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HCC Coding from Documentation ?

  1. #1
    Question HCC Coding from Documentation ?
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    I just started working for a company and the coders are picking up dx's from the History and medication list. For example: CHF is listed in the PMH and Lasix is in the Medications. The Dr did not mention anything about how he is treating the disease.
    They are also filling in the BMI going by the weight and height Dr noted and coding obesity and adding the BMI code. I dont agree with this. This is an electronic record and I dont think we should be adding anything to it. Now what if the doctor documented in the PMH "CHF pt on Lasix" Is this exceptable?
    Please advise...
    Thank you,
    Velma CPC

  2. #2
    Kansas City, MO
    Velma, you have a valid question.

    Fortunatley and unfortunately this is what happens when reimbursement comes from diagnosis codes (HCC/RIsk adjustment).
    I think there is a fine line here. ICD guidelines state step one should be to identify the REASON FOR THE VISIT. If patient is being seen for conjunctivitis, is it then approriate to code the CHF in their problem list? See below.

    Refer to Section IV in the ICD-9-CM Coding Guidelines..

    J. "chronic diseases...may be many times as the patient recieves treatment for the condition"

    K. "Code all documented conditions that co-exist at the time of the encounter/visit and require of affect...treatment or management"

    My thought is there are times when it is, and is not appropriate.

    Does the fact that I am morbidly obese have any bearing on the visit for an eye infection? Not really.
    Does the fact that I have diabetes, but am there for a joint injection for hip pain matter? Probably. A steroid injection can significantly raise blood sugar.I am not being treated for the DM, but it may be considered before giving the injection.

    I think add'l reimbursement based on how sick a patient is can be a good thing. Care of these patients is often more expensive. However...these HCC dx codes are not valid at every visit, and shouldn't always need to be used. A coders mind should NEVER be set on looking for particular codes to meet guidleines for any HCC Risk coding guideline.
    CPT and Dx codes should describe what was done and why.

    if coding these HCC conditions is that important, physicians should be documenting it, then there would be no question..."pt here for hip injection, but has DM, we discussed risks of the steroid..." "pt with uncontrolled dm and HTN here for severe cough....due to co-existing conditions, advised on certain OTC cough meds to avoid...". Not only does this provide clear documentation, but that also affects your level of risk, and can help boost your MDM.

    Ask a physician..."does treating a patient for _________ change if they are healthy vs. if they have____________" if they say yes, suggest they document that and let them know it will support their documentation/MDM/level of risk.

    Hope this helps.

  3. #3
    Default Linda
    Thank you Linda, your answers helped a lot.

  4. #4
    we know we are not supposed to code any conditions listed under PMH, but we also understand that in reality, doctors write their notes all over the places for example you sometimes find Dx written (added) by the margin of the page; just everywhere and anywhere you can and cannot imagine.
    the way i do it is: any Dx with evidence of ongoing treatment even if it is listed under history, i will code it. But i believe the proper way is to suggest the doctor to put the diagnosis in the "correct section" as an addendum or on the next office visit.
    one thing i think it is in a gray area that the 95 and 97 CMS E&M Guidelines stated that "diagnosis can be implied". Implication can mean a lot. if doctor documentated Diabetic with Neuro manifestation 250.60, does that imply patient also has Diabetic neuropathy 357.2 so we can code for both?

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