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HCC coding - ICD-9 coding

  1. #31
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    Tacoma, WA
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    Medical Coding Books
    Quote Originally Posted by rchacon View Post
    Hey Coders, do any of you know of some resourceful websites, etc...on where I can gather some information regarding the "points" when educating MDs on HCC....I know CMS has great info, but was wanting some other sources..

    Thanks
    What sort of points are you looking for? I do Risk Adjustment Auditing for a small payer and I get a lot of my educational info from Ingenix (now called Optum Insight).
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

  2. #32
    Default how hard is HCC to learn
    how hard is the HCC coding to learn where can I find some really good stuff about it

  3. Default Hcc
    I think we should get trained properly, I just applied for a job that only has HCC coding, and I really want that job, but I don't understand HCC coding and I need a quick review.




    Quote Originally Posted by serhaug View Post
    I disagree with keke74 that HCC coding "As far as the Coding Guidelines that your taught as a Coder pretty much doesn't apply to HCC coding most of the time." That is absolutely not true. The HCC model actually specifically refers to the CDC's ICD-9 coding guidelines as the rules to go by when coding for HCC's. I think more accurate is the fact that most coding eduation is geared for CPT coding and so there are not a lot of coders out there with a good clinical understanding of disease processes. It IS true that CMS requires more than just a doctor stating "COPD" in the assessment when the patient is actually in for an ingrown toenail and there was no assessment of the condition. That scenario will very likely not stand up to a RADV audit because CMS requires that you submit the best medical record to support that diagnosis, so what you are looking for in a medical record to support an HCC for RADV audit purposes is a record where the condition is clearly assessed and addressed. For example, an assessment that says "CHF, stable" is much better than just plain old "CHF".

    Regarding the HCC model, some in this thread have stated that it only includes chronic and the most severe diseases. That is not entirely true, either. Some of the conditions included in the model are status conditions, like s/p BKA or artificial openings (i.e. colostomy, tracheostomy, etc.). Certain fractures and conditions like respiratory failure are part of the model, but may or may not be chronic in nature. Another piece of misinformation I have heard is that there are absolutely no V or E-codes in the model. Again, not true.

    I think all of this is just proof that we need to get some really good HCC coding training out there. This branch of coding is only going to grow with the newly-passed health care reform legislation....

  4. Default
    Depending on the company you work for doing HCC coding you probably will be coding wrong if you use codes other than the ones that are HCC. When coding HCC you only want to use dx codes that map to a HCC or RxHCC. Some companies have it already implemented or you have to use an encoder type of HCC lookup to tell you.

    HCC coding is more difficult for old timer coders, you feel like your under coding and you have to find/investigate support from labs, medications, a/p throughout that one and only DOS for the dx(s) during that visit. You have to make sure the Name, DOS, Signature/Date is correct or you may not even have to code it if some of that above info is not even on the document.

    You may have to get with others but, you'll just have to make up your own list.

    Email me if you have any questions..I'm currently on two projects doing HCC, one just coding the other as an auditor.

    Thanks,

    Katie Williams, CPC, HIT

  5. Default
    Demetriary, I am not in Phoenix but if this is a remote position does it matter? I have 10+ years experience in CPT/ICD9 coding and understand what HCC coding is. Would love to give it a try. Can I apply?

    Kathy KIng CPC-H (previously CPC)

  6. Default
    Hiya Pam,
    Update on your site posting cuz I followed your breadcrumb trail and didn't find the full HHC codes. I did locate them in a .pdf file at this link via CMS. https://www.cms.gov/site-search/sear...Health%20Codes

    >>>For Tammy:
    After using the formula illustrated in the .pdf the following can be followed:
    The full CATEGORY list is found on pages 241-258 (Appendix A) Table A-1; Descriptive Statistics on Prospective Diagnoses on pages 259-280 Table A-2; Table A-3 on pages 281-293 lists Medicare's Concurrent Sample Statistics by all Diagnosis Diagnostic Groups (DXG)

    Of course the http://www.hccblog.com/category/hcc-codes/ provides a list of the codes too; albeit not at intense (detailed) as the CMS .pdf file. Along with the last update: http://www.hccblog.com/wp-content/up...dvance2012.pdf thanks to Matt Yuill MD, CPC for providing the data.

  7. Default
    Quote Originally Posted by lisettetrefle@yahoo.com View Post
    Hiya Pam,
    Update on your site posting cuz I followed your breadcrumb trail and didn't find the full HHC codes. I did locate them in a .pdf file at this link via CMS. https://www.cms.gov/site-search/sear...Health%20Codes

    >>>For Tammy:
    After using the formula illustrated in the .pdf the following can be followed:
    The full CATEGORY list is found on pages 241-258 (Appendix A) Table A-1; Descriptive Statistics on Prospective Diagnoses on pages 259-280 Table A-2; Table A-3 on pages 281-293 lists Medicare's Concurrent Sample Statistics by all Diagnosis Diagnostic Groups (DXG)

    Of course the http://www.hccblog.com/category/hcc-codes/ provides a list of the codes too; albeit not at intense (detailed) as the CMS .pdf file. Along with the last update: http://www.hccblog.com/wp-content/up...dvance2012.pdf thanks to Matt Yuill MD, CPC for providing the data.

    Thank you!!!!

  8. #38
    Default
    Quote Originally Posted by deja53 View Post
    I need feedback on HCC coding. Is it easier than straight ICD-9 coding? Is HCC coding more time consuming than straight ICD-9 coding? Is there somewhere I could get a list of the HCC codes?


    Thanks,
    Tammy
    yes, go to cms gov and ask for medicare risk adjustment payment system
    Vicky Llanes
    CPC, CPC-H, CPMA
    AS

  9. Default
    Quote Originally Posted by sammie06 View Post
    Hi
    To anyone who does HCC auditing:
    What is the criteria you look for when billing for COPD? Do you require additional test or do you just go with the physicians documentation?

    Also what requirement do you require for Hypoxemia? Do you require additional test or do you just go with the physicians documentation?

    Thanks for your help.
    There are 2 main types of COPD-496 is a broad term: 1. emphysema- 492.8 is slow progression of lung tissue. You loose the ability to expand and contract 2. Chronic Bronchitis- 491.9 - long-term chronic inflammation.
    COPD also includes chronic asthmatic bronchitis or chronic bronchitis with asthma.
    There is no cure for COPD.
    COPD and associated conditiions are 490-496. Documentation shoould fully describe paticular condition. COPD can be coded from Past medical hx as well as current exacerbation of related conditions. (AHA Coding clinic, 2nd quarter 1990, pg 20;3rd quarter 1997 pg 9; icd-9-cm clinic guidelines sec 1.c.8.b.1, sec 1.c.8.a.4)

    Hypoxia / hypoxemia 799.02 deficiency of oxygen in tissues and blood, There are many causes.hypoxia is not inherent with COPD. When both are documented together, code both.
    Hypoxia/hypoxemia cannot be coded from past medical hx. (AHA coding clinic, 3rd quarter 2009 pg 20 and 2nd quarter 2006 pg 25)

    No tests needed- can't take HCC from labs, xrays) must have e/m progress encounter documentation. SGC

  10. Default COPD, hypoxia, hypoxemia
    COPD 496 is a broad term which includes chronic asthmatic bronchitis and chronic bronchitis with asthma. There are 2 main types: 1. emphysema 492.8 a slow progression and 2. chronic bronchitis 491.9 long term chronic inflammation. No cure for COPD.
    Documentation is to be taken from an E/M encounter progress note or consultation. Labs and xrays are not sufficient.
    COPD can be coded from past medical hx. Hypoxia/hypoxemia cannot come from PMH.
    Documentation should fully describe the particular condition.
    ICD-9-cm Coding guidelines sec 1.C.8.b.1; Sec 1.C.8.a.4 and AHA Coding clinics; 3rd quarter 1997, pg 9; 2nd quarter 1990, pg 20;
    Hypoxia- 799.02 deficiency of oxygen to tissue and blood. hypoxia has many causes. It is not inherent with COPD- code both conditions.(3rd quarter 2009, pg 20) 2nd quartewr 2006, pg 24; hypoxemia is inherent to respiratory failure and is not coded separately.2nd quarter 2006, pg 25. HCC coding is more specific. SGC
    Last edited by scurtis; 11-13-2012 at 10:52 PM. Reason: add info

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