Wiki HCC code submission

[markfla3]

Hello folks,

Can anyone confirm that it's CMS acceptable to submit codes 518.83:Chronic respiratory failure or 518.84:Acute and chronic respiratory failure, from the PCP office setting? Or are these 2 codes only permitted for the hospital setting.

Thank you for any input.

 

[FractalMind]

Hello Markfla,

You would only code/submit what is documented. If the provider documented "Acute on chronic respiratory failure" you only need to code 518.84 since ICD-9 coding guidelines state the highest level of specificity should be coded from a single note.
However, if you have two notes from different providers and both codes are documented separately and supported, then you can submit both codes for HCC coding purposes.

 

[andie.zurbrick]

CRF can be coded from a PCP setting. This is a condition that is going to require follow up after hospital discharge as well as continued treatment because it is a chronic condition.

Acute on Chronic would be more likely to be in an acute setting but could be in a PCP's office under certain circumstances (awaiting transfer to ER for example).