Proper Coding And Top HCC Diagnoses
According to the Centers for Disease Control and Prevention (CDC), chronic disease is responsible for seven of ten deaths each year, and treating people with chronic diseases accounts for 86% of our nation’s total healthcare costs. It is apparent that preventing chronic diseases, or managing symptoms when prevention is not possible, can reduce these costs.
The top 10% of the population accounted for 64.9% of total healthcare expenditures with an annual individual mean expenditure of $28,808. With HCC (Hierarchical Category Conditions) patients costing two to five times more than other groups of populations, the ability to offer cost effective care management solutions is key.
This rising-risk group is not yet sick enough for expensive clinical care, and they are past the point where preventative solutions are effective. This is the care gap.
It's important to examine some of the major HCC (Hierarchical Category Conditions) chronic conditions to understand why coders need to focus on them. HCC diagnoses (dx) codes are chronic conditions recognized by the CMS as being associated with high medical costs and, by focusing on them, can help capture lost revenue dollars while identifying areas of revenue risk.
The most current list of the top HCC diagnoses which should be the focus of teaching and training include:
The number of individuals with disorders is likely to increase further in view of the aging of the population and worsening social problems. This growing burden amounts to a huge cost in terms of human misery, disability and economic loss.
The Importance of Proper Coding
With the current health problems only continuing to escalate, it is of utmost importance for coders to abstract chronic diagnoses correctly from the patient record. Organizations such as the CDC and the WHO need this information to keep track of illness, costs, trends, etc. to better prepare financially for chronically ill patients. It further substantiates our responsibility to continually provide training and updates to our coding team so we are part of the solution and not perpetuating problems that already exist.
With an aging population that continues to grow, our health care system will be changed forever. Are we ready for it? According to the Global Health and Aging report presented by the World Health Organization (WHO), “The number of people aged 65 or older is projected to grow from an estimated 524 million in 2010 to nearly 1.5 billion in 2050.”
This leads to the question “What are the implications of the aging population on health care?” We have all heard the term “baby boomer.” According to the Office of Disease Prevention and Health Promotion, the first Baby Boomers turned 65 in 2011. By 2030, it is projected that more than 60% of this generation will be managing more than one chronic condition. That’s one of many reasons to stay focused on the top HCC and proper coding.