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HCC Coding - explain your process

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coder5254

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Winter Haven, FL
Is there anyone out there who is dong HCC coding? Can you explain your process when coding HCC's? Do you review the entire office note, or only look at the assessment/plan? Do you code from the HPI, ROS, or Exam portion?:)
 
HCC Coding

Hierarchy Condition Category under the medicare risk adjustment program. In this program you are funded by diagnosis codes, not CPT codes. The sicker the patient (the more diagnoses) the more funding you receive. Never paid on CPT code level.:)
 
HCC codes are ICD-9 codes that were given a severity ranking. More specific codes have a higher ranking than unspecified codes. You code as you normally would but just make sure that you are coding with ICD-9 codes as specific as possible and using all the codes that apply to that visit per the documentation. If you use codes with a higher HCC ranking, you get more "credit". For example, if a patient is diabetic and they have other problems associated or caused by the diabetes, use the most specific codes 250.4x or 250.5x, etc instead of 250.0x. Of course, providers need some training also to be most specific in their documentation.
 
The focus would be on the assessment, but we still need to review the entire note to insure that the problem diagnosed was truly assessed. If I remember correctly I don't think, for HCC diagnosing purposes, we are able to take a diagnosis listed in the past medical history as one of their chronic diseases as a diagnosis. I believe the provider still needs document the diagnosis in order for us to use it for HCC data. I hope this helps
 
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HCC Coding

We have been told under PMH if pt has chronic disease such as CHF,
COPD, HTN, etc we could code this even though not under the assessment and plan. Since this would impact the physicians decision making regardless of what he/she is seeing the patient for. Do others do this?
 
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