The Department of Justice, Office of Public Affairs released a notice on Jan. 14, 2026 stating that the government had entered into a settlement with Kaiser Permanente, et al for false claims related to HCC coding. The government contended that Kaiser had overbilled CMS by a billion dollars over a nine-year period. Kaiser agreed to […]
Depression Coding and 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 V28 of HCC, […]
HCC Coding for Medical Practices | Webinar
Recorded March 19th, 2026
1 CEU expires 3/30/27
Risk adjustment coding is a hot topic for Medicare Advantage Organizations and medical practices with risk-based contracts. It’s one of the pillars of payment for Value Based Care. At this webinar, participants will learn how Hierarchical Condition Categories work based on ICD-10-CM rules.
Diabetes Coding in Hierarchical Condition Coding (HCC)
Diabetes is a common chronic condition, included in three distinct HCC categories Patients often have more than one chronic condition of the disease; page down for a Q&A related to how multiple conditions do–and don’t–affect the risk score CodingIntel members can download our guide to Risk Adjusted Diagnosis Coding for Medical Practices for more explanation and […]
Compliance Issues in ICD-10 Coding for Risk Based Contracts and HCCs
How to be a great HCC coder? Know ICD-10-CM Official Guidelines for Coding and Reporting During an encounter: Code conditions assessed and managed. If treatment of an acute or chronic problem is affected by an ongoing condition, note that, and add the ongoing condition to the claim form. If the condition has a manifestation or […]
Coding Guide – Risk Adjusted Diagnosis Coding for Medical Practices
Payment systems and reimbursements are ever-changing in healthcare and the rules of yesterday may or may not work tomorrow. This 24 page guide from CodingIntel is an introduction to risk adjustment coding and the risk adjustment factor (RAF).
Coding for Hypertension in the HCC System | Reference Sheet
This quick reference sheet simplifies coding for hypertension in the HCC system. A must-have resource for clinicians who see patients with hypertension.
Diabetes Coding in V28
This quick reference sheet simplifies coding for diabetes in the HCC system. A must-have resource for clinicians who see patients with diabetes.
HCC Coding: V24 to V28
The transition from V24 to V28 of the HCC model is almost in the rear view mirror. For most groups with risk contracts, this really is old news. We’ve left the video for another year for anyone who needs to catch up on the overview of the change. CMS pays Medicare Advantage (MA) plans using […]
HCC’s in Brief | The Difference Between CMS-HCC and HHS-HCC
Demographics and diagnoses Risk adjusted diagnosis coding is a model used to predict future health care costs based on demographics and diagnoses. It is most commonly used by Medicare to set rates for patients who are in Medicare Advantage plans. A Medicare Advantage plan is paid different amounts for the Medicare patients they cover. The […]
HCC Coding: Round Up of Chronic Conditions
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 […]
HCC Diagnosis Coding: Can you Add a Code from the Past Medical History?
This post describes rules for office/outpatient coding, not facility/DRG rules. Recently a fellow coder wrote to me about risk adjusted diagnosis coding. She was responding to an article that I wrote in which I stated the conditions listed in the past medical history should not be included on the claim form by the coder. I […]
What’s the Difference Between B20 and Z21? Which is Right for Positive HIV Status?
In this post ICD-10-CM diagnosis coding for positive HIV status Medical practice reimbursement for individual claims based on CPT® Common HIV diagnosis codes Question: For an HIV positive patient without symptoms, is the correct diagnosis code Z21 or B20? What difference does it make to reimbursement? Answer: Following ICD-10 guidelines, a patient with HIV status […]