HCC Blog by Caridad

  Learn about the financial relationships that doctors and other healthcare providers have with drug and medical device companies. 2022 data is available

OIG shared this 48 page Toolkit To Help Decrease Improper Payments in Medicare Advantage Through the Identification of High-Risk Diagnosis Codes released December 2023. What Is the Toolkit?  "This toolkit is meant to be a practical, hands-on device that will help MA organizations improve the accuracy of their submitted diagnoses that are at high risk for being miscoded." It includes a list of high-risk diagnosis codes that are consistently submitted to CMS.  This specifically helps the MA plans to adapt actual programming codes to query its internal data systems to accurately identity the enrollees in these high-risk groups. There is programming language included as well. https://oig.hhs.gov/oas/reports/region7/72301213.pdf

 Here is a great article about the "Pill-in-the-Pocket" approach to treating atrial fibrillation. Enjoy [Peer-Reviewed, Web Publication] Feiger, D. Andereck, J. (2020, Nov 2). A “Pill-in-the-Pocket” approach to paroxysmal atrial fibrillation. [NUEM Blog. Expert Commentary by Patil, K]. Retrieved from http://www.nuemblog.com/blog/pill-in-pocket. https://www.nuemblog.com/blog/pill-in-pocket

Here is an online tool to help with finding ICD-11 codes.  It is the 'ICD-11 Coding Tool Mortality and Morbidity Statistics (MMS) 2023-01'. https://icd.who.int/ct11/icd11_mms/en/release Type in a diagnosis term and the system will show you the code. For example, I typed in 'type 2 diabetes', the code is 5A11. There are some other options in the list as well: This can help us become more familiar with this code set.  Disclaimer: This guidance is to be used for an easy reference; the ICD-9-CM and ICD-10-CM code books and the Official Guidelines for Coding and Reporting are the authoritative references for accurate and complete coding. This blog may contain references or links to statutes, regulations, or other policy materials. It is not intended to take the place of either the written law or regulations.  The information presented herein is for general informational purposes only and is accurate as of the date of publication.

 Here is a post from the National Cancer Institute, SEER Training Modules, on International Classification of Diseases for Oncology (ICD-O), third edition, morphology coding. By visiting the webpage you can read about coding for morphology. https://training.seer.cancer.gov/coding/guidelines/morphology.html Also, separately, the ICD-O by World Health Organization, has been used for nearly 35 years, principally in tumor or cancer registries, for coding the site (topography) and the histology (morphology) of the neoplasm, usually obtained from a pathology report. If you want to take a look check out:    https://apps.who.int/iris/bitstream/handle/10665/96612/9789241548496_eng.pdf    if the link doesn't work, enter ICD-O in your browser search engine. The differences between ICD-O and ICD-10 are on page 4 of the pdf. The snip below is on coding for Morphology. https://training.seer.cancer.gov/coding/guidelines/morphology.html Disclaimer: This guidance is to be used for an easy reference

  CMS-Hierarchical Condition Categories (CMS-HCC) Risk Adjustment Model (Non-PACE) In the proposed CY 2024 Advance Notice, on page 3, there is a proposed announcement that the risk scores will be calculated as a blend of 67% of the risk scores calculated with the current model (the 2020 model) and 33% of the risk scores calculated with the updated model (the 2024 model). For CY 2025, they expect risk scores to be calculated as a blend of 33% of the risk scores calculated with the 2020 model and 67% of the risk scores calculated with the 2024 model, and for CY 2026 , they   expect 100% of the risk scores to be calculated with the 2024 model. Link to the document:  Announcement March 31 2023 file:///C:/Users/cjtrujillo/Downloads/2024%20Rate%20Announcement%20033123_FINAL508.pdf Disclaimer: This guidance is to be used for an easy reference; the ICD-9-CM and ICD-10-CM code books and the Official Guidelines for Coding and Reporting are the authoritative references for accurate and co