Doctustech
Part-3
Multiple HCC Modifiers and details on HCC groupings 15 to 21
In the Part 2 edition of the 4-part series, we discussed the changes in disease + disease interaction modifiers and groupings 8-14 of the V28 hierarchies. In this Part 3 edition of the 4-part series, we will examine the the changes in the multiple HCC modifiers and cover the next 6 grouping
Multiple HCC Modifiers
The last add-on metric to look at is the additional value that is added for having a large number of different HCC categories. Patients with five or more different HCCs will have an additional RAF score added as each added diagnosis increases complexity, cost of care, and difficulty in treating these patients. This add-on has a cap of ten different HCCs. Unlike the previous categories, the changes from v24 to v28 result in a higher value being added to the patient’s risk score in almost every possible grouping. On average, these scores have increased by 37.06%.
HCC number changes and groupings part 3 of 4
In the Part 2 edition of the 4-part series, we covered the HCCs in the groupings for Blood Diseases, Cognitive Diseases, Substance Use Disorders, Psychiatric Diseases, Spinal Diseases, Neurological Diseases, and Arrest Diseases. In this Part 3 edition of the 4-part series, we will cover the next 6 groupings, from Heart Diseases to Kidney Diseases.
15) Heart disease group
New categories were added to this grouping with V28 HCC 221 ( Heart Transplant Status/Complications) and HCC 223 (Heart Assist Device/Artificial Heart). Beyond that, the major change that occurred is that the ICD-10s that belonged to V24 HCC 85 (Congestive Heart Failure) have been separated into 7 different V28 HCCs. Heart failure itself now hasm 5 different HCCs depending on the staging and severity of the disease.
V24 HCC 85
–One code (endstage heart failure) is moved to V28 HCC 222 (End Stage Heart Failure) with an increase in RAF of 4.089
–The codes for acute on chronic heart failure have moved to v28 HCC 224 (Acute on Chronic Heart Failure) with a resulting RAF increase of 0.012
–Codes relating to acute heart failure were moved to V28 HCC 225 (Acute Heart Failure (Excludes Acute on Chronic)) with an increase in RAF of 0.012
–Codes related to unspecified heart failure and pulmonary hypertension were moved to V28 HCC 226 (Heart Failure, Except End Stage and Acute) with an increase in RAF of 0.012
–Most codes related to cardiomyopathy were added to V28 HCC 227 (Cardiomyopathy/Myocarditis) with a decrease in RAF of 0.217
–Codes related to PE with acute cor pulmonale have been moved into the vascular disease grouping in V28 HCC 267(Deep Vein Thrombosis and Pulmonary Embolism) with an increase in RAF of 0.030
–One code, cardiomyopathy due to drugs was removed from the model
V24 HCC 86 (Acute Myocardial Infarction) had most of its codes moved to V28 HCC 228 (Acute Myocardial Infarction) with an increase in RAF of 0.052
–The exception to this are the codes related to the rupture chordae tendineae or papillary muscle which were moved to V28 HCC 229 (Unstable Angina and Other Acute Ischemic Heart Disease) with RAF decreasing by 0.011
V24 HCC 86 (Acute Myocardial Infarction) had most of its codes moved to V28 HCC 228 (Acute Myocardial Infarction) with an increase in RAF of 0.052
V24 HCC 88 (Angina Pectoris) had all of its codes removed from the model
V24 HCC 96 (Specified Heart Arrhythmias) had most codes moved to V28 HCC 238 (Specified Heart Arrhythmias) with an increase in RAF of 0.016
–The exception to this are the codes related to the rupture chordae tendineae or papillary muscle which were moved to V28 HCC 229 (Unstable Angina and Other Acute Ischemic Heart Disease) with RAF decreasing by 0.011
16) Cerebrovascular Disease Group
Very few changes in assignment of codes between V24 and V28
V24 HCC 99 (Intracranial Hemorrhage) had all of its codes moved to V28 HCC 248 with a decrease in RAF of 0.006
V24 HCC 100 (Ischemic or Unspecified Stroke) had most codes moved to V28 HCC 249 (Ischemic or Unspecified Stroke) resulting in a decrease in RAF of 0.019
V24 HCC 100 (Ischemic or Unspecified Stroke) had most codes moved to V28 HCC 249 (Ischemic or Unspecified Stroke) resulting in a decrease in RAF of 0.019
V24 HCC 103 (Hemiplegia/Hemiparesis) had all of its codes moved to V28 HCC 253 (Hemiplegia/Hemiparesis) with an increase in RAF of 0.021
HCC 104 had all of its codes moved to V28 HCC 254 (Monoplegia, Other Paralytic Syndromes) with an increase in RAF of 0.018
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17) Vascular Disease Group
Many codes from this group were removed from the model, including many commonly used codes for peripheral vascular disease. Details are as follows:
V24 HCC 106 (Atherosclerosis of the Extremities with Ulceration or Gangrene) had most of its codes moved to V28 HCC 263 (Atherosclerosis of Arteries of the Extremities with Ulceration or Gangrene) with RAF decreasing by 0.426
–Exceptions to this were codes relating to drug-induced diabetes with vascular disease with gangrene were removed from the model
V24 HCC 107 (Vascular Disease with Complications) was dived into V28 HCC 264 (Vascular Disease with Complications), 267 (Deep Vein Thrombosis and Pulmonary Embolism), and 383 (Chronic Ulcer of Skin, Except Pressure, Not Specified as Through to Bone or Muscle)
–Codes moving to V28 HCC 264 includes codes for dissection and ruptured aneurysms, thrombosis or aorta and atheroemboli of extremities. These codes had an increase in RAF of 0.015
–Codes moving to V28 HCC 267 include codes for chronic PE and codes about cor pulmonale. These codes had a decrease in RAF of 0.067
–Codes moving to V28 HCC 383 include codes for ulcers in varicose veins, ulcers in chronic venous HTN, and post-thrombotic ulcers. These codes had an increase in RAF of 0.214
Codes that were removed from the model are extensive and include
-Codes relating to discection of the arteries of head, neck and extremities as well as unspecified dissection of artery
-Codes relating to acute ischemia and infarction of the intestines
-Codes for necrotizing entrocolotis
-One code for ischemia and infarct of kidney
V24 HCC 108 (Vascular Disease) had a few codes divided and the rest removed from the model
–Codes for necrotizing vasculopathies were moved to V28 HCC 94 in the musculoskeletal disease grouping for a decrease in RAF of 0.058
–Codes moving to V24 HCC 264 are the codes relating to atherosclerosis of the extremities with rest pain resulting in an increase in RAF of 0.218
–Codes moving to V28 HCC 267 include codes for acute and chronic embolism and thrombosis of most veins not in the heart, lung, or brain with a resulting RAF increase of RAF 0.136
Codes that were removed from the model include
–Codes for diabetes with PVD without gangreane
–Codes for altherlscloris with with no pain or intermittent claudication
–Codes for unruptured aneysusms of vessels
–Codes for peripheral vascular disease unspecified or other
–Codes for aortic stricture or ectasia
–Codes for vascular disease of the intestine
18) Lung Disease Group
This group adding two new HCCs, V28 HCC 276 (Lung Transplant Status/Complications) and V28 HCC 279 (Severe Persistent Asthma). Most HCCs in this grouping had minor changes, with the exception of V24 HCC 112 (Fibrosis of Lung and Other Chronic Lung Disorders) which had several codes removed and the rest dived between V28 HCC 278 (Idiopathic Pulmonary Fibrosis and Lung Involvement in Systemic Sclerosis) and 280 (Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders). Details are:
V24 HCC 110 (Cystic Fibrosis) has all of its codes moved to V28 HCC 277(Cystic Fibrosis) with an increase in RAF of 0.457
V24 HCC 111 (Chronic Obstructive Pulmonary Disease) had all of its codes moved to V28 HCC 280 with a decrease in RAF of 0.036
V24 HCC 112 (Fibrosis of Lung and Other Chronic Lung Disorders) had several codes removed and the rest divided
–Codes relating to pulmonary fibrosis and systemic sclerosis with lung involvement moved to V28 HCC 278 with an increase in RAF of 0.787
–Most codes moved to V28 280 with an increase in RAF of 0.072
–The codes that were removed from the model include sarcoidosis of lung, drug induced insterstital lung disorders, respiratory conditions due to smoke inhalation or other specified agents, and other rare conditions
V24 HCC 114 (Aspiration and Specified Bacterial Pneumonias) had most of its codes moved the V28 HCC 282 (Aspiration and Specified Bacterial Pneumonias) with a decrease in RAF of 0.048
–Also a single code for ventilator associated pneumonia moved to the arrest disease group v28 HCC 211 (Respiratory Dependence/Tracheostomy Status/Complications) with an increase in RAF of 0.751
V24 HCC 115 (Pneumococcal Pneumonia, Empyema, Lung Abscess) had most of its codes removed from the model. This includes codes for pulmonary histoplasmosis, blastomycosis, and coccidomycosis as well as pneumonia due to H. influenzae, Strept pneumo, and unspecified lobar pneumonia
–Codes relating to lung abscesses and gangrene of the lung were moved to V28 HCC 283 (Empyema, Lung Abscess) with a decrease in RAF of 0.004
19) Eye Disease Group
This group was largely unchanged by the V24-28 conversion
V24 HCC 122 (Proliferative Diabetic Retinopathy and Vitreous Hemorrhage) had most of its codes moved to V28 HCC 298 (Severe Diabetic Eye Disease, Retinal Vein Occlusion, and Vitreous Hemorrhage) with an increase in RAF of 0.099
–Codes relating to drug-induced diabetes with retinopathy were removed from the model
V24 HCC 124 (Exudative Macular Degeneration) had all of its codes moved to V28 HCC 300 (Exudative Macular Degeneration) with an increase in RAF of 0.100
20) Kidney Disease Group
This group had two major HCCs and all codes in them removed from the model, V24 HCC 134 (Dialysis Status) and V24 HCC 135 (Acute Renal Failure). The other significant change to this grouping is the splitting of CKD 3 into separate HCCs for stages 3a and 3b. Details are:
V24 HCC 136 (Chronic Kidney Disease, Stage 5) had all of its codes moved to V28 HCC 326 (Chronic Kidney Disease, Stage 5) with an increase in RAF of 0.674
V24 HCC 137 (Chronic Kidney Disease, Severe (Stage 4)) had all of its codes moved to V28 HCC 327 (Chronic Kidney Disease, Severe (Stage 4)) with an increase in RAF of 0.347
V24 HCC 138 (Chronic Kidney Disease, Moderate (Stage 3)) was divided
–Codes relating to CKD stage 3b were moved to V28 HCC 328 (Chronic Kidney Disease, Moderate (Stage 3B)) with an increase in RAF of 0.116
–Codes relating to CKD stages 3a or unspecified were moved to V28 HCC 329 (Chronic Kidney Disease, Moderate (Stage 3, Except 3B)) with an increase in RAF of 0.116
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