HCC Coding Education For Family Physicians – AAFP

Specificity and accuracy are the keys to any successful Value-Based Care program. And clinical vignettes are a great way to learn.

 

Five years ago, the AAFP (American Academy of Family Physicians) published a crash course to educate family physicians on HCC coding. To this day, the clinical vignettes from this family physician HCC coding education course are still a great example of how and why family physicians need to diagnose specifically and code accurately in order to fully capture and treat the actual needs of their patients.

 

So if you are trying to educate family physicians on HCC coding, this Crash Course is a great place to start. As always, the M.E.A.T. criteria must be met in order to properly diagnose and accurately code any diagnosis. 

 

What is the M.E.A.T Criteria in HCC coding?

• Monitor – signs, symptoms, disease progression, disease regression 
• Evaluate – test results, medication effectiveness, response to treatment 
• Assess – ordering tests, discussion, review records, counseling 
• Treat – medications, therapies, other modalities

 

And here are the clinical vignettes presented in the AAFP’s HCC Coding Education Crash Course for Family Physicians:

 

Risk Adjustment Scores vs. Optimized Risk Adjustment Scores in Common Primary Care Encounters

Family Physician HCC Coding Example #1

Patient with DM II presents for routine follow-up. A1C 8.3. Also has stable COPD, oxygen dependent. O2 DME papers signed earlier this year.

 

ICD-10	Description	RAF		ICD-10	Description	RAF
J44.9	COPD	0.328		J44.9	COPD	0.328
E11.9	DM Unspec	0.118		Z99.81	Oxygen Dep
				J96.11	Chronic Resp Failure w/ hypoxia	0.318
				E11.65	DM w/ hyperglycemia	0.318
	Total risk=	0.446			Total optimized risk=	0.964

 

 

Family Physician HCC Coding Example #2

68 y/o patient with hypertension and hyperlipidemia and BMI 37.2. Has been using CPAP for years.

 

ICD-10	Description	RAF		ICD-10	Description	RAF
I10	Hypertension			I10	Hypertension
E78.5	Hyperlipidemia			E78.5	Hyperlipidemia
G47.33	Sleep Apnea			G47.33	Sleep apnea
				Z68.37	BMI 37.0-37.9
				E66.01	Morbid Obesity	0.273
	Total risk=	0.00			Total optimized risk=	0.273

 

Family Physician HCC Coding Example #3

Patient with diabetes and polyneuropathy. Right great toe amputated several years ago. He continues to smoke. Patient brought in multiple records from other providers. In addition to refill of meds, you counseled for 5 minutes regarding smoking cessation. You spend 35 minutes reviewing and summarizing the outside records and include that in the visit note.

 

ICD-10	Description	RAF		ICD-10	Description	RAF
E11.9	DM Unspec	0.118		E11.41	DM w/ polyneuropathy	0.318
F17.219	Nicotine dep/cig			F17.419	Nicotine dep/cig
				Z89.412	Acquired loss L great toe	0.588
	Total risk=	0.118			Total optimized risk=	0.906

 

Family Physician HCC Coding Example #4

Patient with HTN comes in for upper respiratory infection. Remote history of colon cancer and now has a chronic colostomy bag. DME orders signed earlier in the year.

 

ICD-10	Description	RAF		ICD-10	Description	RAF
J06.9	Upper Respiratory Infection			J06.9	Upper Respiratory Infection
I10	Hypertension			I10	Hypertension
				Z93.3	Colostomy status	0.651
	Total risk=	0.00			Total optimized risk=	0.651

 

 

Family Physician HCC Coding Example #5

76 y/o presents with swelling of the left arm, redness, and pain. He takes warfarin for atrial fibrillation. He is also a liver transplant patient. Given IM ceftriaxone. PT/INR and CBC ordered.

 

ICD-10	Description	RAF		ICD-10	Description	RAF
L03.114	Cellulitis of L upper ext			L03.114	Cellulitis of L upper ext
I48.91	Unspec afib	0.295		I48.2	Chronic afib	0.295
				Z79.01	Long term anticoag therapy
				Z97.4	Liver transplant status	0.891
	Total risk=	0.295			Total optimized risk=	1.186

 

Family Physician HCC Coding Example #6

Patient for follow-up of major depression, improving. New med started 6 weeks ago.

 

ICD-10	Description	RAF		ICD-10	Description	RAF
F32.9	Major depression, single, unspec			F32.1	Major depression, single episode, moderate	0.33
	Total risk= .000				Total optimized risk=	0.33

 

 

When educating doctors on HCC coding, be sure to avoid common HCC coding pitfalls by remembering these rules:

• Use documentation and coding to capture the severity of illness/risk of high cost

• Make sure that you capture the complexity of the patient

• Major issues need to be captured at least once a year (clock restarts Jan. 1)

 

 

To access the full AAFP HCC Coding Education for Family Physicians Crash Course, Click Here.

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While this crash course is a great place to start, family physicians prefer to learn HCC coding and documentation for Risk Adjustment in the DoctusTech HCC coding education app. It is the only tool that consistently ranks #1 with both physicians and operators. Demo the app today.