Physician Practice

Q&A: Physician documentation needed to meet HCC coding requirements

Physician Practice Insider, January 13, 2015

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 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 it during each encounter for which it is relevant, but it doesn't have to be documented, coded, and billed for every encounter for purposes of calculating HCCs.

Meeting these requirements 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. Even if the physician already addressed and documented it, you have to revalidate that information for HCCs at least once per year.

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: This question was originally answered in the HCPro newsletter, Briefings on APCs.

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