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Top 10 Most Common HCC Codes

Jul 25

HCC (Hierarchal Risk Adjustment)

Numerous instances of insurance companies underpaying or rejecting coverage for sick people can be found throughout history. Most patients should have access to economical healthcare, as per the Affordable Healthcare Act (ACA). A stronger framework was required to direct greater medical expenditures toward worse patients and to proactively forecast how much money will be spent on healthcare in the coming years. 

This is when the Hierarchical Condition Category (HCC) hazard management model, currently in use by the Facilities for Medicare and Medicaid Services (CMS), acquired importance since it analyses health status in a "base year" to forecast expenses in the next year. 

One of the most important decisions you will ever make is selecting a Revenue Cycle Company (RCM) to outsource your focused medical billing

Among the many clever ways to code, a person's risk accommodation is with HCC. It is centered upon the International Classification of Diseases, Tenth Revision (ICD-10) classification system, where each patient is given a risk score depending on their current medical state. The person's sex, age, and ICD-10 codes are linked to the HCC coding to get the real Risk Adjustment Factor rating. Then, by examining the individuals' RAF ratings, the insurance firms project their expenditures. The expenditure is then multiplied by the RAF Score to allocate more funds to patients who require them the most. 

The significance of HCC coding for clinicians and ACOs

HCC medical coding services ought to be obvious as a huge equalizer for clinicians and ACOs. Prior to the broad implementation of the HCC risk adjustment paradigm, just the statistics of the patients were considered to determine how much would be reimbursed. Since it was well known that patient healthcare expenses varied from context to context, payers had legitimate reasons to be concerned about illogical payments. The funders and CMS returned to the traditional default method of allocating cash to patients indiscriminately because there were no codified means to code and decipher those variations in public health sectors prior to the HCC model.

The HCC coding approach aids in precisely weighing the clinical issues that patients face, increasing the funding system's precision. By precisely classifying patients' clinical circumstances to enable the accurate estimation of RAF Ratings, clinicians can greatly enhance care outcomes. The administration and payers may then focus on cash, which would have the biggest impact thanks to correct classification and RAF Scores. In conclusion, accurate coding creates a win-win situation for everyone in the system.

Leading 10 HCC Codes with the Most Use

  1. Complication-free diabetes (HCC 19)
  2. Cancers of the chest, prostate, and other organs (HCC 12)
  3. Chronic Effects from Diabetes (HCC 18)
  4. Convulsions and Epilepsy Conditions (HCC 79)
  5. Specific Arrhythmias of the Heart (HCC 96)
  6. Congestive cardiac failure, number six (HCC 85)
  7. Other important Endocrine and Metabolic diseases (HCC 23)
  8. Acute disruptive pulmonary disease (COPD) 8. (HCC 111)
  9. Serious depression, mania, and paranoia (HCC 59)
  10. Serious obesity (HCC 22)

Because of the usage of combination codes for diseases, frequent symptoms, and manifestations, coding HCCs for various long-term health problems has become harder with the adoption of ICD-10.

Dual diagnoses, a diagnosis with a related indication or sensation, and a diagnosis with a related consequence can all be classified using a single combined code. There is no doubt that disease interactions affect reimbursement. ICD-9 requires etiology and symptom codes to be used in the precise order for accurate classification. Combined codes nowadays enable the use of a single code, reducing the instances of numerous code occurrences and sorting issues.

Having doctors accurately report on every person's risk adjustment prescription depending on clinical health record data from face-to-face contact is a difficulty for coders. Therefore for the condition to be stated on a claim, specific paperwork in the healthcare record must be available. The level of payment for an HCC request is directly impacted by the absence of this paperwork. Due to the potential for many illnesses or potential illnesses to be indicated by the aggregation of biographical data and risk variables, patients are frequently given more than one HCC. This poses particular difficulties for coding teams.

Key Elements to the HCC Model's Revenue Maximization

To increase and safeguard revenue under HCCs, three key actions must be taken.

  • Employ linking vocabulary: When there are two distinct HCCs, like congestive cardiac failure and diabetes, doctors should employ "connecting language" in the medical records (due to, linked to, since of, etc.). The greatest amount of compensation will be allowed if the right connecting language is used to show the causal connection between the symptom coding (diabetes and the related CHF).
  • Perform a yearly risk adjustment evaluation: It is essential for doctors to meticulously record HCCs each year. To calculate how much the MA plan would be compensated for a person's care, be certain to yearly evaluate the seriousness of the disease and death risk for every patient. Profits can be affected and have a greater effect a year after the patient is diagnosed with hyperglycemia than what they did the year before when socioeconomic and population factors were all you had to go on. These services provided involve multiple visits to an endocrinologist, admittance for foot ulcers, usual sugar levels testing, etc.
  • Describe persistent conditions: It all boils down to paperwork once more. A doctor will lose money if crucial data is not recorded at each patient session with a terminally unwell patient. Because the coder could only code from a practitioner's paperwork but not from the laboratory testing, if a lab test reveals that a diabetic person's blood glucose is high and the doctor does not record it here in the chart, a chance to raise revenue is missed.

The HCC model's primary objective is to support improved health management and precise MA plan compensation. Given that 1.4 million Americans receive a diabetes diagnosis each year, there is still room for improving clinical records and coding precision to increase compensation. Only by submitting accurate and on-time HCC paperwork will you be able to enhance your revenue cycle and earn fair compensation from CMS.

Typical HCC code mistakes

The top 10 mistakes made are listed in this list.

  1. Credentialed signings and legal signatures were absent from the document.
  2. Electronic healthcare documents (EHRs) were not verified. Check again for a digital signature.
  3. The chronological summary of a diagnosis or conditions within the healthcare record did not employ the most suitable ICD-9-CM code.
  4. The information entered into the database does not fit the diagnosis codes submitted for invoicing. Your invoice could be invalidated by even seemingly insignificant variations, such as the distinction between 311 Depressive Disorder and 296.20 Major Depressive Affective Disorder.
  5. The documentation lacked any proof of observation, inspection, evaluation, and medication.
  6. Medical illnesses that are persistent were not classified as such.
  7. Information on illnesses and signs was not as specific as it may have been in the records.
  8. Documentation for chronic diseases was not collected on an annual basis.
  9. The essential appearance code was not reported.
  10. Outdated codes were applied rather than modern ones.

Working with a firm that offers you trained coders, who help to guarantee that coding, invoicing, adherence, and other related activities are done timely and accurately, is the best approach to overcome the difficulties posed by wrong submissions. It will free up more of your time so that you can treat patients, which is what you do well. Coding mistakes result in rejected claims, which ultimately result in economic damage.