Wiki Coding HCCs from an ECHO report

[emcee101]

I work for a large insurance company, and we are having a problem with one of our vendors coding HCCs from ECHO reports. Since there are not face to face provider visits, we all feel that there i sno way that they qualify for rish adjustment under CMS guidelines. Can anyone provide concrete proof of this from CMS or from another health plan perhaps? I would love something to give to them that can show, without question, that this does not meet RA guidelines since they have been fighting us about if for quite some time. Thanks for any help.

 

[RChicketti]

? Ensure the accuracy and integrity of risk adjustment data submitted to CMS. All diagnosis codes submitted must be documented in the medical record and must be documented as a result of a face-to-face visit. The diagnosis must be coded according to International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) Guidelines for Coding and Reporting.

http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/mc86c07.pdf

Hope this helps!

 

[emcee101]

We all know that it is not a face-to-face encounter, but the vendor is arguing that an echo (or a path report for that matter) constitutes a face-to-face encounter. I am looking for documentation specific to diagnostic studies not being a face-to-face encounter. Thanks for the info you sent though.