risk adjustment coding

sdunaway1

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Hayden, ID
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Can you please help me understand this, I work for a neurosurgeon's office and we were recently given a lower fee schedule due to having 26 % healthier pts compared to other neurosurgeons in our area( Idaho). We have since appealed and have received an exception due to not coding the comorbidities accurately. I am putting together an education session for the providers in our office and am now understanding that not all comorbidities give us credit for the risk adjustment score per patient. Can you please direct me to the correct appllicable HCC code list so we are coding correctly and getting the credit that we deserve for seeing such an unhealthy population?

We have received and found in research such contradicting information - Can you please help??

Thank you ,

Stephanie
 
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I am an HCC coder for a payer. A lot of the "chronic conditions" are on the HCC list, we tell our providers to DOCUMENT and code any chronic condition the member has. The rule is to "code all documented conditions that co-exist at the time of the encounter/visit and require or affect patient care, treatment, or management. Do not code conditions that were previously treated and no longer exist". The key is that it must also be documented in the date of service or it can not be coded.
 
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