This page addresses follow-up questions and additional information pertinent to our webinar
The MEAT of Risk Adjustment Coding: Applying Additional Diagnosis Criteria
** 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. 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.
A: Yes, when documentation is not clear or is conflicting, it is appropriate to query the provider. 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: When the classification includes the terms “with” or “in”, this is interpreted as associated with, and therefore the classification assumes a causal relationship. Some common diagnoses that fall under these guidelines include hypertension, chronic kidney disease, heart disease, heart failure, and also diabetes with associated complications.
A: When the classification includes the terms “with” or “in”, this is interpreted as associated with, and therefore the classification assumes a causal relationship. Some common diagnoses that fall under these guidelines include hypertension, chronic kidney disease, heart disease, heart failure, and also 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 into 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.
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 into 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?
Theresa Rosa, MSIT-HI, RHIA, CCS
Theresa brings more than 15 years of experience in health information management and coding to her role at Haugen Consulting Group. Her career spans leadership roles, where she developed a reputation for excellence in compliant coding and documentation practices, revenue cycle optimization, and coder education. As a Certified Coding Specialist (CCS) and Registered Health Information Administrator (RHIA), Theresa has overseen inpatient and outpatient coding operations, conducted high-level audits, and led staff development initiatives across multiple medical centers. She has provided policy guidance and coding oversight nationally, co-chairing the VHA National Coding Council and being a subject matter expert for the VHA HIM Program Office.
0 Comments