The Coding Corner

NEPHO is working to close down 2022 and preparing for 2023. There are a few keys areas to make sure practices and providers are focusing on to the start of January 2023. The two priority areas include the following:

Hierarchical condition categories (HCCs) Coding Capture: All chronic conditions captured in 2022 will reset as of January 1, 2023.

  • Chronic conditions should be coded and captured on an ongoing basis to support quality patient care.
    • Example: A patient with Diastolic congestive heart failure and hypertension should be coded as follows annually: Chronic CHF: I50.32 and hypertension with CHF: I11.0.
  • Treatment and care for the condition needs to be supported by documentation and diagnosis capture.
    • Example: Mr. Jones is taking Lisinopril and following up with Cardiology to manage his CHF I150.32.
  • All diagnoses that receive care and management during a patient encounter should be captured.
    • Example: Mr. Jones depression has been stable taking Celexa and seeing his counselor monthly. Recurrent depression would be coded as patient still on medication treatment: F33.81.
  • Conditions that are no longer active and/or not being treated should not be captured/reported. This should include problem list diagnoses that have be resolved.
    • Example: Mr. Jones Type II diabetes has resolved as he has been following a low salt diet and exercise routine. Diabetes Type II E11.9 should be updated on the problem list as “resolved” as it is no longer an active problem.
  • Capture “history of” and “status” of conditions when there is an impact on patient current care or treatment.
    • Example: Mr. Jones has history of prostate cancer. He has been cancer free for 12 years. History of prostate cancer will be captured as: Z85.46.

Diagnoses captured need to be supported by documentation. A diagnosis does not have to be in the assessment portion of the note. Providing a status update is sufficient to capture the diagnosis.

  • Example: Mr. Jones Type I diabetes is stable and is managed by Endocrinology. Type I diabetes E10.9 can be coded as documentation supports diagnosis capture.

Please reach out to Jessica Bryan, with general coding questions and help with capturing HCC codes for 2023.