This article will describe risk coding for a few common, chronic illnesses. This article isn’t comprehensive about all chronic conditions.  My focus in this article is on commonly seen conditions in medical practices. If a condition is prevalent, then coding for it accurately is important in risk based diagnosis coding.

Key points in coding chronic conditions and HCC codes

• Remember that conditions need to be reported annually. Some consultants advise reporting chronic conditions twice yearly, if the patient is seen. If a claim is denied, the diagnosis codes don’t get to the payer. The payer wipes the slate clean and doesn’t credit conditions that were reported last year. Medicare Advantage Organizations are prohibited from using diagnoses unless they were reported in the calendar year.  This year’s diagnoses determine the subsequent year’s payments.
• Conditions are reported when managed and assessed by an eligible professional at an encounter.
• Be specific when reporting chronic conditions, whenever possible.
• If the chronic condition has a code for a manifestation or complication, and that describes the patient, use that code. “with claudication” with spasm” “with ulceration.”
• Examples below are HCC V28