Wiki Acute codes while HCC coding

[kerenorozco]

Good morning, so I am new to HCC coding. Sometime we get a report of acute codes that were no allowed by the insurance since our goal is to bill only chronic conditions
Is there a way to identify which are acute before submitting to the plan? I have asked but no one can tell me for sure. I am just trying to avoid resubmitting claims.
Any input will help. thank you.

 

[TThivierge]

Hi Kerenorozco
First must follow providers documentation in which hopefully he or she will use Chronic vs Acute depending on the illness severity or if ongoing illness. I have come across some providers will use phrase to help coder determine if ongoing or patient has condition & suffered so many months with illness=chronic. But coding manual states physician should document the word chronic in the notation or explanation so medical coder will know. Thus I code it chronic. The ICD10 manual does have a list of chronic vs acute diseases,but listed under each condition. The Dx G89.2 Chronic Pain must have words in the doc's documentation in order to use it related to limbs or body muscles dx M79 or M25 blocks. Thus if provider stated patient has chronic neck pain I 'd code it as dx M54.2 neck pain, & dx G89.2. All this is in the ICD10 manual regarding coding chronic pain. In the ICD10 manual if check out terms Acute & Chronic must go to each condition. Here are list of commonly used conditions from my providers when documents these illnesses....
Chronic Depression dx F34.1, vs Major Depression see Dx block F32
Chronic Headaches (many types) see dx block G44.02 & G44.22
Chronic Back Ache M54.51, then Causalgia lower limbs and upper limbs see dx G56.4 and G57.7,
Chronic OM on ears see dx block H66.9 and dx H65.3 is Acute OM
Chronic Hives dx L50.8
Chronic kidneys Ds N18 vs Acute Kidney Failure dx N17
Chronic Constipation K59.04 or K59.09 dx blocks
Acute Stomach pain R10.0 vs R10.1 blocks vs general stomach pain per area
Chronic Atrial Fin. dx I48.20
Acute Right heart Failure dx i50.811 vs Chronic Right Heart Failure I50.812
Acute Resp. Failure dx J96 .0 vs Chronic Respiratory Failure dx J96.1

I hope this info helps you. But you can always check the ICD10 manual hardcopy or goggle the computerized coding encoder you are using.
Lady T