The HCC model used for MA patients categorizes ICD-9-CM diagnosis codes into disease groups that are similar both clinically and financially. 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 ?� �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+�� Welcome to Healthcare Coding & Consulting Services (a.k.a. Coding and HCC Guide Sample page. on a sample of accounts. Some codes have RAF value. 7 Hierarchical condition category coding helps communicate patient complexity and paint a picture of the whole patient. 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. 0000012259 00000 n 0000008307 00000 n Map the Chronic Condition to the HCC. Remote position. 0000041031 00000 n 0000044358 00000 n 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. CC: Ms. Jones is a 70 -year-old female who comes in today for her follow up of her diabetes and COPD. 0000004052 00000 n Sepsis as an Infection Following a Procedure. 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. By accounting for difference in patient complexity, quality and cost performance can be more appropriately measured. 0000047866 00000 n *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). 0000057394 00000 n 0000022939 00000 n 0000016066 00000 n HCCS), one of the country's premier providers of remote coding and auditing services. 0000013946 00000 n The AAFP has a long history of supporting health equity and reducing health disparities in patient care. 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 H�\��n�0E�� HCC codes are … 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 0000016312 00000 n 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. • 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. 0000024552 00000 n Some do not. 0000012830 00000 n Only diagnoses that map to an HCC are used in risk adjustment score calculation. Join a nationwide community of residency program leaders at the upcoming Residency Leadership Summit. 218-327-6789 Direct line . Documentation must be accurate and support the diagnosis. 0000044429 00000 n 0000057716 00000 n 0000057315 00000 n Topics offered are focused on your adult patient panel to ultimately improve patient care/outcomes. CMS will factor all three HCCs in when making a payment to the MA plan. Although few can simply sit down and begin HCC coding, the training is very straightforward. 0000034232 00000 n Grand Rapids, MN 55744 . 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 0000000016 00000 n 0000001804 00000 n Get information to help you prepare your practice, counsel your patients and administer the vaccine. 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). The AAFP’s Adult Medicine course gives you the most up-to-date information to best care for your adult patients. Hierarchical condition category (HCC) coding is a risk-adjustment model originally designed to estimate future health care costs for patients. 0000015460 00000 n Contractor HCC Risk Adjustment Coder-Remote, 09/2015 to Current INSIGHT GLOBAL – Atlanta, GA. h���1 0ð4�a\w�C&`�'MF[����! A hierarchy is created so that patients are coded for the most severe manifestation among related … • For unrelated diseases, HCCs accumulate, so patients can have more than one HCC attributed to them. HCC coding is designed to estimate future health care costs for patients. 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 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 Examples ICD-10 HCC1 HCC weight2 Notes Type 2 diabetes (T2D) T2D without complications E11.9 19 0.104 Always has HCC weight. What would you code? 0000016790 00000 n For example, each MRI performed, or unit of anesthesia would be billed at a predetermined rate. 0000056928 00000 n 0000024934 00000 n Providers must thoroughly document all chronic disease processes and manifestations in the patient’s medical record for proper HCC coding. 0000016037 00000 n H�lWɎ���Wԑ. 0000019966 00000 n 0000056849 00000 n Examples of conditions that map to an HCC include: COPD; Diabetes; HIV status; Parkinson’s; Organ transplants; Amputation status; CHF 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. %PDF-1.4 %���� 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. 0000004480 00000 n 0000016211 00000 n CMS requires an encounter each calendar year and diagnosis by an APRN, PA or physician. 0000014406 00000 n 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”. Using algorithms, insurances can use a patient’s RAF score to predict costs. 2019 Optum360, LLC i Contents ... Risk Adjustment Coding and HCC Guide Chapter 1. The quick and easy explanation of what HCC’s are is each HCC is mapped to certain ICD-10-CM codes or code ranges. 0000017098 00000 n HCC Coding … trailer <]/Prev 85177/XRefStm 1600>> startxref 0 %%EOF 1073 0 obj <>stream 1023 51 M.E.A.T. ��� 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 In addition to helping predict health care resource utilization, RAF scores are used to risk adjust quality and cost metrics. *These are sample patients only, using 2017 CMS HCC model values and 2018 ICD-10 codes. Along with demographic factors (such as age and gender), insurance companies use HCC coding to assign patients a risk adjustment factor (RAF) score. HCC Coding Hierarchical Condition Categories and How They Affect Reimbursement. 0000049781 00000 n For example, a patient with few serious health conditions could be expected to have average medical costs for a given time. 0000036833 00000 n Copyright © 2020 American Academy of Family Physicians. 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 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 … The code T84.4 previously referred to as an infection … 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 0000004595 00000 n If you you want a basic, strong understanding of HCC coding and risk adjustment, you're in the right place. It gives them a skill that others do not have and that medical offices demand. HCC(s) that will be dropped are identified in the disease hierarchy column in the table. *These are sample patients only, using 2017 CMS HCC model values and 2018 ICD-10 codes. As always, you’ll learn from expert faculty who are practicing family physicians. 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. 0000040946 00000 n HCC coding, which we introduced (or reintroduced) in our previous blog, What is HCC Coding? She has had no issues or complaints since her last visit to the office. 0000001316 00000 n Register now for single sessions or entire courses. 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 should include language from a physician which establishes a causal link between the disease (DM) and the complication (CKD). There are more than 9,000 ICD-10 codes that map to 79 HCC codes in the risk adjustment payment model. 0000049430 00000 n 0000026401 00000 n Is Your Diagnosis Coding Ready for Risk Adjustment? 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.”) The Coding Advisory Committee comprises of Cigna-HealthSpring varied coding representation. However, a patient with multiple chronic conditions would be expected to have higher health care utilization and costs. 0000047983 00000 n 0000014799 00000 n CFO/Accountant . Each of those diagnoses maps to a separate HCC. HCC training and certification makes a person valuable. 0000003596 00000 n 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. Each HCC is mapped to an ICD-10 code. 0000003083 00000 n Hierarchical condition category relies on ICD-10 coding to assign risk scores to patients. 1023 0 obj <> endobj xref 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. 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. 218-327-5545 Fax Increased severity doesn’t usually increase risk adjustment factor (RAF). This is the power of becoming a home-based HCC … Advanced Life Support in Obstetrics (ALSO®). 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. 0000033780 00000 n This is the beauty of this opportunity. nd 1219 SE 2 Ave . One reason that coders should report chronic conditions (including history and status codes) on outpatient records is the HCC’s—Hierarchical Condition Categories. The most efficient sample size is the smallest one that best reflects an accurate representation of their coding accuracy and risk. All rights Reserved. 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 . 0000001600 00000 n 0000049134 00000 n These providers must recapture ICD-10-CM codes for certain chronic conditions. 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. For example: the physician documents that a male patient suffers from heart disease, stroke, and cancer. 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, … 0000001964 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 Coding from chief complaint: example 1 . 0000011838 00000 n 0000028615 00000 n Members Only. 0000033956 00000 n 0000056808 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, ICD-9-CM code 356.9 (unspecified idiopathic peripheral neuropathy) is one of dozens of neuropathy codes to correlate to HCC 071. See Also HCC Coding, Risk Adjustment, and Physician Income: What You Need to Know – FPM Journal She has a history of DVT and peripheral vascular disease. 0000013410 00000 n Type 2 diabetes with diabetic polyneuropathy. 0000021357 00000 n