Chronic 8?

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Hello,

I am an hcc coding auditor and for the most part if a diagnosis does not have meat or tamper we do not code it. Some clients refer to a "Chronic 8" conditions list which are considered to be conditions that never go away that do not require meat in order to capture as current. these conditions are afib, dm, copd, ms, hemiplegia, RA, parkinsons, pulmonary htn. We like to follow CMS guidelines and be conservative. I cannot find any guidence on where this "Chronic 8" came from and if it's supported by CMS, Coding Clinic, etc? Does anyone know where I can find out where this comes from?
 
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I highly suggest you visit this link: https://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/Risk-Adjustors.html


This link has information regarding the most common Risk Adjustment models, HCC and RxHCC. Additionally, there are sections for "Regulations & Guidance", "Research, Statistics, Data & Systems", and the like. These can shed light on some of the information you're looking for.


The "chronic conditions" list varies, depending upon the company you work for, and the client's that your company audits for - whether a commercial health plan, or providers. Location is astronomically important. There are new/different guidelines for every geographical region. For example, treatment costs are going to be much higher in a large city than in a rural community. Auditing for risk adjustment purposes is just that- you want to collect, analyze, and extract (audit) conditions that are risky (costly) to treat. Basically the goal is to estimate treatment costs.


The "chronics" are the ones that Medicare determines to be high-risk/very expensive to treat. Some companies/clients/health plans/and even different risk adjustment models have their own list of chronics.


This link https://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/Risk-Adjustors-Items/RiskOtherModel-Related.html offers a ZIP file for an Excel table of chronic conditions - over 1,700 of them.


For the organization I work for, we have 14 "chronics."


To sum up all of the unnecessary jargon I've provided above, "it depends." And the conditions are not static, conditions are being added/removed/modified constantly. It's an ever-evolving orb of overwhelming information about complex diagnoses which Medicare finds the most financially annoying.


Check with your company, the "higher-ups". Especially the documentation specialists and perhaps even client relations or possibly a "sales" or "retention" departments, they'll clarify quite a bit for you. Also, you can check with your clients (health plans, practices, etc.) about which specific chronic conditions/information they're most concerned with.


I hope this helps!!


Happy Auditing!
Sara Clark, CPC, CCS

Quick update: here is the "home" link, the one I gave you was after I clicked on "Risk Adjustors Items"! Sorry! https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Chronic-Conditions/
 
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Thanks Sara!

Hello,

I am an hcc coding auditor and for the most part if a diagnosis does not have meat or tamper we do not code it. Some clients refer to a "Chronic 8" conditions list which are considered to be conditions that never go away that do not require meat in order to capture as current. these conditions are afib, dm, copd, ms, hemiplegia, RA, parkinsons, pulmonary htn. We like to follow CMS guidelines and be conservative. I cannot find any guidence on where this "Chronic 8" came from and if it's supported by CMS, Coding Clinic, etc? Does anyone know where I can find out where this comes from?
 
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