By now, you may have come to terms that MRA, as we know it, is on its way out. If you’re not informed about the changes for 2024, we urge you to read the first installment of this article series. In this article, we’ll cover the commonly coded conditions in primary care that are slated for removal from the CMS-HCC model. The list below does not reflect all of the codes being removed from the current model. For a complete list of the 2024 CMS-HCC model, including tabs for the removed and added codes, please click here.
Hematological
- Anemias due to enzyme deficiencies
- Hemolytic & aplastic anemias
- Alpha and other thalassemias
- Sickle cell trait
- Coagulation defects
- “Penias” such as thrombocytopenia, neutropenia, pancytopenia
- Immunodeficiencies
- Purpuras
Endocrine
- Drug or chemical induced diabetes mellitus (with all manifestations)
- Glandular conditions, such as those affecting the parathyroid, pituitary and thymus
- Malnutrition
- Metabolic disorders such as carnitine deficiencies, homocystinuria
Substance Use Disorders
- Alcohol & cannabis use and abuse with intoxication (with/without other complications)
Psychiatric
- Bipolar disorder in remission
- Major depressive disorder, single and recurrent episodes, mild
- Major depressive disorder, single and recurrent episodes, in remission
Neurological
- Degenerative diseases of the nervous system (including cerebral atrophy)
- Polyneuropathies, including inflammatory, radiation-induced and those in diseases classified elsewhere
- Guillain-Barre syndrome
Cardiac
- Anginas (except unstable)
- Supraventricular tachycardia
- All ASHDs with angina (except unstable)
- Atherosclerosis of aorta
- Atherosclerosis of renal artery
- All atheroscleroses of the lower extremity (except with rest pain or ulcer)
- All unruptured aneurysms
- Peripheral vascular disease
- Other arterial conditions, such as tortuous, ectatic, dissection of arteries, including intestinal
Rheumatological
- Most Sjogren’s syndrome (except with lung involvement)
- Polymyalgia rheumatica
- Connective tissue diseases
- Spinal enthesopathy
- Sacroiliitis
- Infective & inflammatory spondylopathies
Renal
- Acute kidney failure
- Hyperparathyroidism of renal origin
Other
- Toe amputations
- Dependence on renal dialysis
As a company in the risk adjustment space since 2003, this list leaves us speechless, but honestly, we’ve seen some of these removals coming. Regardless of the tenuous connection to future medical costs and the fact that many of these conditions are reported by some providers without foundation, the losses in funding will be huge. If you’re reaching for whiskey or Häagen-Dazs®, take heart. First, some interesting codes were added to the CMS-HCC model: benign carcinoid tumors, retinal vein occlusions, severe asthma, phemigoids and malignant ascites. And second, read on for some things you can do right now to soften the landing for your practice.