In the early days of the CMS-HCC model, providers were not versed at all on the inner workings of the risk adjusted payment paradigm or the conditions included. And admittedly, much has changed in these 18 years. Most providers know that diabetes, congestive heart failure and cancers are in the model. But in our work with clients, we still see conditions that get missed in addition to those that stretch credulity. In fairness and because we’ve seen firsthand the ramifications of the latter, we’ve focused a lot on coding compliance in recent years but let’s review some oft-overlooked conditions in the MRA model during this blog series.
Under the vascular category (HCC 108) is ICD-10-CM code I77.1, Stricture of Artery. This widely-encompassing code, used for narrowed vessels, is for conditions that don’t have their own codes. Because diagnoses like peripheral vascular disease (I73.9) and carotid stenosis, unspecified (I65.29) have their own diagnosis codes, we cannot use the stricture code for them.
But for tortuous vessels (aorta and carotids are the most common), you would use I77.1. These findings can be found in radiologic studies such as x-rays, CT scans and even carotid ultrasounds. Remember that although this may be an incidental finding and may not require active treatment, a proper assessment must be documented. Simply mentioning the condition isn’t enough. Be sure to document how you are treating, even if you’re just managing the patient’s blood pressure and lipids, which impact the strictured artery.