HCC Coding and Medicare Advantage

"From the December 2013 Chat": Free for all! Get CEU's!"

Q #1: Alicia, would you please explain “Medicare Advantage Coding” please?

A: That has to do with HCC Coding, Medicare Advantage, and they do diagnosis coding. So, Medicare Advantage Coding is done for HCC Coding and that’s hierarchical coding. It’s done for projection on how much they need to set aside for a patient for the next year. So, if a person has diabetes and that’s all that they have, then they know to set aside there would be a specific number like a 19; so for 19 they set aside x amount for the next year. If a person is a diabetic, has hypertension and high cholesterol and also has had their toe amputated, then those all get HCC codes and they know to set more money aside. And it has to be a diagnosis code that is – you know, not all diagnoses have HCCs only ones that are life-altering like diabetes.

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