by Rose T. Dunn, MBA, RHIA, CPA, FACHE
We recently received a note from a colleague:
“I have a question about emergency room facility coding regarding hcc. If the pt comes in with headache or rash or other diagnoses such as injuries and the physician states pt has diabetes or hypertension but does not state that diabetes or hypertension is affecting treatment should we code these chronic conditions?”
This is a great question and one I often see when working with my clients on the issue of correct Hierarchical Condition Category (HCC) coding.
The physician does not need to specifically state that those other conditions, diabetes and hypertension, affect the condition for which the patient is presenting to the ED. However, if it is apparent from the documentation that the physician assessed the other conditions then they should be coded. Examples of the types of documentation to look for include that the physician:
– Monitored for these other conditions, e.g. ordered a lab test;
– Evaluated them, e.g. noted the medication dosage for one or the other or while the patient was in the ED ensured some food was available for the diabetic; or
– Treated either of them along with the presenting condition.
If the documentation is not in the record, coders always have the option to query the physician to provide additional information or clarity. However, keep in mind that querying ED physicians may not be worth the effort since ED encounters are often paid on leveling basis.
I’d welcome any readers who routinely work in an HCC environment to add your perspectives. What has been your experience?
Introduction to HCC Coding
Complete and accurate coding for Hierarchical Condition Categories (HCCs) presents an opportunity for improved data quality and appropriate reimbursement. Learn how from nationally recognized HCC expert, Rose T. Dunn, MBA, RHIA, CPA, FACHE.