This page addresses follow-up questions and additional information pertinent to our webinar
The MEAT of Risk Adjustment Coding.
** The coding information and guidance are valid at the time of publishing. Learners are encouraged to research
subsequent official guidance in the areas associated with the topic as they can change rapidly.

Q: If it’s not clear if the cancer is current, should you query the provider? 
A: Yes, when documentation is not clear or is conflicting it is appropriate to query the provider. As I mentioned, the guidelines state if the cancer is excised, eradicated, or is no longer being treated, then the history code would be assigned. Coders should query if that is not clear in the documentation.

Q: To use a combination code, must the documentation explicitly link the conditions? 
A: We get this question a lot when educating coders. When the classification includes the terms “with” or “in” this is interpreted as associated with and therefore the classification assumes a causal relationship. We discussed some common diagnoses that fall under these guidelines that included hypertension, chronic kidney disease, heart disease and heart failure, as well as diabetes with associated complications.

Q: Are SDOH codes included in the current CMS-HCC risk model? 
A: Currently social determinants of health are not included in the HCC model but there is talk that could be coming in the future. It is important to note that several codes for homelessness have been made CCs when it comes to MS-DRG grouping. There is talk that more SDOH codes will be included in the future so I would not be surprised if they are included in the risk adjustment payment models at some point.

Looking for additional information on this topic?

Purchase Webinar