Along with demographic factors (such as age and gender), insurance companies use HCC coding to assign patients a risk adjustment factor (RAF) score. The code T84.4 previously referred to as an infection … Example of HCC Scoring Poor Coding • 72 yo institutionalized male:1.323 • Pneumonia coded as J18.9: 0 • Total HCC score: 1.323 • Total Cost: $12,152.14 Better Coding • 72 yo institutionalized male: 1.323 • Aspiration Pneumonia J69.0: .067 • Tobacco Use F17.210: 0 • Total HCC score: 1.39 • Total Cost: $12,767.55 Complete Coding Some examples of disease registries that correlate with HCC conditions include: Arthritis Atrial fibrillation Congestive heart failure (CHF) Chronic kidney disease (CKD) Chronic obstructive pulmonary disease (COPD) Depression Morbid obesity Each HCC is mapped to an ICD-10 code. *These are sample patients only, using 2017 CMS HCC model values and 2018 ICD-10 codes. Chief Resident Leadership Development Program, Family Medicine Board Review Express Livestream, Residency Leadership Summit (formerly PDW RPS) Virtual Conference, PerformanceNavigator® Workshop: Cardiometabolic Conditions Livestream, Physician Health and Well-being Conference Livestream, AAFP Leadership Virtual Conference (ACLF and NCCL), Children's Health Insurance Program (CHIP), Donate to Support FamMedPAC (AAFP Members Only), FamMedPAC Board of Directors (AAFP Members Only), News From 2019 Congress of Delegates & FMX, News From 2018 Congress of Delegates & FMX, HCC Coding, Risk Adjustment, and Physician Income: What You Need to Know. 0000028615 00000 n 0000001964 00000 n Is Your Diagnosis Coding Ready for Risk Adjustment? 0000024552 00000 n H�\��n�0E�� In addition to helping predict health care resource utilization, RAF scores are used to risk adjust quality and cost metrics. 0000011838 00000 n The AAFP has a long history of supporting health equity and reducing health disparities in patient care. Remote position. See Also HCC Coding, Risk Adjustment, and Physician Income: What You Need to Know – FPM Journal Type 2 diabetes with diabetic polyneuropathy. HCC coding is designed to estimate future health care costs for patients. 0000024934 00000 n 0000022939 00000 n Map the Chronic Condition to the HCC. 2019 Optum360, LLC i Contents ... Risk Adjustment Coding and HCC Guide Chapter 1. Only diagnoses that map to an HCC are used in risk adjustment score calculation. 0000001804 00000 n 0000040946 00000 n HCC Coding Audits Medicare Advantage was created in 1997, and in 2007 the risk adjustment phase in was completed for the participating Medicare Managed Care Organizations (“MCO’s.”) The risk adjusted reimbursement model is based on chronic and cumulative conditions called “hierarchial condition categories (“HCC’s.”) A hierarchy is created so that patients are coded for the most severe manifestation among related … Each of those diagnoses maps to a separate HCC. 0000014406 00000 n This is the power of becoming a home-based HCC … M.E.A.T. H�lWɎ���Wԑ. 0000001600 00000 n 0000019966 00000 n *These are sample patients only, using 2017 CMS HCC model values and 2018 ICD-10 codes. 0000013410 00000 n 0000057394 00000 n Join a nationwide community of residency program leaders at the upcoming Residency Leadership Summit. 0000012259 00000 n 0000016037 00000 n HCC Medical Coder 07/2015 to 04/2017 RCM Health Information Management Gardena, CA Job duties included performing chart reviews to provide and/or verify accurate Medicare HCC and Affordable Care Act (ACA) HCC diagnostic coding based on services rendered in an outpatient and inpatient setting. For example, a patient with few serious health conditions could be expected to have average medical costs for a given time. HCC Coding Hierarchical Condition Categories and How They Affect Reimbursement. Validated HCC Coding requires documenting: - Diagnosis - Status of Condition - Plan of Action For example: “CHF, stable, continue current meds” (document current medication member is taking for condition) “Diabetic CKD III controlled, continue current meds, follow up appt, labs 6 months”. 0000004480 00000 n Documentation must be accurate and support the diagnosis. Grand Rapids, MN 55744 . 0000014799 00000 n 0000016066 00000 n Risk Adjustment Basics 2019 Optum360, LLC 11 MS-DRG Compared to HCC There is an increasing need for hospital inpatient coders to learn the outpatient coding rules Hierarchical condition category relies on ICD-10 coding to assign risk scores to patients. Register now for single sessions or entire courses. As always, you’ll learn from expert faculty who are practicing family physicians. HCC coding, which we introduced (or reintroduced) in our previous blog, What is HCC Coding? GUIDELINES FOR CODING COMPLICATIONS - Records submitted to validate HCCs that encompass additional manifestations or complications related to the disease - Example: E11.22: Type 2 Diabetes with diabetic chronic kidney disease. In the traditional fee-for-service reimbursement model that healthcare organizations have been using for decades, providers are paid for the volume and types of services performed. Perform chart reviews which include coding, abstracting, house calls, analyze physician base, ER, inpatient and outpatient medical records ensuring productivity/quality using accurate ICD-9/ICD-10-CM coding guidelines and HCC/RxHCC/PACE HCC value codes, Clinical chart investigator. 0000049430 00000 n The Coding Advisory Committee comprises of Cigna-HealthSpring varied coding representation. 7 0000001316 00000 n 0000012830 00000 n Members Only. 0000044429 00000 n HCC training and certification makes a person valuable. 0000017098 00000 n Advanced Life Support in Obstetrics (ALSO®). Here are examples of unspecified codes which do suffice as HCC appropriate: B18.9 – chronic viral hepatitis, unspecified F20.9 – schizophrenia, unspecified F33.40 – major depressive disorder, recurrent, in remission, unspecified G82.20 – paraplegia, unspecified I20.9 – angina pectoris, unspecified One reason that coders should report chronic conditions (including history and status codes) on outpatient records is the HCC’s—Hierarchical Condition Categories. Welcome to Healthcare Coding & Consulting Services (a.k.a. Get information to help you prepare your practice, counsel your patients and administer the vaccine. 1023 51 This entity provides the foundation for the establishment of acceptable CMS RADV guidance for HCC diagnosis coding, as well as ICD-10-CM coding guidelines that are applied to all Cigna-HealthSpring coding initiatives. These providers must recapture ICD-10-CM codes for certain chronic conditions. This is the beauty of this opportunity. Examples of conditions that map to an HCC include: COPD; Diabetes; HIV status; Parkinson’s; Organ transplants; Amputation status; CHF This is supported by Coding Clinic, 4th Quarter, 2000, which states in part: "When coding for physician services, whether provided in the hospital inpatient setting or in the physician office, coders should be guided by the Diagnostic Coding and Reporting Guidelines for Outpatient Services (Hospital- Based and Physician Office). HCCS), one of the country's premier providers of remote coding and auditing services. All rights Reserved. 0000021357 00000 n h���1 0ð4�a\w�C&`�'MF[����! Travel Medicine Livestream | March 19-20 | Become better informed about guidance and recognize travel-related disease and risks as you see your patients before or after their travels. nd 1219 SE 2 Ave . It gives them a skill that others do not have and that medical offices demand. 0000047866 00000 n There are more than 9,000 ICD-10 codes that map to 79 HCC codes in the risk adjustment payment model. The Centers for Medicare & Medicaid Services (CMS) HCC model was initiated in 2004, but is becoming increasingly prevalent as the environment shifts to value-based payment models. By accounting for difference in patient complexity, quality and cost performance can be more appropriately measured. 0000026401 00000 n 0000003083 00000 n Increased severity doesn’t usually increase risk adjustment factor (RAF). Coding and HCC Guide Sample page. 0000015460 00000 n Topics offered are focused on your adult patient panel to ultimately improve patient care/outcomes. HCC Category Descriptor / Example Diagnoses 2019 HCC Value ICD-10 Code 169 Vertebral Fractures without Spinal Cord Injury 0.476 Collapsed vertebra, not elsewhere classified, site unspec., initial encounter for fracture M48.50XA Age-related osteoporosis with current pathological fracture, vertebra(e), initial encounter for fracture Some codes have RAF value. ��� endstream endobj 1024 0 obj <>/Metadata 15 0 R/Pages 14 0 R/StructTreeRoot 17 0 R/Type/Catalog/ViewerPreferences<>>> endobj 1025 0 obj >/PageWidthList<0 612.0>>>>>>/Resources<>/Font<>/ProcSet[/PDF/Text]/Properties<>/XObject<>>>/Rotate 0/StructParents 0/TrimBox[0.0 0.0 612.0 792.0]/Type/Page>> endobj 1026 0 obj <>stream The HCC model used for MA patients categorizes ICD-9-CM diagnosis codes into disease groups that are similar both clinically and financially. HCC codes are … HCC Coding … Some do not. She has a history of DVT and peripheral vascular disease. 0000004052 00000 n • For unrelated diseases, HCCs accumulate, so patients can have more than one HCC attributed to them. 0000013946 00000 n HCC Category ICD-10-CM Code Description RAF Value Validated by Current Documentation Improved Documentation HCC 58 F33.41 Major depressive disorder, recurrent, in partial remission 0.395 No Yes HCC 12 C50.919 Malignant neoplasm of unspecified site of unspecified female breast 0.146 Yes Yes HCC 22 E66.2 Obesity hypoventilation syndrome (OHS) 0.273 No Yes Demographics 54-year-old, … trailer <]/Prev 85177/XRefStm 1600>> startxref 0 %%EOF 1073 0 obj <>stream 0000056808 00000 n j���Z���Y�#s��Bg���Y�,\+�Z �J�VB��p_��/������������O����x����n{I)������I���|M�0�\�_�%� (�J endstream endobj 1027 0 obj <> endobj 1028 0 obj <> endobj 1029 0 obj <> endobj 1030 0 obj <>stream For example: the physician documents that a male patient suffers from heart disease, stroke, and cancer. Examples ICD-10 HCC1 HCC weight2 Notes Type 2 diabetes (T2D) T2D without complications E11.9 19 0.104 Always has HCC weight. 0000057716 00000 n 0000004595 00000 n Providers must thoroughly document all chronic disease processes and manifestations in the patient’s medical record for proper HCC coding. The AAFP’s Adult Medicine course gives you the most up-to-date information to best care for your adult patients. ?� �ǭ�"�I+塻�M�&)Rc�C����V]i���s��r��lc?��OڝN���.�y��V�^�},����v�����S3e.�]ϓ���0umʿ��yJWs�� {�-�ߩ��ǣ�y_�nM���㧞4NfaV+��!�6�椦���]��O׻\�먦����i�N�c�jj�Q�z����_�*4v��w�e�C�Ѥ����b�O������xM^�7� ���Ֆ99vI^�+r�df�E�e�E�e�E�c�C��dvdf�C���9��^���ס�{"?���ϙ=�=�=�z�����׳�G/���SX+�� 0000033780 00000 n Although few can simply sit down and begin HCC coding, the training is very straightforward. Sepsis as an Infection Following a Procedure. 0000033956 00000 n CC: Ms. Jones is a 70 -year-old female who comes in today for her follow up of her diabetes and COPD. Coding for Asthma- Excludes 2 This category also excludes (Excludes 2): •Asthma with chronic obstructive pulmonary disease (J44.9)(HCC) •Chronic asthmatic (obstructive) bronchitis (J44.9) (HCC) •Chronic obstructive asthma (J44.9) (HCC) These conditions can … 0000056928 00000 n Using algorithms, insurances can use a patient’s RAF score to predict costs. 0000034232 00000 n h�b```b``������4�A�X��,[�g30�k`�X8��|�`���2�7���2�@��@����AH@�dx�*��$>h[�n=�!���7��8�400/bn,��qH̀�3}��#�g�]��/��-B�2�v(&:���̐"� �2��n3#�1��f`��G��� ��; u4� endstream endobj 1072 0 obj <>/Filter/FlateDecode/Index[17 1006]/Length 51/Size 1023/Type/XRef/W[1 1 1]>>stream If you you want a basic, strong understanding of HCC coding and risk adjustment, you're in the right place. %PDF-1.4 %���� Hierarchical condition category (HCC) coding is a risk-adjustment model originally designed to estimate future health care costs for patients. CFO/Accountant . Coding from chief complaint: example 1 . HCC(s) that will be dropped are identified in the disease hierarchy column in the table. She has had no issues or complaints since her last visit to the office. 0000016211 00000 n 0000003596 00000 n 0000049134 00000 n The most efficient sample size is the smallest one that best reflects an accurate representation of their coding accuracy and risk. Copyright © 2020 American Academy of Family Physicians. on a sample of accounts. Today, Hierarchical Condition Categories (HCC) is "suddenly" on every coding leader's and commercial payer's radar, even though HCC has actually been around for nearly two decades. Contractor HCC Risk Adjustment Coder-Remote, 09/2015 to Current INSIGHT GLOBAL – Atlanta, GA. Sample of Coefficients for HCCs Based on Community and Institutional Beneficiaries •Risk Adjustment is an additive model used to predict future health costs –Coefficients are added across HCCs What would you code? 0000008307 00000 n We pride ourselves in proving that we are more than the typical vendor and we hope to have an opportunity to show you how we at HCCS achieve this goal. 0000016790 00000 n However, a patient with multiple chronic conditions would be expected to have higher health care utilization and costs. 0000047983 00000 n For example, each MRI performed, or unit of anesthesia would be billed at a predetermined rate. 0000000016 00000 n 0000057315 00000 n The quick and easy explanation of what HCC’s are is each HCC is mapped to certain ICD-10-CM codes or code ranges. *Example #1: A 68-year-old patient with type 2 diabetes with no complications, hypertension, and a body mass index (BMI) of 37.2, *Example #2: A 68-year old patient with type 2 diabetes with diabetic polyneuropathy, hypertension, morbid obesity with a BMI of 37.2, and status post-left below knee amputation (BKA). 0000036833 00000 n 218-327-6789 Direct line . is at the heart of HCC coding and clinical documentation and is defined as follows: Monitor-signs, symptoms, disease progression, disease regression Evaluate-test results, medication effectiveness, response to treatment 0000044358 00000 n If you understand the importance of Hierarchical Condition Category (HCC) codes, but don’t know where to start with this complicated but critical element of coding in a value based world, there is a light at the end of the tunnel. Hierarchical Condition Category coding — or HCC coding — was implemented by the Centers for Medicare and Medicaid Services (CMS) in 2004 to help estimate the healthcare costs of Medicare enrollees in the coming year. CMS will factor all three HCCs in when making a payment to the MA plan. Hierarchical condition category coding helps communicate patient complexity and paint a picture of the whole patient. 218-327-5545 Fax For example: If HCC 18 (diabetes with chronic complication) is reported, then HCC 19 (diabetes without complication) will be dropped if both are reported in the same calendar year Only HCC 18 will be used in calculating the Medicare Advantage Accurate risk adjustment coding will continue to increase in importance; if you’d like further information or to request a coding education session for your facility, please contact me: Sarah Duell, BSBM, CPC, CRC Itasca Medical Care . CMS requires an encounter each calendar year and diagnosis by an APRN, PA or physician. 1023 0 obj <> endobj xref • Accurately reflect patient acuity (HCC scores) Benefits of the Annual Wellness Visit • Health Risk Assessment to review problem lists • Review family & medical histories Components of the Annual Wellness Visit • A maximum of 12 conditions can be coded per claim • 4 in the header. 0000056849 00000 n 0000041031 00000 n should include language from a physician which establishes a causal link between the disease (DM) and the complication (CKD). 0000016312 00000 n For example, ICD-9-CM code 356.9 (unspecified idiopathic peripheral neuropathy) is one of dozens of neuropathy codes to correlate to HCC 071. Stay Dialed In on the Fight for Family Medicine, AAFP Digital Assistant Pilot Opportunities Available, Access HCC Crash Course: Absorbing the Impact for all you need to know about HCC coding, including practical application in your practice. 0000049781 00000 n
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