Problem List
The structured list of active and resolved diagnoses maintained in the electronic health record.
1 min read · Last reviewed May 23, 2026
At a glance
- Category
- Documentation
- Primary sources
- 2
- Workspace handoff
- revenue audit →
Where this comes up
Providers meet this term in the chart and at the post-visit review — encounter notes, problem lists, medication reconciliation, signed orders, and the time/elements that defend the billed code. If documentation does not support the code, the code does not survive an audit.
Full definition
What it is in practice
The problem list is the central source for problem-based MDM and for capturing HCC categories in value-based contracts. ONC certification requires structured problem lists in CEHRT.
How it shows up in your practice
Periodically reconcile the problem list. Stale active problems cause incorrect HCC scoring; resolved problems that linger as active inflate severity inaccurately.
Sources
- CMS — Promoting Interoperability Programshttps://www.cms.gov/medicare/regulations-guidance/promoting-interoperability-programs
- CMS — CEHRT (Certified EHR Technology)https://www.cms.gov/regulations-and-guidance/legislation/ehrincentiveprograms/certification.html
Run problem-list reconciliation in Revenue Audit
Open revenue audit →Related terms
- DocumentationHCC (Hierarchical Condition Category)The CMS risk-adjustment model that groups ICD-10 codes into categories used to predict the cost of care for Medicare Advantage enrollees.
- CodingICD-10-CMThe Clinical Modification of the WHO ICD-10 code set used in the United States to report diagnoses.
- DocumentationMedication ReconciliationThe process of creating an accurate list of all medications a patient is taking and comparing it against new orders to identify discrepancies.
- DocumentationDocumentation SpecificityThe level of detail in clinical documentation needed to support the diagnosis and service codes reported.
D3rx is a healthcare-billing and compliance research aid maintained by D3rx Inc. Articles are drafted by an LLM (Anthropic Claude) against primary HHS, OCR, CMS, eCFR, NIST, and state-regulator publications, and reviewed for restraint and source fidelity by the D3rx team.
Reviewer status: a named credentialed reviewer (CHC, CHPC, or healthcare attorney) is being engaged. Until that engagement is finalized, this page does not claim credentialed review.
Related across the archive
- GlossaryDocumentation SpecificityThe level of detail in clinical documentation needed to support the diagnosis and service codes reported.
- GlossaryHCC (Hierarchical Condition Category)The CMS risk-adjustment model that groups ICD-10 codes into categories used to predict the cost of care for Medicare Advantage enrollees.
- GlossaryMedication ReconciliationThe process of creating an accurate list of all medications a patient is taking and comparing it against new orders to identify discrepancies.
- GlossaryICD-10-CMThe Clinical Modification of the WHO ICD-10 code set used in the United States to report diagnoses.
- GlossaryPatient PortalA secure web-based application that lets patients access portions of their health information and communicate with the practice.
- GlossaryCEHRTCertified Electronic Health Record Technology — EHR software certified by ONC to meet specific functional and interoperability criteria.
- GlossaryPromoting InteroperabilityThe CMS program (formerly Meaningful Use) that rewards demonstrated use of CEHRT to improve patient care.
- GlossaryPreclusion ListCMS list of prescribers and providers whose claims and prescriptions are denied payment by Medicare Advantage and Part D.
This glossary entry is a research aid for billing and compliance staff. It does not provide legal, medical, or financial advice and does not replace counsel. References cited link to primary sources at HHS, OCR, CMS, eCFR, NIST, and the relevant payer or industry body.