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What Skills are Needed for HCC Coding?


by Rose T. Dunn, MBA, RHIA, CPA, FACHE

I recently received a question from a coder interested in HCC Coding: “Should a person be proficient in CPT and HCPCS coding in order to be an HCC coder?”

The short answer is no: HCC coding is not reliant upon CPT or HCPCS skills.

HCCs are based on ICD-10-CM codes. Approximately 10,000 of the ICD-10-CM codes qualify for placement in a payment HCC. While the source of the data that determines an HCC may come from a hospital’s claim or the physician’s office claim it is only the diagnosis code, the ICD-10-CM code, that is used for HCCs.

An individual doing HCC coding needs to have solid anatomy and physiology knowledge, strong medical terminology skills and, of course, ICD-10-CM proficiency. However, since HCCs apply to physicians and other providers, if the individual is working in a provider practice environment, the individual will probably be required to do CPT and HCPCS coding as well.

Even though the Hierarchical Condition Categories (HCCs) have been around since 2004, and used by Medicare Advantage, Medicaid, and risk sharing programs, the interest in HCCs by coding professionals is relatively recent. HCCs and other aspects of risk adjustment are felt by some, myself included, to represent an excellent opportunity for coders to master a new area of knowledge. I encourage my coding colleagues to embrace the challenge and dive into HCC coding.

 

Fundamentals of 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.

About the Author

Rose Dunn
Rose Dunn is the Chief Operating Officer at First Class Solutions, Inc., a healthcare information management leader since 1988. Rose is the author of “The Revenue Integrity Manager’s Guidebook” available from the National Association of Healthcare Revenue Integrity and other books on Coding Management and Auditing from HCPro. She engaged herself in ICD-10 more than 10 years before it was implemented. She is assisting Libman Education in the development of an HCC educational program. Rose holds a BS and MBA from Saint Louis University.

3 thoughts on “What Skills are Needed for HCC Coding?

  1. Joni Dion - June 19, 2019 at 3:45 pm

    Great information, I absolutely agree, HCCs will take on an even greater role in the future.
    This is the time for coding professionasl to increase their skill set and prepare for the future.
    Thanks so much for your valuable insight.

    Reply
  2. Mildred Bethea - June 25, 2019 at 8:52 pm

    All I knew was that I wanted to be a coder. I had so many challenges trying to get my degree, RHIT certification, being rejected do to not having had coding experience, and then I heard if HCC. I then took the all day Saturday course with Ann Barnaby for basic HCC, and then the door unlocked for me. I’m grateful to say it’s been of course an interesting journey of learning, but I’m working in my field and I can say my specialty is becoming HCC.

    Reply
    • Billie - June 29, 2019 at 8:10 pm

      Mildred, was this the only HCC training you took before you took the HCC cert test?

      Reply

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