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HCC Coding - explain your process

  1. #1
    Exclamation HCC Coding - explain your process
    Medical Coding Books
    Is there anyone out there who is dong HCC coding? Can you explain your process when coding HCC's? Do you review the entire office note, or only look at the assessment/plan? Do you code from the HPI, ROS, or Exam portion?

  2. #2
    what is HCC coding?

  3. #3
    Default HCC Coding
    Hierarchy Condition Category under the medicare risk adjustment program. In this program you are funded by diagnosis codes, not CPT codes. The sicker the patient (the more diagnoses) the more funding you receive. Never paid on CPT code level.

  4. #4
    HCC codes are ICD-9 codes that were given a severity ranking. More specific codes have a higher ranking than unspecified codes. You code as you normally would but just make sure that you are coding with ICD-9 codes as specific as possible and using all the codes that apply to that visit per the documentation. If you use codes with a higher HCC ranking, you get more "credit". For example, if a patient is diabetic and they have other problems associated or caused by the diabetes, use the most specific codes 250.4x or 250.5x, etc instead of 250.0x. Of course, providers need some training also to be most specific in their documentation.
    Pam Tienter, CPC, COC, CPC-P, CCS-P, CPMA, CPC-I, AAPC Fellow
    AHIMA Approved ICD-10-CM/PCS Trainer
    AAPC National ICD-10-CM Trainer

  5. #5
    The focus would be on the assessment, but we still need to review the entire note to insure that the problem diagnosed was truly assessed. If I remember correctly I don't think, for HCC diagnosing purposes, we are able to take a diagnosis listed in the past medical history as one of their chronic diseases as a diagnosis. I believe the provider still needs document the diagnosis in order for us to use it for HCC data. I hope this helps
    Last edited by marleee; 10-03-2008 at 04:11 PM.
    Leona Kiamahoe CPC, CPC-H, CPC-P

  6. #6
    Default HCC Coding
    We have been told under PMH if pt has chronic disease such as CHF,
    COPD, HTN, etc we could code this even though not under the assessment and plan. Since this would impact the physicians decision making regardless of what he/she is seeing the patient for. Do others do this?

  7. #7
    That is also my understanding. Make sure though that the diagnosis coded from PMH is always chronic.

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