Importance of Hierarchical Condition Category Coding

The collection and validation of patient diagnoses are organized first by diseases and conditions and then by condition categories. Hierarchical Condition Categories (HCC) play a vital role in demonstrating illness complexity, assessing the health of populations, and payment for healthcare services. The importance of consistent, accurate, and complete documentation in the medical record can’t be overemphasized. Documentation and specificity are the keys to success with HCC coding. For example, chart documentation must show that the condition was monitored, evaluated, assessed, or treated. A diagnosis code may only be reported if explicitly spelled in the medical record.

Improving the accuracy of clinical documentation positively impacts Risk Adjustment Factor (RAF) scores and coding. This course will help your team ensure that consistent, accurate, and complete documentation processes are in place. Get clarity for HCC coding situations. For example, two data sources determine a patient’s RAF - demographics and health status based on ICD-10-CM codes.

Learning objectives include:

• Optimize Hierarchical Condition Categories (HCC) and Risk Adjustment models
• Identify the entities that use HCC and Risk Adjustment for population health and reimbursement.
• Review best HCC Coding best practices
• Develop an internal action plan to leverage HCC Coding

Register for the program here