Introduction | Depression coding in HCC

In fee-for-service medicine:

Diagnosis coding establishes the medical necessity for a service. At times, it 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 V28 of HCC, fewer codes in categories F32 and F33 risk adjust.

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.