HCC Coding

coder1

Guru
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Good Afternoon Coding World,

I am new to auditing for risk adjustment coding. Currently, Coders at my job are allowed to code:


HCC 22 ,if BMI is greater than 40, but provider has not documented obesity or pulled the info from constitutional portion of the exam.

HCC 18, if Accu-check was done, but provider has not documented diabetes.


Could you please provide me with information that either support or don't support this. I know that there is a year to address conditions but i'm very confused as to how this could be ok.

Thanks in advance.
 

Leily911

Networker
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HCC 22 ,if BMI is greater than 40, but provider has not documented obesity or pulled the info from constitutional portion of the exam.

HCC 18, if Accu-check was done, but provider has not documented diabetes.


It is my understanding that unless the provider has specifically mentioned the patient to be obese you cannot code the BMI codes even if it has an HCC value. If you do, you are diagnosing the patient with obesity and you are not a physician. You can ask the provider for clarification.

If the provider has not documented diabetes, look for previous DOS(s) to see if diabetes has ever been mentioned within that year. You can also look at the medication list to see if any of them are diabetes related. If so, contact the physician and discuss the issue and if the patient did indeed have Diabetes and it was not documented properly, the physician needs to make an addendum to the note for that DOS with the additional diagnosis.

hope this helps
 
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