Talking HCCs: The Role of Coders in HCCs

by Rose T. Dunn, MBA, RHIA, CPA, FACHE and Laurie M. Johnson, MS, RHIA, FAHIMA

Hierarchical Condition Categories (HCCs) are utilized by Medicare Advantage and Affordable Care Act (Obamacare) payers for approximately 30 million individuals currently. Use of HCCs is projected to grow significantly in coming years. Join us for a discussion of HCCs by two industry leaders: Rose T. Dunn, MBA, RHIA, CPA, FACHE, and Laurie M. Johnson, MS, RHIA, FAHIMA.


Laurie: Rose, you’ve been speaking on HCCs for some time now, why do you think hospital coding professionals should know more about HCCs?



Rose: Hospital coding can make a significant difference in the reimbursement to their medical staff members, Accountable Care Organization (ACO) or Shared Savings program serving Medicare Advantage members.

Beyond coding the principal and significant secondaries, coding all co-morbidities, regardless of how insignificant, that were addressed during the stay can supplement the profile of a member with additional HCCs that add to the overall reimbursement (risk adjustment factor) for the members.

Now a question for you Laurie: you have also been in the industry quite some time, do you think that we’ll see hospital coding professionals start to infiltrate the physician office coding arena in either a coding or documentation improvement capacity?


Laurie: I think we will. I have seen hospitals buy physician practices and soon realize that physicians do not assign high quality diagnosis codes through the electronic health record. It is a missed opportunity and too important to ignore.

I was recently doing a presentation on HCCs and some physicians were bitterly complaining about this task. I sympathize with them. My analogy is that no one would ask me to suture a laceration or do surgery so we should not ask physicians to code. This is a job for coders!

As hospitals are more involved on the professional side, my hope is that hospital administration staff will realize that skilled, credentialed coders are a valuable asset.


Introduction to HCC Coding  Go beyond just the diagnoses — really understand the methodology behind HCCs! Learn how from nationally recognized HCC expert, Rose T. Dunn, MBA, RHIA, CPA, FACHE.




Rose T. Dunn, MBA, RHIA, CPA, FACHE Rose Dunn is the Chief Operating Officer of First Class Solutions, Inc., a healthcare information management leader since 1988, offering professional consulting services in health information management operations and information governance issues, as well as coding support, coding quality reviews, privacy/security guidance, temporary (interim) management, revenue cycle oversight, and accreditation preparation.  Rose is the author of Libman Education’s online course: Fundamentals of HCC Coding as well as “The Revenue Integrity Manager’s Guidebook” available from the National Association of Healthcare Revenue Integrity and other books on coding management and auditing. Ms. Dunn holds a B.S. and M.B.A. from Saint Louis University.Contact Rose at 314-209-7800 or [email protected]


Laurie M. Johnson, MS, RHIA, FAHIMA Laurie M. Johnson is a senior consultant at Revenue Cycle Solutions, LLC, a revenue cycle consulting firm specializing in revenue cycle assessments and work plan implementation; interim management with focus on process improvement; and revenue cycle education for hospitals and physician practices. Laurie is a past president of PHIMA and author of clinical coding articles for Journal of AHIMA and ICD-10 Monitor.

Disclaimer: This article is written for educational purposes only. Every reasonable effort has been made to ensure its accuracy and completeness. It is the responsibility of the reader to refer to the definitions, descriptions, conventions, and guidelines specific to each coding classification, as well as relevant laws and regulations when selecting and reporting medical codes.

About the Author

Libman Education
Libman Education is recognized by individual HIM professionals and their employers as the trusted resource for training on medical record coding. Over 12,000 individuals enroll annually in Libman Education’s WebinarPlus™ self-paced online courses written by leading industry experts. Our focus is on coding from beginner to advanced (ICD-10-CM, ICD-10-PCS, CPT), as well as coding credential prep (both AHIMA and AAPC), and other topics where in-depth specialized knowledge of relevant coding systems and their application is essential (Auditing, CDI, HCCs, IR/CV, LTAC, SNF, Home Health, IRF, and Pediatrics).

4 thoughts on “Talking HCCs: The Role of Coders in HCCs

  1. Brenda Everts - March 27, 2019 at 3:31 pm

    Is this just an article or is there a webinar from BLI regarding this topic that the email was sent on?

    Thanks Brenda Everts

    • Libman Education - March 27, 2019 at 6:54 pm

      Hi Brenda,
      Thanks for your inquiry. This is just an article but Libman Education is pleased to offer a full course on HCCs by author Rose Dunn. Fundamentals of HCC Coding is an online, self-paced course that provides comprehensive instruction to ensure complete and accurate HCC coding to improve data quality and ensure appropriate reimbursement.

  2. Lori Pittenger - April 16, 2019 at 7:26 pm

    I do Provider Education for HCC on teaching the Physician and Mid-levels how to code and Document, in their practice. It also helps with compliance risks so no, not all Physician’s and Mid-levels know how to code nor do Coders know how to save lives but together we can help them accomplish becoming better coders and better at documentation for HCC at the end of the day that is what we all want.

    • Rose T. Dunn - May 2, 2019 at 6:13 pm

      Ms. Pittenger makes an excellent point and using that approach to encourage clinicians and coders to collaborate will benefit all involved. Thanks for sharing the comment.