Depression coding in Hierarchical Condition Coding (HCC)

Introduction | Depression coding in HCC

In fee-for-service medicine:

Diagnosis coding establishes medical necessity, and may be the reason for a denial, particularly for diagnostic tests or procedures. Services with national or local coverage policies often have specific diagnosis codes that are required for payment.

In risk based contracts or Accountable Care Organizations (ACOs):

Payers assess the acuity of a panel of patients, and use that acuity along with age/gender distribution, cost, quality and outcomes, to provide incentive payments or decrease payments at the end of a contract year.

What should physicians and other practitioners do?

Document underlying medical problems that require or affect treatment—even if you are not treating the problem at this visit.

CodingIntel members can download the entire Risk Based Diagnosis Coding (Billing Guide) for more explanation and examples. This article is specific to depression.

Our mission is to provide accurate, comprehensive, up-to-date coding information, allowing medical practices to increase revenue, decrease coding denials and reduce compliance risk. That's what coding knowledge can do.

In 1988, CodingIntel.com founder Betsy Nicoletti started a Medical Services Organization for a rural hospital, supporting physician practice. She has been a self-employed consultant since 1998. She estimates that in the last 20 years her audience members number over 28,400 at in person events and webinars. She has had 2,500 meetings with clinical providers and reviewed over 43,000 medical notes. She knows what questions need answers and developed this resource to answer those questions. For more about Betsy visit www.betsynicoletti.com.