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News Assigning diagnoses from the Problem List or Past Medical History/HCC

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Lori

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Last year, Kim the Coder shared the guidance from AHA Coding Clinic that coders cannot assign diagnoses from the Problem List or Past Medical History, that the physician must indicate that the diagnosis affected care and management at that encounter. She received lots of comments - some that this did not apply to HCC coding and that she was wrong.

Here is confirmation from the AHA Coding Clinic that the guidance DOES apply to HCC coding:
AHA Coding Clinic – Second Quarter 2022, page 30
“The Coding Clinic advice that additional diagnoses in the outpatient setting must affect care and management of the patient was related to the coding for a single specific encounter in time. Coding for risk adjustment, such as for HCCs, involves the collection of known current chronic conditions over the course of a year. While a patient’s chronic condition may not have affected care or needed management during a specific individual outpatient visit, the chronic condition would be captured for HCC coding from other visits, encounters or hospitalizations when the chronic condition affected care or needed management.”
 
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