Unfortunately, many healthcare providers don’t accurately capture all medical conditions in their patient documentation, resulting in inaccurate or missed hierarchical condition category (HCC) codes. One of the essential HCC coding tips you’ll learn is to never overlook chronic conditions, even if they’re not being actively treated.

The fact that these conditions are part of your patient’s medical history means that they still influence patient care. As such, you need to be aware of the most commonly missed codes so you are extra careful when doing your HCC coding.

Knowing the codes that are frequently overlooked will help you choose the right HCC coding solution to reduce your risk of missing them. In this post, we’ll explore some of the most commonly missed HCC codes.

Transplant Status Codes

Transplant status codes need to be entered into the system when the patient record indicates that they had a tissue or organ transplant. A transplant impacts future medical care, even if the transplant doesn’t develop complications.

For instance, your transplant patient may require continuous monitoring and the use of medication that prevents organ rejection for the rest of their life. Don’t overlook any transplant in your patient’s record even if their visit to your facility isn’t related to that procedure.

The Tabular List of ICD-10-CM contains an Excludes1 statement explaining that you don’t have to report the transplant status category Z94-code if the transplant complication has already been recorded. When there is an issue, it’s your responsibility as the healthcare provider to determine whether to report the code as transplant status or transplant complication. 

Here are some of the transplant status codes you should report:

• Z94.81 bone marrow transplant status code
• Z94.0 kidney transplant status code
• Z94.2 lung transplant status code
• Z94.1 heart transplant status code

Here are common transplant complication codes you should report yearly:

• T86.811 lung transplant failure code
• T86.810 lung transplant rejection code
• T86.812 lung transplant infection code
• T86.818 other lung transplant complications code
• T86.01 bone marrow transplant rejection code
• T86.03 bone marrow transplant infection code
• T86.02 bone marrow failure code
• T86. 09 other bone marrow complications code

Amputation Status Codes

Amputation HCC codes are often missed, especially when they aren’t obvious in test results. These codes should be reported because the amputee might need special care, even when they visit your facility looking for medical care for conditions not related to the amputation.

There are two categories of amputation codes: amputation status codes and amputation compilation codes.

Amputation status codes include:

• Z89.411 acquired absence of right great toe code
• Z89.412 acquired absence of left great toe code
• Z89.431 acquired absence of right foot code
• Z89.432 acquired absence of left foot code

Amputation complication codes include:

• T87.81 dehiscence of amputation stump code
• T87.89 other complications of amputation stump code

Diabetes With Complication Codes

Diabetes is a severe chronic condition that requires long-term use of medication. However, it’s very easy for healthcare providers to miss codes related to diabetic complications.

For one, some healthcare providers overlook the long-term use of insulin (Z79.4 long-term use of insulin code). You need to understand all potential issues when reporting about diabetes and related complications.

Codes for patients with diabetes without complications are:

• E10.9 Type 1 diabetes mellitus without complications code
• E11.9 Type 2 diabetes mellitus without complications code

Codes for diabetes with complications include:

• E10.40 type 1 diabetes mellitus with diabetic neuropathy, unspecified code
• E10.621 type 1 diabetes mellitus with foot ulcer code
• E11.40 type 2 diabetes mellitus with diabetic neuropathy, unspecified code
• E11.621 type 2 diabetes mellitus with foot ulcer code

This list should help you evaluate your patient’s documentation to identify any HCC codes you may have missed. 

In Summary

As a healthcare provider dealing with high-risk patients, the worst mistake you can make is overlooking serious conditions when entering information to adjust the health risks of the patient. Use Inferscience to capture all chronic illnesses of your patients at least once per year to ensure that you’re well-prepared with the right resources and get appropriate reimbursement for your services!

References:

https://www.aapc.com/blog/83868-top-miscoded-hccs/

https://www.rcxrules.com/blog/common-hcc-codes