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HCC code submission

M

markfla3

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Saluda, NC
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.
 
Last edited:
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.
 
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).
 
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