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Depression coding in Hierarchical Condition Coding (HCC)

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 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?

Follow ICD-10 rules. The General Guidelines for outpatient visits say, “Code all documented conditions which exist at the time of the visit that require or affect patient care or treatment.” If the patient’s underlying medical problems that require or affect treatment, document them in the assessment/plan and use those codes on the claim form.

For example, a surgeon sees patient with kidney disease, diabetes and heart disease, and sends the patient for pre-op clearance.  The patient’s underlying medical conditions affect the surgeon’s treatment of the patient.  The surgeon should report these underlying conditions that affect the patient’s treatment. Of course, this needs to be documented in the assessment and plan and show the surgeon’s clinical thinking.

CodingIntel members can download the entire Risk Based Diagnosis Coding (Billing Guide) for more explanation and examples.  This article is specific to depression. To unlock the rest of this article, more on HCC and risk adjusted diagnosis coding, and access our comprehensive coding resource library, become a member. Already a member? Login

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Relevant Search Terms: HCC, risk based coding, depression risk coding, ICD-10 diagnosis coding, risk adjustment scores

Last revised December 28, 2020 - Betsy
Tags: diagnosis coding, HCC, ICD-10, primary care, psychiatry, risk adjusted coding

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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.

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