HCC Coding for Providers: Coexisting Conditions

Submitted by Barbara Fenton, MD, FACP, Medical Director of Augusta Care Partners

This month our focus is coexisting chronic conditions. You may not be aware of it, but each year – come January 1^st – your patient undergoes the “Miracle Cure”!

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. ¹

What coexisting chronic conditions do you code? Per the CMS Participant Guide, “Physicians should document and code all conditions that co-exist at the time of the encounter/visit that require or affect patient care treatment or management.” ²

Co-existing conditions include:

• Chronic, ongoing conditions – e.g. diabetes, atrial fibrillation, congestive heart failure, COPD. These conditions generally require ongoing medication and have potential for acute exacerbations when an acute condition presents to be treated.
• Status conditions – e.g. amputations, ostomies, organ transplants, dialysis, morbid obesity, malnutrition. These conditions were discussed in our last Team Trends.

Commonly missed chronic conditions:

If you have not yet attended the HCC & Risk Adjustment Provider CME Meetings, there are two more scheduled – May 30^th and June 20^th. This helps meet providers’ Tier 1 incentive requirement for HQEP in 2018. All staff are welcome.

And remember to stay tuned for more HCC tips in our next Team Trends!

Sources:

1. https://www.cdc.gov/nchs/data/icd/10cmguidelines_fy2018_final.pdf
2. 2008 Risk Adjustment Data Technical Assistance For Medicare Advantage Organizations Participant Guide 6.4.1 Co-existing and Related Conditions