Latest HCC Coding Guidelines You Need To Know — Inferscience

The hierarchical condition category relies on ICD-10 coding to assign risk scores to patients. Each HCC is mapped to an ICD-10 code. Along with demographic factors (such as age and gender), insurance companies use HCC coding to assign patients a risk adjustment factor (RAF) score.

Here are the some of the HCC Code Guidelines-
1- Locating a code in the ICD-10-CM.
2- Level of Detail in Coding.
3- Code or codes from A00.0 through T88.9, Z00-Z99.8, U00-U85.
4- Signs and symptoms.
5- Conditions that are an integral part of a disease process.
6- Conditions that are not an integral part of a disease process.
7- Multiple coding for a single condition.
8- Acute and Chronic Conditions.
9- Combination Code.
10- Sequela (Late Effects).
11- Impending or Threatened Condition.
12- Reporting Same Diagnosis Code More than Once.
13- Laterality.
14- Documentation by Clinicians Other than the Patient’s Provider.
15- Syndromes.
16- Documentation of Complications of Care.
17- Borderline Diagnosis.
18- Use of Sign/Symptom/Unspecified Codes.
19- Coding for Healthcare Encounters in Hurricane Aftermath.
The above mentioned are the general HCC Code Guidelines we have to follow, hope this article will clear your doubts. if need any assistance feel free to contact us we will be happy to help you.