OCM Coding Question

ndanh01

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Our company does OCM coding, it's an HCC type model for Oncology.
We haven't started yet but we are looking at a program that will allow us to catch missed codes.

This program has a list of missed HCC codes for a patient that are from other databases (CMS) and including ours. What we are potentially being asked to do is to use the software and locate pt's with missing HCC codes (missing, meaning we didn't submit it recently).

Then audit our charts for the patients to see if the missing HCC's were addressed. If, those missing HCC's were not addressed we would print a spreadsheet of those code and give to the providers to notify them of all the HCC codes that were not addressed and leave it up to the providers to address them with the patient in their future visits.

Is it appropriate as coders to query the provider on possible missing HCC codes obtained from claims data outside of our practice. If not, would anyone have any suggestions on how your company captures missing HCC codes.
 

nikkitaylor

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Are you referring to outside notes that may not include HCC codes?

Nikki Taylor, MSHCI, COC, CPC, CPMA, CRC
Sr. Development Editor, AAPC
 

ndanh01

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Are you referring to outside notes that may not include HCC codes?

Nikki Taylor, MSHCI, COC, CPC, CPMA, CRC
Sr. Development Editor, AAPC
The program we are looking into has access to the CMS database for all HCC codes that have been billed from all of the other providers the patient has seen including us. For the outside providers we will not see their chart notes we only know that the pt's HCC qualified condition exist because we see the dx's listed in the CMS database. Our providers may or may not be aware of the condition that is HCC qualified.
 
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