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.