HCC coding for physicians

HCC coding for physicians

HCC coding is a risk adjustment model that is used to calculate risk scores to predict health care costs for reimbursement. HCC stands for Hierarchical Categorical Condition and implemented by the Center for Medicare and Medicaid Services in 2000. Physicians should be aware of the coding system and understand how it is used in order to accurate select the appropriate codes for diagnosis. Precise and complete diagnosis coding will affect payment adjustments, utilization, quality measures, and patient satisfaction. Some practices often forget to report status codes and failing to do so has undesirable consequences in risk-adjusted coding. As the healthcare system evolves to focusing more on the quality of care provided, correctly reporting the severity of illness for patients becomes every more imperative.

Common HCC coding errors

  1. Health records not having appropriate signatures with credentials. If the health record is electronic, it often is missing an authentication and electronic signature.
  2. Unclear or incorrect diagnosis code is assigned. Many times the highest degree of specificity was not appropriately assigned to the diagnosis. Some times the wrong diagnosis code was assigned to begin with, leading to discrepancies between the billed diagnosis and the actual descriptions in the medical documents.
  3. Missing information to an assigned diagnosis code. Even when the correct diagnosis code was assigned, there may lack proper documentation. Additional required documentation includes the monitoring, evaluation, assessment, and treatment of a condition.
  4. Inconsistent documentation of diagnosis codes. Not all practices document patient chronic conditions and status codes on an annual basis. Additionally, chronic conditions like hepatitis, may not be coded as a chronic disease.

Ways to improve HCC coding

As a physician, you and your health care facility should always look for ways to improve your clinical documentation. Consider developing a compliance plan involving both prospective and retrospective chart reviews, and internal and external ongoing monitoring boards with regular feedback. It is important to review the medical records and information based on official coding guidelines.

HCC Coders can help!

Don’t let inaccurate HCC coding affect your practice. Instead, team up with the specialists at HCC Coders to fulfill your HCC coding needs. We have expert coders who can complete coding for you, perform prospective and retrospective chart reviews, and identify opportunities for improvement in your coding. We also have access to the latest HCC coding software and certified coders for in-house use. Rely on us to completely handle all of your coding activities and highlighting of any key coding or documentation errors or omissions. Don’t wait any longer. Give us a call today at 877-328-2343.