Risk adjustment coding - hcc code documentation

sdunaway1

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We are a specialist office and have been researching how much documentation needs to be given within the patient' s note to support the comorbidiitie dx codes that we are adding for risk adjustment coding . We have been told it is ok to put only the dx codes within the dx area of the note but have also been told that we need to put in further documentation stating that the patient has XXXX that is being managed by an outside physician and the condition may effect the outcome of care.

If there is any concrete documentation out there that anyone has to show what the true answer is - will you please share?

Thank you ,

Stephanie
 

angela87165

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Documentation for HCC codes

The company I work for does HCC coding for payers. It follows the same documentation rules as regular coding. As long as the documentation states the patient has the condition in the assessment/ plan, not in PMH or a history of the condition, you should be fine. The new guidelines state that the physician’s statement of diagnosis is enough. But it does help to add in that condition is treated elsewhere or have a medication linked to it in the medication list. For instance, in the medication list it says: Metformin for diabetes. But some payers still are requiring us to use TAMPER for conditions in the assessment/ plan. I hope I have helped!
 
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