HCC Coding

We have begun auditing some HCC coders, but I have some questions before I proceed. If a provider links a diagnosis to a lab within the progress note, would you add the HCC to the claim without any further documentation?
In my opinion, I would expect to see some more documentation, like the stability of the condition or the med the patient is on etc. Something in the provider's own words as opposed to a "click".

Also, what documentation is needed to support a condition as being managed. For example, in the HPI it states "She has cardiomyopathy. She is on a beta blocker to promote optimal heart pumping. Her last echo was in March 2015."
Then they have Cardiomyopathy listed in the assessment, but there is no treatment plan for the condition. Is this enough to give credit for this condition for HCC purposes?

Any feedback is appreciated.


  • I agree with your first question. In order to bill the diagnosis for an OV, I expect to see a discussion. If it is only linked to a lab I only tie it to the lab. Unless it's a new diagnosis, then I ask the doctor to clarify where the diagnosis originated.

    I was told by one Risk Adjustment plan that they expect to see a plan or assessment for each condition being billed. But another one recently told us as long as the condition is mentioned they count it.

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