HCC Coding Tips: Status Conditions

CMS requires all HCC diagnoses be submitted each and every year the condition is present. Thus, it is of critical importance that patients be seen by a qualified provider and all current HCC diagnoses be evaluated and reported at least once each year. Complete and accurate coding to the highest specificity must be done at a face to face visit, which is the only way CMS will know how sick or complex your patients actually are.

The following are status conditions that must be documented and coded at least once during the calendar year:

  1. Any amputation status
  2. Any artificial opening status, e.g. tracheostomy, gastrostomy, ileostomy, colostomy, cystostomy, ureterostomy, urethrostomy
  3. Any tissue or organ transplant status
  4. Renal dialysis status, and non-compliance with renal dialysis (when present)
  5. Hemiplegia, diplegia, or paraplegia
  6. Morbid obesity; Note: you will need to enter E66.01 AND the specific BMI code: Z68.4X. (For morbid obesity with alveolar hypoventilation use E66.2)