For a comprehensive code list, please refer to the ICD-10-CM codebook for correct coding and reporting. Common condition codes that no longer map to payment V28 CMS-HCCs and additional information are identified with a ≠.

2025 COMMON HCC ICD-10 CODES When documenting chronic conditions, remember: 1) Coding is based on clear documentation that includes a diagnostic statement and ongoing treatment plan. Any condition that is taken into account or affects patient care, treatment or management at the time of the encounter should be documented and coded. 2) The encounter

Each HCC is mapped to an ICD-10-CM code. 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 and Documentation Tips COVID-19 Diagnosis Codes Only confirmed diagnosis of coronavirus disease should be coded. Presumptive positive COVID-19 test result should be coded as confirmed. Cardiovascular – Do not code unstable Angina in the office (usually ER or INPT only). If CAD consider Angina if patient on B-Blocker,

Jan 20, 2024 · HCC coding is a process by which a professional coder reviews medical records and abstracts (searches for and identifies) supported diagnosis codes that are clinically significant in a risk adjustment payment model.

Jun 25, 2024 · The HCC coding system is complex and ever-evolving. Here's your HCC coding cheat sheet 2023 to the top missed and confusing HCC codes.

• Define and understand HCC/RAF Coding as opposed to CPT (Current Procedure Terminology)/RVU(Relative Value Unit) Coding. • Describe how HCC Codes are captured and reported. • Understand the impact of precision and timing of HCC Codes. • A working familiarity with most common HCC Codes and most common under-reported HCC Codes.

Hierarchical Condition Category (HCC) coding is a risk-adjustment model created by the centers for Medicare & Medicaid Services (CMS) to estimate future health care costs for patients. CMS maps an ICD-10 code to exactly one HCC to assign risk scores to patients. Payers assign patients a risk-adjustment factor (RAF) using HCC scores and demographic.

Contents Risk Adjustment Coding and HCC Guide 2 2022 Optum360, LLC Audit Scenario 3 Rationale—CMS-HCC Model ...................................................................................... 51

Category (HCC) Coding (continued) • There are over 9,700 ICD-10-CM codes that map to one or more of the 86 HCC codes included in the 2021 CMS-HCC Risk Adjustment Model. Examples of Conditions represented include: o Amputation o Chronic Kidney Disease o Chronic Obstructive Pulmonary Disease o Coagulation Defects o Congestive Heart Failure