This page addresses follow-up questions and additional information pertinent to our webinar
The MEAT of Risk Adjustment.
** 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 conflicting it is appropriate to query the provider
A: Yes, when documentation is not clear or conflicting it is appropriate to query the provider
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.
A: When the classification includes the terms “with” or “in” this is interpreted as associated with and therefore the classification assumes a causal relationship.
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. One of the codes I have heard may be considered is homelessness. It’s pretty clear how lack of stable housing could have an impact on the patient’s health.
A: Currently, social determinants of health are not included in the HCC model but there is talk that could be coming in the future. One of the codes I have heard may be considered is homelessness. It’s pretty clear how lack of stable housing could have an impact on the patient’s health.
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Jennifer Cayce, RHIT, CCS, CCS-P, CPC
Director of Coding Quality & Compliance
As a Director of Coding Quality & Compliance, Jennifer brings over 20 years of health information management, auditing, and coding experience to Haugen Consulting Group. During her career, Jennifer has served as an inpatient and outpatient medical coder, lead coder, coding supervisor, auditor, and has developed training materials for multiple areas of HIM. Jennifer was integral in the development of web-based HIM education for coders, providers, clinical documentation improvement specialists, case managers, and patient access professionals. During her time as a coding supervisor, Jennifer experienced a high success rate when appealing RAC and other external audit findings. At the Haugen Consulting Group, Jennifer coordinates and leads the facility audit team and provides coding expertise and support to clients.
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