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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

Part 1
Part 2
Part 3
Part 4

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%.

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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

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

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 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

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 that were removed from the model are extensive and include

V24 HCC 108 (Vascular Disease) had a few codes divided and the rest removed from the model

Codes that were removed from the model include

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

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

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

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

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

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