I understand that the long-term insulin code (Z79.4) should be used when appropriate. But, I am being asked, if the patient has DM2 with neuropathy which maps to an HCC of 18, why bother with the insulin code because it maps to a 19 and will be removed due to the hierarchy. Does insulin add the .106 to the RAF or is it truly removed?
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Wiki Long-term insulin use
- Thread starter cwmiusa
- Start date
Pathos
True Blue
HCC 19 is not included in the RAF calculations, if you are already reporting HCC 18. I don't have the RA Trump list handy right now, but there is an extensive list by CMS which shows what codes are "trumped" over other codes, like in this situation.
If you do want to submit Z79.4 along with E11.4x, then you should be ok. Just don't expect to get that extra RAF score associated with Z79.4.
If you do want to submit Z79.4 along with E11.4x, then you should be ok. Just don't expect to get that extra RAF score associated with Z79.4.