Monitor – the patient’s signs, symptoms, disease progression, disease regression Įvaluate – test results, medication effectiveness, response to treatment Īssess/Address – ordering tests, discussion, review records, counseling and As HCCs continue to evolve, best practices for documentation in the HCC world follow the culture of MEAT, which is an acronym that auditors have used to describe the four requirements for complete and accurate documentation: The coding for HCCs is only as good as the documentation found in the medical record. Per Section IV, subsection I, chronic diseases treated on an ongoing basis may be coded and reported as many times as the patient received treatment and care for the conditions. However, history codes (categories Z80–Z87) may be used as secondary codes if the historical condition or family history has an impact on current care or influences treatment.
M.e.a.t. checklist hcc code#
Providers are required to document all conditions evaluated during each face-to-face visit this documentation should include the history of present illness (HPI), examination, and medical decision making.Ĭode all documented conditions that coexist at the time of the encounter/visit, and require or affect patient care, treatment, or management.ĭo not code conditions that were previously treated and no longer exist. Section IV of the guidelines requires that all documented conditions must be directly “relevant” to or “affect” the specific encounter.
M.e.a.t. checklist hcc professional#
Section I for conventions, general coding guidelines, and chapter-specific guidelines applies to the outpatient setting and professional fee coding for physician and non-physician provider services. Section IV of the guidelines has specific instructions for coding and reporting of outpatient services. The following should be adhered to when coding:Īll ICD-10-CM coding assignments should be based on the ICD-10-CM Official Guidelines for Coding and Reporting for the current fiscal year. An ICD-10-CM code can map to more than one HCC, because ICD-10-CM contains combination codes (i.e., a code can represent two diagnoses or a diagnosis with a complication).Īt the foundation of HCCs is accurate coding of the ICD-10-CM diagnosis code based on the documentation found in the medical record. For consideration, there are more than 9,500 ICD-10-CM diagnosis codes that map to one or more of the 79 HCC codes in the CMS-HCC Risk Adjustment model. The structure is then further divided so that the groups break down into similar predictive costs for the beneficiaries’ future healthcare costs. In the HCC system structure, patients are placed into categories based on the ICD-10-CM diagnosis code assignment the ICD-10-CM code assignments group patients who are clinically similar into the same group (HCC).
The majority of conditions submitted for HCCs are chronic conditions (a few acute conditions qualify as well) that the patient has, which have been documented by the provider with ICD-10-CM diagnosis code(s) submitted on the claim form.
Of note, like any other CMS reimbursement methodology, the HCC Risk Adjustment Factor platform is subject to audit by CMS and its contractors. It is a predictive model - based on medical record documentation and submitted ICD-10-CM diagnosis codes for the plan enrollees - with an underlying purpose to adjust capitated payments made to providers in these plans based on the beneficiaries’ health.
Since its inception, the understanding and significance of HCCs has grown and taken on considerable financial importance for physicians, physician groups (and physician extenders), health systems, and Medicare Advantage plans.ĬMS defines HCCs as a risk adjustment model used to calculate risk scores to predict future healthcare costs. The implementation of HCCs by CMS for the Medicare Advantage plans began in 2000, and they have been steadily phasing in this process over time. The Centers for Medicare & Medicaid Services (CMS) introduced Hierarchical Condition Categories (HCCs) and the architecture of the Risk Adjustment Factor with their mandate in 1997. Lisa Knowles ( is a Compliance, Education and Privacy Officer at Harmony Healthcare in Tampa, FL.
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