| ICD-10 | DESCRIPTION | RAF |
|---|---|---|
| Demographics (age and gender) | 0.323 | |
| E11.9 | Type 2 diabetes mellitus without complications | 0.105 |
| I10 | Essential (primary) hypertension | 0.000 |
86 HCC codesThere are more than 9,700 ICD-10-CM codes that map to one or more of the 86 HCC codes included in the 2020 CMS-HCC Risk Adjustment Model (Version 24).
HCCs, or Hierarchical Condition Categories, are sets of medical codes that are linked to specific clinical diagnoses. Since 2004, HCCs have been used by the Centers for Medicare and Medicaid Services (CMS) as part of a risk-adjustment model that identifies individuals with serious acute or chronic conditions.
Optimal coding would include the major depression (HCC 59) with a weight of 0.309, morbid obesity (HCC22) with a weight of 0.250 and type 2 diabetes with chronic com- plications HCC 18 (because of the proteinuria) with a weight of 0.302.
CMS HCCs are used to calculate risk-adjusted reimbursement rates for patients enrolled in Medicare and Medicare Advantage programs. HHS uses a different set of HCCs to determine risk-adjustment reimbursement rates for those with insurance plans on the Affordable Care Act (ACA) marketplace.
CMS hierarchical condition categoriesThe CMS hierarchical condition categories (CMS-HCC) model, implemented in 2004, adjusts Medicare capitation payments to Medicare Advantage health care plans for the health. expenditure risk of their enrollees. Its intended use is to pay plans appropriately for their. expected relative costs.
HCC Coding 101 CMS uses HCCs to reimburse Medicare Advantage plans based on the health of their members. It pays accurately for the predicted cost expenditures of patients by adjusting those payments based on demographic information and patient health status.
What is hepatocellular carcinoma (HCC)? Hepatocellular carcinoma is the most common form of liver cancer. It is a serious illness that can be life-threatening. If it diagnosed early, hepatocellular carcinoma can be treated with surgery to remove the cancerous tumor or with a liver transplant.
The 2019 CMS risk adjustment model is version 23. The Centers for Medicare & Medicaid Services (CMS) released, in April, the latest update to the CMS-hierarchical condition category (HCC) Risk Adjustment Model (V23). It applies to payment year 2019.
29) all map to HCC 85 (Heart Failure)....Table 2.HCCCategory DescriptionRelative Factor110Cystic Fibrosis0.509111COPD0.335112Fibrosis Of Lung and Other Chronic Lung Disorders0.2168 more rows
The CMS- HCC model adjusts Part C monthly payments to Medicare Advantage plans and PACE organizations. Risk scores are relative and reflect the standard benefit: Each beneficiary's risk score is calculated to estimate that specific beneficiary's expected costs, relative to the average beneficiary.
There are three types of HCC review processes Prospective, Retrospective and Concurrent review.
71,000For 2021, there are over 71,000 ICD-10-CM diagnosis codes in 86 categories for the CMS-HCC Version 24 risk adjustment model. HCCs reflect hierarchies among related disease categories.