Risk adjusted diagnoses are classified into hierarchical condition categories (HCCs). Some HCCs are in a hierarchy. Imagine the HCCs on a ladder, if you will. As you climb up the HCC ladder, the HCCs on the lower rungs are ‘replaced’ by the HCCs on the higher rungs. Here are some examples:

• HCC 19 – if this is the only one reported, it is included in the payment
• HCC 18 – if 19 and 18 are reported, 19 is dropped and only 18 is included in the payment
• HCC8 – Metastatic cancer trumps primary cancers (HCCs 9, 10, 11 & 12)

However, as we explained in this Ask An Expert answer, it’s best to report all the MRA diagnoses documented by the clinician, despite any hierarchy issues unless there a specific coding guideline that precludes it.