Healthcare Coding Glossary
Plain-English definitions for the 15 healthcare coding, risk-adjustment, and compliance terms that come up when you integrate AutoICD or evaluate any clinical-AI vendor. Each entry links to a longer page with a working API call.
Risk Adjustment
Audit
Risk Adjustment Data Validation Audit(RADV)
CMS audit that verifies submitted MA / ACA diagnosis codes are supported by the medical record.
Specificity Upgrade
Replacing an unspecified ICD-10-CM code with a more specific one supported by the documentation.
Denial Risk
Probability that a submitted diagnosis or procedure code is rejected, downcoded, or sent to medical review.
Coding Standards
ICD-10-CM
The U.S. clinical modification of WHO ICD-10, maintained by NCHS and CMS for diagnosis coding on all U.S. healthcare claims.
ICD-11
WHO's 2022 successor to ICD-10, with stem codes, post-coordination via extension codes, and a digital-first specification.
International Classification of Functioning, Disability and Health(ICF)
WHO classification for describing how a condition affects body functions, activities, and participation, complementary to ICD diagnoses.
Logical Observation Identifiers Names and Codes(LOINC)
Regenstrief-maintained code system that names laboratory tests, clinical observations, and document types.
SNOMED CT
Comprehensive multilingual clinical terminology with over 350,000 concepts, designed for EHR documentation and clinical decision support.
Cross-Mappings
Unified Medical Language System(UMLS)
NLM's terminology integration layer with over 220 source vocabularies unified by Concept Unique Identifiers (CUIs).
RxNorm
NLM's normalized vocabulary for clinical drugs, with stable RxCUI identifiers across brands, strengths, and dose forms.
Crosswalk (Code Mapping)
A mapping table that translates codes between two classifications, e.g., ICD-10-CM to ICD-11.