by Rose T. Dunn, MBA, RHIA, CPA, CHPS, FACHE, FHFMA
If you are wondering whether the documentation for a patient seen in the emergency department is relevant to HCC coding, the answer is an emphatic Yes! In fact, claims from the emergency department and any other outpatient hospital department qualify for HCC capture.
These outpatient service providers need similar education on the nuances of HCCs to encourage their documentation of all relevant conditions the patient has. Whether the services are provided in the emergency department, rehabilitation, hospital ambulatory surgery, clinics or any other outpatient setting, education of the outpatient providers is very important.
So what are we asking these providers to document? Our long-time standard for when to code a condition is if it meets one or more of the MEAT criteria: that is the condition is Measured or Monitored; Evaluated; Assessed or Addressed; and/or Treated.
- Monitor – signs, symptoms, disease progression, disease regression
- Evaluate – test results, medication effectiveness, response to treatment
- Assess/Address – ordering tests, discussion, review records, counseling
- Treat – medications, therapies, other modalities
My advice to physician practices is that their CDI and coding staff work to ensure documentation is complete and demonstrates all four MEAT elements.
HCC – Fundamentals of Hierarchical Condition Categories
Go beyond just the diagnoses — really understand the methodology behind HCCs! Prepare for the future of healthcare reimbursement with “HCC: Fundamentals of Hierarchical Condition Categories,” by nationally recognized HCC authority Rose T. Dunn, MBA, RHIA, CPA, FACHE. Learn more here.
Looking for hands-on practice in HCCs?
Try “HCC: Fundamentals of Hierarchical Condition Categories
with Practice Cases.” Includes “Abstract & Code It!” exercises to reinforce learning. Learn more here.