Originally published on kevinmd.com

When I talk to medical practices about Hierarchical Condition Category (HCCs) and risk-adjusted diagnosis coding, I receive a lot of questions that point to the existence of persistent urban legends. Let’s separate fact from fiction.

Don’t miss our Billing Guide on Risk-adjusted Diagnosis Coding for an in-depth look at this topic.

Urban legend #1:  CPT^® fee-for-service coding will be a distant memory when we switch from volume to value

Not anytime soon. Medicare’s newer payment models including Alternative Payment Models (APMs)and Accountable Care Organizations (ACOs) are built on top of fee-for-service coding.

One of the key metrics of success in the ACO model is the cost benchmark. Did the ACO spend more or less than the benchmark in caring for the patients attributed to it? And cost is measured based on—you guessed it–fee-for-service claims submitted for the attributed beneficiaries during the contract year. Medical practices will be submitting claims with CPT and HCPCS codes for the foreseeable future.