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ICD-10 and HCC Coding for Risk Adjustment

  1. #1
    Urbana, IL
    Default ICD-10 and HCC Coding for Risk Adjustment
    Medical Coding Books
    With all the changes from day to day, I am sure the topic is hush hush for a reason, but I thought I would take a stab at asking. Has anyone found materials supporting the changes to be expected with Hierarchical Condition Categories with regard to ICD-10? I have heard that DRGs have been tasked for investigation in approximately 2015 but I am wondering if anyone has found articles or proposals by CMS on their risk adjustment system for Medicare Advantage plans.

  2. Default
    I haven't seen anything. I wouldn't suppose that there will be much info for a while since the first recalculation using the ICD-10s won't happen until July 2015.
    Sherry Miller, MBA/HCM, CPC, CEMC
    Epic Management, LP

  3. #3
    Lakeland, FL
    Default National Conference
    I just got back from AAPC national conference and this very question was asked. The speaker had come to the same conclusion that nothing has been mentioned. I honestly don't think too much will happen. ICD-10 is about being very specific to the coding there won't be much in unspecific codes. I don't think there will be much of an impact. They just put out this afternoon that the push back for ICD-10 is now 2014. I think in 2014 that when we will know.

  4. #4
    Urbana, IL
    Thank you for your insight, I am on the same page. I plan to do the mapping/cross walking of the current 3000+ I9s as they relate to the I10s in the 70 medical HCCs with the hopes that we will be able to use a mapping tool of sorts to do the bulk of the work. If anyone else has insight or if data is found please feel free to share, and I will do the same.
    Dawn Peterson
    Coding Consultant/Billing and Coding Instructor
    Illinois, USA

  5. #5
    Professional Coders of Central Pennsylvania (PCOCPA), Harrisburg, Pennsylvania
    I attended a Risk Adjustment conference 2 weeks ago and asked the CMS presenter about this. I was told that they are still in process with reviewing; that the mapping/crosswalking will require significant clinical, as well as significant coding, consideration.
    Jennifer (Jenny) M. Oravecz, CPC
    Past Vice President/Education Officer (2012/2011) of Professional Coders of Central Pennsylvania (PCOCPA), Harrisburg, Pennsylvania
    Past President/President-Elect (2009/2008) of Professional Coders of Tidewater, Chesapeake, Virginia

  6. #6
    Charleston, South Carolina
    At the Coordination and Maintenance Meeting, it was said that since the DRGs were recently converted to MS-DRGs (a couple of years ago), that they would most likely wait two years (after implementation of I-10) and review the data before upgrading the MS-DRGs. Remember too, that CMS is two years behind when reviewing data.

    Hope this helps!!
    Last edited by mmorningstarcpc; 04-26-2012 at 06:39 AM.
    Machelle Morningstar, CPC, COC, CEMC, COSC
    AHIMA Approved ICD-10-CM/PCS Trainer

  7. #7
    Default Hcc & icd10
    Great Information - very much appreciated - Thank you

    Claudine Rosson, CPC, CPC-I
    Clinical Quality Analyst, SR
    Lifeprint Health

  8. Default HCC/Risk Adjustment
    I am over the inpatient CDI program at our acute care facility and we are looking to expand into the physician practice. I am looking for any organization who has an outpatient CDI program in place, or a program which focuses on documentation review/HCC capture, risk adjustment. If anyone has a program (success stories or opportunities) they are willing to discuss, please contact me at the email below, I would from someone who as already been through an implementation.

    Reeanna Henderson

    Reeanna Henderson MBA-HM, BSN
    AVP Case Management/CDI
    McLeod Regional

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