Understanding Coding Gaps

Last updated: October 27, 2025

Introduction

Coding gaps are potential opportunities to enhance the accuracy of a patient's diagnosis coding, especially for risk adjustment programs like Hierarchical Condition Categories (HCC). This article explains how coding gaps work in Canvas Medical and how to create, validate, defer, and assess them to improve documentation accuracy and support billing compliance.

User's Guide

What Are Coding Gaps?

Coding gaps occur when a diagnosis or condition relevant to risk adjustment is missing or not properly documented in the patient's record. By identifying and addressing these gaps, practices can:

  • Improve documentation accuracy

  • Support proper risk adjustment coding

  • Ensure billing compliance

  • Enhance clinical records for better patient care

Creating a Coding Gap

Document potential coding gaps by suggesting diagnoses that may be missing from the patient's record.

To create a coding gap:

  1. Add the Create Coding Gap command to a note

  2. Complete the following fields:

    • Create Coding Gap: Diagnosis being evaluated for coding gap (you can add multiple ICD-10 codes to a single coding gap)

    • Status: Select the current status

      • Created: Coding gap suggested but requires further validation for relevancy (a protocol card will be created indicating review is needed)

      • Create and Validate: Suggested coding gap is relevant and can bypass validation

    • Date: Accept default (day command was created) or modify as needed

    • Notes: Any additional details pertaining to the coding gap

  3. Click Record to create the coding gap

Understanding Multiple Diagnoses in Coding Gaps:

The Create Coding Gap command supports adding multiple ICD-10 codes to represent a detected issue. This one-to-many relationship allows each ICD-10 code to serve as evidence for the coding gap. Common use cases include:

  • Buddy codes: Related diagnoses that are often documented together for comprehensive risk adjustment

  • Related conditions: Multiple ICD-10 codes that collectively represent a single clinical issue

When the coding gap is assessed, each ICD-10 code diagnosed represents a distinct condition that will be added to the patient's record.

Validating Coding Gaps

Confirm suggested coding gaps as clinically relevant and document their validity.

To validate a coding gap:

Choose one of these methods:

  • Click Validate in the protocol card under the patient panel protocol view

  • Manually add the Validate Coding Gap command to a note

Complete the following fields:

  1. Validate Coding Gap: Name of condition being validated

  2. Status: Indicate the validity of the diagnosis (Valid or Invalid)

  3. Date: Accept default (day command was created) or modify as needed

  4. Note: Review carried-forward notes from Create Coding Gap command and modify if necessary

  5. Click Record to update the coding gap

If the coding gap is recorded as Valid, the diagnosis appears in the patient summary under the Coding Gaps section.

Reviewing Validated Coding Gaps

Access comprehensive information about validated coding gaps directly from the patient summary.

To review a validated coding gap:

  1. Navigate to the Patient Summary

  2. Click the condition listed under Coding Gaps

The modal displays:

  • Heading: Coding gap ICD-10 description and code

  • Validated: Date the command was committed and who performed it

  • Note: Information from the Validated Coding Gap command, if applicable

  • Reference: Any linked resources added to the command

Deferring Coding Gaps

Temporarily postpone action on coding gaps when additional information or follow-up is needed.

To defer a coding gap:

Choose one of these methods:

  • Click Defer from the Patient Summary

  • Add the Defer Coding Gap command to a note

  • Click Record to save

Deferred coding gaps redisplay on the Patient Summary or in the Assess Coding Gap command after 5 days, allowing for reassessment or additional deferral.

Assessing Coding Gaps

Review coding gaps and either accept or refute them.

To assess a coding gap:

Choose one of these methods:

  • Click Assess from the Patient Summary

  • Add the Assess Coding Gap command to a note

Complete the following fields:

  1. Assess Coding Gap: Name of condition being assessed

  2. Status: Select acceptance status for the condition

    • Accept and Diagnose: Diagnosis applies to the patient and will become an active condition

    • Refute: Diagnosis does not apply to the patient and is denied

  3. Note: Review carried-forward note from Validate Coding Gap command

  4. Diagnose: Official diagnosis of the assessed condition

  5. Background: Review carried-forward background from Validate Coding Gap command and modify if necessary

  6. Today's Assessment: Document assessment made at the current visit

  7. Click Record to add the diagnosis to the patient record

What happens after assessment:

  • If accepted, the diagnosis drops to the conditions list in the patient summary as an active condition

  • If refuted, document the reason it is not valid in the Note field and commit the command to remove the coding gap

Configuration & Set Up

To use the Coding Gaps feature, contact Canvas Support to enable this functionality for your practice.

FAQ & Troubleshooting

Q: Do I need to validate every coding gap I create?

A: No. If you select "Create and Validate" when creating the coding gap, it bypasses the validation step. Use "Created" status when the coding gap requires further review.

Q: What happens to deferred coding gaps?

A: Deferred coding gaps reappear on the Patient Summary or in the Assess Coding Gap command after 5 days, giving you another opportunity to assess or defer them again.

Q: Can I refute a coding gap without adding it to the patient's conditions?

A: Yes. When assessing a coding gap, select "Refute" as the status, document the reason in the Note field, and commit the command. This removes the coding gap from the patient's record.

Q: Why can I add multiple diagnoses to a single coding gap?

A: The Create Coding Gap command supports multiple ICD-10 codes to represent a detected issue. Each code serves as evidence for the coding gap, supporting a one-to-many relationship. Common use cases include buddy codes (related diagnoses often documented together) and related conditions that collectively represent a single clinical issue. When you assess the coding gap, each ICD-10 code becomes a distinct condition in the patient's record.

Related Resources

Keywords: coding gaps, HCC, risk adjustment, diagnosis coding, validate coding gap, defer coding gap, assess coding gap, billing compliance, documentation accuracy

Categories: Clinical Documentation, Condition Management, Risk Adjustment