Ask An Expert: risk adjusted diagnoses
| Q: | A specialist’s consultation report came back three weeks after our patient had a face-to-face visit with the PCP, and revealed some new risk adjusted diagnoses. Can my PCP make an addendum and report them? |
| A: |
Probably not. An addendum is used when the patient was assessed for a condition during the visit and the PCP needed some additional information, to be received very timely, in order to make a definite diagnosis. Addenda are not used … Read Full Post |
| Q: | How does risk adjusted payment work with regard to hierarchies? I’ve heard that some ICD-9-CM codes ‘trump’ others. |
| A: |
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’ … Read Full Post |