May 28, 2024

Top Questions from the HCC Best Practices Webinar

Looking for more information about HCC Best Practices? BESLER Senior Coding Analyst Victoria Hernandez answers your questions from the recent webinar.

To watch Victoria’s HCC Best Practices Webinar, click HERE.

1. Can CKD be linked to both HTN and DM?
  
  Per Section I.A.15., “The word ‘with’ or ‘in’ should be interpreted to mean ‘associated with’ or ‘due to’ when it appears in a code title, the Alphabetic Index (either under a main term or subterm), or an instructional note in the Tabular List. The classification presumes a causal relationship between the two conditions linked by these terms in the Alphabetic Index or Tabular List. These conditions should be coded as related even in the absence of provider documentation explicitly linking them, unless the documentation clearly states the conditions are unrelated or when another guideline exists that specifically requires a documented linkage between two conditions (e.g., sepsis guideline for ‘acute organ dysfunction that is clearly associated with the sepsis’).”
  
  Per Section I.C.9.a., “The classification presumes a causal relationship between hypertension and heart involvement and Alphabetic Index. These conditions should be coded as related even in the absence of provider documentation explicitly linking them, unless the documentation clearly states the conditions are unrelated.”
2. For the improper patient slide, is there a list by state?
  
  Yes, the Henry J. Kaiser Family Foundation website provides statistics on Medicare Advantage enrollment by state and by county.
  Medicare Advantage in 2023: Enrollment Update and Key Trends | KFF
3. What is the current version for 2024? V22, v24, or v28?
  
  The latest version of the CMS-HCC model is V28, which was finalized in 2023 for implementation in calendar year 2024.
4. Is there specific guidelines for ambulatory surgery for HCCs?
  
  The ICD-10-CM Official Guidelines for Coding and Reporting Section IV. Diagnostic Coding and Reporting Guidelines for Outpatient Services should be applied when reporting diagnosis codes (including HCCs) in the outpatient setting.