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Hierarchical Condition Category (HCC) coding is a risk-adjustment model created by the centers for Medicare & Medicaid Services (CMS) to estimate future health care costs for patients. CMS maps an ICD-10 code to exactly one HCC to assign risk scores to patients.
2025 COMMON HCC ICD-10 CODES. When documenting chronic conditions, remember: 1) Coding is based on clear documentation that includes a diagnostic statement and ongoing treatment plan.
Hierarchical condition category coding helps communicate patient complexity and paint a picture of the whole patient. In addition to helping predict health care resource utilization, RAF scores...
HIV (Z21) or AIDS (B20) Cardiomyopathy. CC Coding Quick ReferenceICD-10-CM Codes that Impact the V28 CMS- HCC ModelFor a comprehensive code l. st, please refer to the ICD-10-CM codebook for correct coding and reporting. Common condition codes that no longer map. Cardiovascular Diseases Nervous System Diseases.
2024 HCC Coding and Documentation Tips. Updated January 2024. Always make sure that you are using the current year ICD-10 codes. Validated HCC Coding requires documenting: Diagnosis. Status of Condition. Plan of Action. Once a Year, Document Chronic Active Conditions commonly not documented.
The Purpose of Hierarchical Condition Category (HCC) Coding (continued) There are over 9,700 ICD-10-CM codes that map to one or more of the 86 HCC codes included in the 2021 CMS-HCC Risk Adjustment Model. Examples of Conditions represented include: Amputation. Chronic Kidney Disease.
HCC coding is a process by which a professional coder reviews medical records and abstracts (searches for and identifies) supported diagnosis codes that are clinically significant in a risk adjustment payment model.