Health Information Management

Q&A: Capturing comorbid conditions in provider-based clinics

CDI Strategies, November 20, 2014

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Q: I work in a large, provider-based orthopedic clinic with a rheumatology department that has many patients who are very ill with several comorbid conditions. Does the physician need to document every comorbid condition that impacts his or her medical decision making for each encounter? Do we need to code every comorbidity each time in order to meet hierarchical condition category (HCC) requirements?

A: The condition only has to be reported once per calendar year. Ideally, you're going to capture that in each encounter that it's relevant for, but it doesn't have to be documented, coded, and billed for every encounter.

This can be challenging due to the problem list. Just because the physician documented it on the problem list last year, doesn't mean you don't have to address it this year. At least once a year, even if it's already been addressed and documented, you have to revalidate that information for HCCs.

I've reviewed many records with chronic conditions appearing on the problem list that the provider sees in the electronic health record and doesn't document again. That's a problem because coders can't code off the problem list.

Editor’s note: Elaine King, MHS, RHIA, CHP, CHDA, CDIP, FAHIMA, AHIMA-approved ICD-10 CM/PCS trainer, senior HIM consultant for Nuance Communications in Dunwoody, Georgia, and Bonnie S. Cassidy, MPA, RHIA, FAHIMA, FHIMSS, AHIMA-approved ICD-10-CM/PCS trainer, senior director of HIM innovation for Nuance Communications in Atlanta answered this question. This Q&A was adapted from

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