The Coding Corner Archives

The Coding Corner - November 2018 Edition

Coding Corner - December 2018 Edition

ICD-10- CM Diagnosis Codes Reset January 1, 2019

  • A major component of the Hierarchical Condition Categories (HCCs) model is that the individual HCCs are only valid for one year. Regardless of the HCCs fundamental chronicity, on January 1, 2019 the patient’s HCC listing will be blank.
  • For example, a patient with diabetes with complications would need to have a face-to-face encounter with a provider where diabetes is discussed and documented for the appropriate
    HCC to be reported in the new base year.
  • There are two important aspects to remember when HCC coding:
  • Analyzing health record documentation to identify reportable conditions
  • Accurately assigning ICD-10-CM codes to these conditions
  • Providers and risk adjustment professionals need to work together to ensure quality and thorough documentation of patient conditions to support risk adjustment and quality reporting initiatives. With such an emphasis on yearly code capture, provider education becomes a higher priority early in the year to prevent the loss of HCC diagnosis.
  • The NEPHO will be working to educate providers beginning early 2019 to help continue efforts to impact the patient’s health status.
  • The following coding education will be a focus for 2019:
  • Risk Adjustment Accurate Documentation and Coding Practices
  • Importance of Risk Adjustment
  • Risk Adjustment Auditing and Monitoring
  • The NEPHO will be working with providers directly to address education opportunities and to ensure accurate coding and reporting of HCCs is continued through the year. Working together can help ensure compliance and optimal financial results under HCC risk adjustment contract models.
  • Please reach out to NEPHO directly if you would like to review risk adjustment education opportunities for your practice. Contact Shawn Bromley at or call 978-236-1704.