Appropriate capture and documentation of HCC Codes for patients is critical for accurate risk adjustment scores. Understanding how the over 9,700 ICD-10-CM codes map to one or more of the 86 HCC codes within the CMS-HCC Risk Adjust Model (Version 24), can feel overwhelming.
To help your team recognize and create strategies to capture the most prevalent HCCs, it is beneficial to understand the patient conditions and coding/documentation requirements associated with the top 10 most frequently occurring HCCs.
Top 10 Most Common HCC Codes
- Diabetes without Complication (HCC 19)
- Breast, Prostate, and Other Cancers and Tumors (HCC 12)
- Diabetes with Chronic Complications (HCC 18)
- Seizure Disorders and Convulsions (HCC 79)
- Specified Heart Arrhythmias (HCC 96)
- Congestive Heart Failure (HCC 85)
- Other Significant Endocrine and Metabolic Disorders (HCC 23)
- Chronic Obstructive Pulmonary Disease (HCC 111)
- Major Depressive, Bipolar, and Paranoid Disorders (HCC 59)
- Morbid Obesity (HCC 22)
Find out which HCC codes present the biggest opportunity for your group to boost RAF score accuracy.
RCxRules automatically reviews 100% of diagnosis codes coming out of your EMR to ensure correct HCC codes are captured. Embedded in your existing workflow, RCxRules dramatically streamlines your HCC concurrent review process.
Sources:
- https://providers.amerigroup.com/Documents/ALL_CARE_CMSHCCRAModel.pdf
- Common HCC codes: Data on file with RCxRules
