that year’s ICD-10 rules. The user toggles to 2020, ensuring the correct logic is used for historical review.

HCC Tagging

Risk-adjustable codes are automatically tagged for both Medicare Advantage and ACA plans. Eliminate guesswork and streamline accurate capture of Hierarchical Condition Categories (HCCs) during the coding process.

Example Use Case:

While reviewing patient documentation, a coder enters several diagnosis codes. The Encoder automatically tags the ones that map to HCC categories for Medicare Advantage or ACA, highlighting risk-impacting codes that need documentation validation and RAF scoring.

DX <-> MA Mappings

Visualize the relationship from diagnosis codes to Medicare Advantage HCC categories—and vice versa. Start with a diagnosis to see its HCC impact, or begin with an HCC to find all qualifying ICD-10 codes. Understand how coding selections influence risk scoring in both clinical and reimbursement contexts.

Example Use Cases:

DX -> MA (Diagnosis to Medicare Advantage) A coder starts with an ICD-10 diagnosis and wants to know which HCC it triggers in the MA model.

MA -> DX (Medicare Advantage to Diagnosis) A risk adjustment auditor or coder wants to identify which diagnosis codes satisfy a specific HCC to ensure complete capture.

CMS MA HCC Coefficients & Hierarchies

Access CMS-assigned coefficients and HCC hierarchies directly within Risk Adjustment Encoder. View the values tied to each HCC and clearly understand the hierarchy structure to improve coding defensibility, documentation accuracy and financial impact.

Example Use Cases:

A coding specialist is reviewing documentation for a Medicare Advantage patient. By opening the CMS MA HCC Coefficients & Hierarchies Page, they can instantly see the CMS-published value assigned to the documented HCC and whether any hierarchy exclusions apply. This helps ensure accurate risk adjustment coding, audit readiness and proper reimbursement.