Wiki HCC with New E&M guidelines

[smihm]

Morning
Under the NEW E&M guidelines some items conflict with HCC coding- since the level is determined by MDM
Problems was defined as a condition that is evaluated and treated- it specifically states just notating another provider is treating does not count as addressed. This contradicts with some conditions that risk adjust
For example; a pt with DM with Ophthalmology complications- the PCP is never going to treat. Therefore; when the Providers uses an HCC in A&P documents Stable - pt following current treatment has follow up with DR XYZ - this will not count toward the level of service- I am assuming it will still be validated/Captured on the HCC side ?

Thanks

 

[thomas7331]

Yes, I don't see any conflict created by the new guidelines that wasn't there before under the old guidelines - you can report a diagnosis on the claim for HCC purposes, if required and so directed by your organization, since the provider has documented it as present at the encounter but not count it toward the MDM for purposes of assigning the E&M level if the provider did not evaluate or treat it at that encounter. I'd recommend putting this question to your employer for clarification so you can be sure you coding is aligned with their policies on this.