Under the MA program, the Centers for Medicare & Medicaid Services (CMS) makes monthly payments to MA organizations according to a system of risk adjustment that depends on the health status of each enrollee. The OIG continues to perform audits of HCC codes this has been on the organization’s work plan for years. Because MA plans are federally funded, the Office of Inspector General (OIG) and the United States Department of Justice (DOJ) conduct coding audits to confirm there is documentation in the record to support HCC diagnosis codes. HCC diagnosis codes are used in payment to Medicare Advantage (MA) risk adjustment plans. It also applies to documentation and coding of hierarchical condition category (HCC) diagnoses – if an HCC diagnosis is not documented and supported with Monitoring, Evaluating, Assessing or Treating (MEAT) criteria, then it should not be coded and submitted on a claim. I have used this statement while teaching ICD-10-CM and CPT® coding classes. I have used this statement educating physicians and nurses on the importance of accurate and complete documentation of the patient’s clinical picture. The OIG and DOJ expect compliant HCC documentationĪs a clinical documentation integrity (CDI) and coding professional, I’ve often heard the statement: This article originally appeared in Revenue Cycle Advisor. Be sure to review all documentation specific to your individual scenario before determining appropriate action. ” This answer was provided based on limited information. It could have been imported as part of a template, but it won’t necessarily meet the MEAT or TAMPER criteria.Įditor’s Note: Shea Lunt, RHIA, CPC, CPMA, PMP, a consultant for Haugen Consulting Group, answered this question during the HCPro webinar, “ HCCs: Physician Practice Coding and Documentation Strategies for Success. You might see documentation differ between providers, but as long as it meets the MEAT criteria or the TAMPER (treatment, assessment, monitor, plan, evaluate, and referral) criteria, a condition can be coded from anywhere in the note-except for the problem list.ĭo not code off the problem list unless it is specifically addressed in the note. Only one element of MEAT is needed, but the more elements included in the documentation, the better. “Treated” is any note about medication, therapy, surgery, or any other modality addressing treatment of the condition.“Assessed” is for whether there are any tests, discussion, review of records, or counseling.Is there some statement regarding medication efficacy or treatment response? For “evaluated,” look at whether there were test results.“Monitored” could be things such as signs or symptoms or disease progression or regression in the notes.As long as the documentation meets the MEAT (monitored, evaluated, assessed, treated) criteria, it can be reported from anywhere in the note. The coding guidelines don’t change with HCCs. Q: What clinical documentation is acceptable to pull Hierarchical Condition Category (HCC) information from for reporting purposes? Would you code from history of present illness, past medical history, active problem list, or the assessment?Ī: Follow the coding guidelines when reporting diagnosis codes for HCC purposes.
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