Which pairing best represents essential knowledge for HCC coding?

Which pairing best represents essential knowledge for HCC coding?

• A. ICD-9-CM and project guidelines
• B. ICD-10-CM and project guidelines
• C. ICD-10-CM and CPT guidelines
• D. ICD-9-CM and CPT guidelines

Answer: (B)

Essential knowledge for HCC coding is using the ICD-10-CM diagnosis coding system together with the CMS-HCC project guidelines that govern how diagnoses map to risk-adjustment HCCs. ICD-10-CM provides the specific condition codes, while CPT guidelines relate to procedures rather than risk-adjustment diagnoses, so they don’t guide which codes drive HCCs. ICD-9-CM is outdated for current practice, so relying on it would miss the required current mapping to HCCs. By following the CMS-HCC project guidelines, you ensure the correct selection and sequencing of diagnoses to accurately assign HCCs and reflect patient risk. This combination is what practitioners rely on to build accurate HCC risk scores.

Essential knowledge for HCC coding is using the ICD-10-CM diagnosis coding system together with the CMS-HCC project guidelines that govern how diagnoses map to risk-adjustment HCCs. ICD-10-CM provides the specific condition codes, while CPT guidelines relate to procedures rather than risk-adjustment diagnoses, so they don’t guide which codes drive HCCs. ICD-9-CM is outdated for current practice, so relying on it would miss the required current mapping to HCCs. By following the CMS-HCC project guidelines, you ensure the correct selection and sequencing of diagnoses to accurately assign HCCs and reflect patient risk. This combination is what practitioners rely on to build accurate HCC risk scores.