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ICD-10 code G89.4 for Chronic pain syndrome is a medical classification medical classification A medical classification is used to transform descriptions of medical diagnoses or procedures into standardized statistical code in a process known as clinical coding. https://en.wikipedia.org › wiki › Medical_classification

Medical classification – Wikipedia

as listed by WHO under the range – Diseases of the nervous system.
ICD-10-CM Code for Other chronic pain G89.29.

Is chronic pain a Nanda?

Diagnoses – Commonly used NANDA-I nursing diagnoses for pain include Acute Pain (duration less than 3 months) and Chronic Pain, See Table 11.5 for more information regarding these diagnoses. For more information about defining characteristics and related factors for other NANDA-I nursing diagnoses, refer to a current nursing diagnosis resource. Table 11.5 Pain NANDA-I Nursing Diagnoses

NANDA-I Diagnosis	Definition	Defining Characteristics
Acute Pain	Unpleasant sensory and emotional experience associated with acute or potential tissue damage, or described in terms of such damage; sudden or slow onset of any intensity from mild to severe with an anticipated or predictable end, and with a duration of less than 3 months.	Alteration in sleep pattern Appetite change Change in physiological parameters (i.e., blood pressure, heart rate, respiratory rate) Diaphoresis Distraction behavior Evidence of pain using standardized pain behavior checklist for those unable to communicate verbally Expressive behavior Facial expression of pain Guarding behavior Hopelessness Narrowed focus Protective behavior Proxy report of pain behavior/activity changes Pupil dilation Restlessness Self-focused Self-report of intensity using standardized pain scale Self-report of pain characteristics using standardized pain instrument
Chronic Pain	Unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage (International Association for the Study of Pain); sudden or slow onset of any intensity from mild to severe, constant or recurring without anticipated or predictable end, and with a duration of greater than 3 months.	Alteration in ability to continue previous activities Alteration in sleep pattern Anorexia Evidence of pain using standardized pain behavior checklist for those unable to communicate verbally Facial expression of pain Proxy report of pain behavior/activity changes Self-focused Self-report of intensity using standardized pain scale Self-report of pain characteristics using standardized pain instrument

What is the code for acute and chronic?

I think you are thinking about the timeframe for MI (myocardial infarcts) on Chapter 9 of the ICD-10-CM, which tells you about how to code an MI that has happened within 4 weeks of another one, or if its older than 4 weeks, etc. There is no specific guideline that says how to code acute or chronic based on time, the main guideline about acute and chronic is, when you have a condition specified as both, acute on chronic, the acute code will go first followed by the chronic code.

• Now also, one thing that I’ve learned in my previous jobs and in trainings, is that we as coders, can not assume.
• We don’t have medicine degree so it is the providers responsibility to specify when a condition is acute or chronic, or both.
• If not, then your option will be unspecified, because if you decide to go “acute” based on timing, then at that point you are giving a diagnosis to the patient, not the provider.

So be careful with that, unless like Mitchel stated, if there is a guideline telling you what to assume, then follow it, but if not, then a query and provider education will be needed. If you believe documentation supports acute vs chronic, then make sure to query, I’ve had seen a lot of scenarios where I think “oh I think the provider is trying to say this” but then I query and the provider came back and said something completely different, that’s why they are the ones that have to provide the diagnosis.

What is ICD 11 and Chronic pain?

ICD-11 Chronic Pain Codes A key ‘first’ in ICD-11 is that the new system provides a single diagnostic code for chronic pain ( MG30.0 Chronic primary pain ). The manual also provides other codes for the most common and relevant groups of pain conditions.

Is chronic pain a DSM diagnosis?

Pain disorder is one of several somatoform disorders described in the revised, fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR).

What is the new classification of chronic pain?

Table 1 – Glossary of ICD-11 terms. The new ICD category for “Chronic Pain” comprises the most common clinically relevant disorders. These disorders were divided into 7 groups (Fig. ​ 1 ): (1) chronic primary pain, (2) chronic cancer pain, (3) chronic posttraumatic and postsurgical pain, (4) chronic neuropathic pain, (5) chronic headache and orofacial pain, (6) chronic visceral pain, and (7) chronic musculoskeletal pain.

• Experts assigned to each group are responsible for the definition of diagnostic criteria and the selection of the diagnoses to be included under these subcategories of chronic pain.
• Thanks to Bedirhan Üstün and Robert Jakob of the WHO, these pain diagnoses are now integrated in the beta version of ICD-11 ( http://id.who.int/icd/entity/1581976053 ).

The Task Force is generating content models for single entities to describe their clinical characteristics. After peer review overseen by the WHO Steering Committee, 39 the classification of chronic pain will be voted into action by the World Health Assembly in 2017. Organizational chart of Task Force, IASP, and WHO interactions. The IASP Task Force was created by the IASP council and its scope defined in direct consultation of the chairs (R.D.T. and W.R.) with WHO representatives in 2012. The Task Force reports to the IASP Council on an annual basis.

What are the classifications of chronic pain?

The body has three main types of chronic pain. Chronic pain is defined as pain that lasts 3 months or longer. Chronic pain is not easily healed or moderated by at-home remedies, and typically requires the attention of a pain specialist. There is not always a known cause of chronic pain, whereas other times, the pain is a lingering symptom of an injury or accident.

When pain lasts for any length of time, there can be changes in the spinal cord and how the brain perceives pain. Chronic pain can affect the entire central nervous system, resulting in severe pain that is hard to treat. It can be become so debilitating and problematic that it is often accompanied by depression or other psychological issues.

There are two main types of chronic pain in the human body: neuropathic and nociceptive pain.

What is the ICD-10 code for chronic illness unspecified?

ICD-10 code R69 for Illness, unspecified is a medical classification as listed by WHO under the range – Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified, –

Do you code chronic conditions?

Chronic illnesses – Primary care physicians spend a significant amount of time managing patients’ chronic illnesses. When determining the level of service for office visits involving chronic illnesses, here’s what to remember:

One stable chronic illness is a level 3 problem, Two (or more) stable chronic Illnesses is a level 4 problem, One unstable chronic illness is a level 4 problem.

So what constitutes a stable chronic illness versus an unstable one? Chronic conditions (e.g., hypertension, coronary artery disease, asthma, obesity, or chronic kidney disease) are considered unstable for coding purposes if they are fluctuating, not at goal, not improving, elevated, worsening, or uncontrolled.

Using these terms when documenting your assessment/plan (e.g. “HTN is elevated, losartan increased to 100 mg”) is a helpful signal to coders, auditors, or insurance companies to confirm that you performed level 4 work. Failing to clarify in the documentation that improving conditions are still not to goal can result in level 4 visits being incorrectly down-coded to level 3, resulting in significant loss of revenue.

For example, “Diabetes is markedly improved” could signal a level 3 problem, while “Diabetes is markedly improved (A1C has dropped from 14 to 10) but still not to goal ” makes it clear that this remains a level 4 problem. Similarly, “Depression improved” is a level 3 problem, but “Depression improved but still significant, increase sertraline to 100mg” describes a chronic condition that is not to goal or not controlled and, thus, a level 4 problem.

When can chronic conditions be coded?

Chronic conditions are the driving force in determining healthcare outcomes and costs in today’s value-based world, hence the interest in the Hierarchical Condition Category (HCC) coding payment model. Coding chronic conditions and co-morbidities is becoming increasingly critical as the healthcare landscape shifts toward value-based care.

Value-based care attempts to advance the triple aim of providing better care for individuals, improving population health management strategies, and reducing healthcare costs. Proper coding can play a vital role in achieving these goals by identifying the patient’s true burden of illness. Recognizing, documenting, and coding the patient’s actual condition is important in value-based care for several reasons.

First, it provides the necessary information in the patients’ records to make sure physicians are proactively monitoring and managing all ongoing chronic conditions. Not only does this enable high-quality, coordinated care and reduce costly hospital admissions and emergency room visits, it also provides the framework necessary to ensure that providers are following quality measures that must be reported for value-based payment.

Additionally, detailed documentation and coding encourage more patient engagement, an important part of value-based care. When patient records contain an accurate recap of all ongoing conditions, physicians can more easily discuss these concerns with patients, educating and encouraging them to make lifestyle changes and take a more active role in their care.

Lastly, proper documentation and coding validate and substantiate the cost of care, a critical component of value-based care that is under constant scrutiny by the Centers for Medicare & Medicaid Services (CMS) and private payers. Value-Based Care Brings HCC Coding to the Forefront Chronic conditions are the driving force in determining healthcare outcomes and costs in today’s value-based world.

Consequently, there is much interest in the Hierarchical Condition Category (HCC) coding payment model. HCCs are disease groups organized into body systems or similar disease processes. CMS HCC Medicare Advantage (MA) is a reimbursement framework specifically designed by CMS as a way of giving weight to chronic conditions to make appropriate and accurate payments for enrollees with differences in expected costs of care.

The goal of risk adjustment is to pay Medicare Advantage and prescription drug programs accurately and fairly by adjusting payments for enrollees based on demographics and health status. Patients with chronic conditions are assigned a risk score based on their overall health status, relative risk that the condition will worsen, and various demographic characteristics.

This risk adjustment factor (RAF) is a statistical tool that predicts speculated healthcare cost by reported ICD-10 diagnosis codes that identify future risk. Potential risk could include hospital admissions for a chronic condition exacerbation, costly treatments, or ongoing medications that may require consistent funding.

With the HCC payment model, providers should annually report all chronic conditions and co-morbidities to the highest level of specificity. The more chronic conditions a patient has, the more care may be required, so yearly reporting is crucial to ensure quality of care as well as proper funding.

If providers do not report all conditions, money funded for a certain patient could be put into a negative balance, creating difficulties for the provider, payer, and patient. A closer look at a few examples may provide insight into why accurate documentation is so critical. For breast cancer patients, for example, initial treatment may include surgery, radiation, and chemotherapy.

The patient may also take medication as a precautionary measure to prevent reoccurrence. Once the initial treatment is completed, the physician may document the patient’s condition as “history of breast cancer.” However, since the patient is still on medication, which must be funded, this does not accurately reflect the patient’s status, nor does it follow ICD-10 risk adjustment guidelines for reporting current diagnoses or history of diagnoses.

1. If the patient is taking medications, then we as educators must collaborate with and guide providers on appropriate documentation to support current versus history.
2. Several years later, say this same patient is diagnosed with metastatic breast cancer that has spread to the lungs.
3. The oncologist documents that the patient was seen for metastatic breast cancer, but neglects to indicate it has metastasized to the lungs.

From the payer’s perspective, the patient has stable metastatic breast cancer, since the provider did not report the HCC code for metastatic disease that has progressed to other organs, a chronic condition CMS recognizes as requiring more funding. The true risk factor would probably be a 3.2, representing a more accurate picture of the real burden of illness, alerting the payer that adjustment in funding will need to accommodate the new severity of illness.

• In another example, if a patient has a history of below-the-knee amputation, the physician may not view this as a chronic condition.
• However, the amputation may have been caused by vascular disease, a chronic condition that should be documented.
• Providers should focus on care that might be needed in the future, even if the care is related to past conditions.

Risk adjustment payment methodologies are being used across a variety of federal and state programs, as well as private and commercial insurance plans. While there are differences in these models, they basically all embrace the same methodology as the CMS HCC plan.

Whatever the model, providers can ensure that they are getting credit for quality outcomes by consistently performing key activities that support quality care, such as engaging with patients, coordinating care with other providers, assessing, documenting, and reporting any diagnosis that affects the outcome of the patient’s visit or care plan; discussing any diagnosis relating to whether the condition is chronic or not; and closely monitoring chronic conditions.

Providers should think about possible exacerbations or anything in the patient’s condition that may require future funding, and document each condition to the highest level of specificity. The chronic conditions providers should be following are listed in the Medicare HCC list, and all providers should be familiar with that information.

All pertinent information should be included in the provider’s progress notes. Report everything from the office visit that affects the plan of care for the chronic condition. Chronic conditions must be coded annually with the highest level of specificity. Patients must be evaluated by a medical doctor, a DO, a nurse practitioner, or an advanced practice provider during a face-to-face visit. All chronic conditions should be discussed and documented when meeting with a new patient. If the condition does not affect the patient’s care six months from the initial visit, there is no need to report it again. Document only confirmed diagnoses, not suspected conditions. Do not cut and paste the patient’s problem list and transfer it into the progress notes. Providers must link the chronic condition with the care plan by evaluating, assessing, monitoring, or treating the condition in some way, documenting care they provided or plan to provide. If chronic conditions are not linked to the care plan and a data validation audit occurs, the code will be removed and not counted as part of the patient’s risk adjustment factor. Progress notes must be signed by the provider for chronic conditions to count for an office visit.

Keep Current and Have Processes in Place Practices must have policies and efficient processes in place to support providers in properly documenting and reporting diagnosis codes for chronic conditions. Staff should refer to Medicare’s website at regular intervals to stay current with the latest guidelines for appropriate coding of HCCs.

Policies should be established to ensure that every office in the practice updates their CPT and ICD-10 code books annually. Key personnel should become familiar with industry resources, not only for the HCC payment plan, but for similar models as well. Finally, a process should be developed to ensure that all information in the provider’s progress notes is reported to payers in a timely fashion.

Healthcare organizations that follow these best practices will master the art and science of documenting and coding chronic conditions, supporting high-quality, value-based care while optimizing revenue.

Does chronic pain have time frame to code?

Pain is a common complaint that physicians of all specialties treat. However, assessment of patients is a challenge as it depends upon self-report measures that, though valid, cannot convey the complexity of the pain experience. Likewise, correct code assignment on claims is also a challenge as there are extensive ICD-10 guidelines on how different types of pain should be reported and the code sequencing process.

Acute vs chronic: Providers may document pain as acute or chronic.,Acute pain is that which lasts from minutes to about three months. Chronic pain lasts for a longer time and maybe constant or recur frequently. Chronic pain is often due to a health condition, like arthritis, fibromyalgia, or a spine condition. Traumatic: This refers to pain caused by traumatic injuries such as an accident or fracture. Postoperative: This is the occurrence of pain after operation, which can occur in the joints and muscles, and head and limbs. Site specific: ICD-10 requires capturing anatomic Site specific pain relates to that in a specific anatomic region such as the arm, shoulder, etc). Pain is a symptom of a confirmed diagnosis: Examples of pain associated with a confirmed diagnosis include pain due to ankylosing spondylitis (AS) and abdominal pain due to S igns and symptoms with a confirmed diagnosis should not be reported if the signs or symptom are integral to the diagnosis.

ICD-10 Pain Codes ICD-10 has more than 162 codes for reporting pain. The ICD-10-CM Official Guidelines for Coding and Reporting include extensive notes and instructions for coding pain. Pain codes are found in many ICD-10 chapters such as Chapter 6 (G00-G99 – Diseases of the Nervous System), Chapter 7 (H00-H59 – Diseases of the Eye & Adnexa), Chapter 13 (M00-M99 Diseases of the Musculoskeletal System and Connective Tissue), and Chapter 19 (S00-T88 – Injury, Poisoning, and Certain Other Consequences of External Causes).

Sequencing pain codes

ICD-10 pain codes are assigned and sequenced based on the encounter notes and the reason for the admission/encounter. When pain is the primary diagnosis, codes from the G89 category can be sequenced first.

When the reason for the visit/service is specifically for pain management or pain control, the code(s) from the G89 category describing the patient’s pain should be assigned and listed first. In this situation, the provider is treating the pain and not the condition causing it. Codes from category G89 should not be reported as the first-listed diagnosis if the underlying (definitive) diagnosis (g., spinal fusion, kyphoplasty) is known and the reason for the service is to manage/treat the underlying condition.

Here are two examples from AAPC:

If the reason for the visit is pain management for acute neck pain from trauma, report G89.11 Acute pain due to traumafollowed by M54.2 Cervicalgia Report neoplasm related pain (acute) (chronic)(G89.3) as the first-listed diagnosis when the encounter is for pain control. Neoplasm should be reported as an additional code.

Site-specific pain codes

Correctly identify the site and/or source of the pain. Codes from the G89 category may be reported in conjunction with codes that identify the site of pain to provide additional information about the type of pain. For example, both codes should be assigned if the code describes the site of the pain, but does not fully explain if the pain is acute or chronic.

Chronic pain

The ICD official guidelines state: “There is no time frame defining when pain becomes chronic pain. The provider’s documentation should be used to guide use of these codes” (Section I.C.6.b.4). So when the provider documents pain as chronic, it should be reported as chronic.

Postoperative pain

ICD-10 guidelines state “routine or expected postoperative pain immediately after surgery&rdquo should not be coded. Postoperative pain that is documented as associated with a specific postoperative complication should be reported with the right postoperative pain code from category G89, Pain not elsewhere classified.

1. There are 4 post-operative pain codes: G89.12 Acute post-thoracotomy pain G89.18 Other acute post-procedural pain G89.22 Chronic post-thoracotomy pain G89.28 Other chronic post-procedural pain Acute or chronic pain can occur due to various post-operative complications, for e.g.
2. Postoperative infection, foreign body accidentally left in the body following a procedure, and complications of implants, grafts, and prosthetic devices.

The coder should review the medical record to determine if there is a cause-and-effect relationship the complication and the pain. If the documentation states that the postoperative pain is due to a complication of the procedure, the primary diagnosis is the complication.

Neoplasm related pain

Pain can occur due to a neoplastic process such as a tumor compressing or infiltrating tissue, from treatments and diagnostic procedures, or from skin, nerve, and other changes caused by a hormone imbalance or immune response. If the reason for the encounter is to control the neoplasm-related pain, G89 should be assigned as the principal code with the specific neoplasm code as the secondary diagnosis.

• Careful Documentation is Key to Correct Coding It is up to the clinician is to accurately document the nature of patient’s medical condition and the services performed to address that condition.
• This is important for the coding team in a pain management billing company to assign the correct codes consistent with the documentation.

While there are separate ICD-10 codes for pain due to trauma, post-thoracotomy pain, other post procedural pain, and other pain, there is no specific timeframe identifying when the pain becomes chronic. The provider’s documentation should be used to guide code assignment.

Do you code chronic conditions?

Chronic illnesses – Primary care physicians spend a significant amount of time managing patients’ chronic illnesses. When determining the level of service for office visits involving chronic illnesses, here’s what to remember:

One stable chronic illness is a level 3 problem, Two (or more) stable chronic Illnesses is a level 4 problem, One unstable chronic illness is a level 4 problem.

So what constitutes a stable chronic illness versus an unstable one? Chronic conditions (e.g., hypertension, coronary artery disease, asthma, obesity, or chronic kidney disease) are considered unstable for coding purposes if they are fluctuating, not at goal, not improving, elevated, worsening, or uncontrolled.

• Using these terms when documenting your assessment/plan (e.g.
• HTN is elevated, losartan increased to 100 mg”) is a helpful signal to coders, auditors, or insurance companies to confirm that you performed level 4 work.
• Failing to clarify in the documentation that improving conditions are still not to goal can result in level 4 visits being incorrectly down-coded to level 3, resulting in significant loss of revenue.

For example, “Diabetes is markedly improved” could signal a level 3 problem, while “Diabetes is markedly improved (A1C has dropped from 14 to 10) but still not to goal ” makes it clear that this remains a level 4 problem. Similarly, “Depression improved” is a level 3 problem, but “Depression improved but still significant, increase sertraline to 100mg” describes a chronic condition that is not to goal or not controlled and, thus, a level 4 problem.

Do you code for pain?

The general rule is that you should sequence the G89. – pain code first when the reason for the admission or encounter is pain control or pain management.

When can chronic conditions be coded?

Chronic conditions are the driving force in determining healthcare outcomes and costs in today’s value-based world, hence the interest in the Hierarchical Condition Category (HCC) coding payment model. Coding chronic conditions and co-morbidities is becoming increasingly critical as the healthcare landscape shifts toward value-based care.

1. Value-based care attempts to advance the triple aim of providing better care for individuals, improving population health management strategies, and reducing healthcare costs.
2. Proper coding can play a vital role in achieving these goals by identifying the patient’s true burden of illness.
3. Recognizing, documenting, and coding the patient’s actual condition is important in value-based care for several reasons.

First, it provides the necessary information in the patients’ records to make sure physicians are proactively monitoring and managing all ongoing chronic conditions. Not only does this enable high-quality, coordinated care and reduce costly hospital admissions and emergency room visits, it also provides the framework necessary to ensure that providers are following quality measures that must be reported for value-based payment.

1. Additionally, detailed documentation and coding encourage more patient engagement, an important part of value-based care.
2. When patient records contain an accurate recap of all ongoing conditions, physicians can more easily discuss these concerns with patients, educating and encouraging them to make lifestyle changes and take a more active role in their care.

Lastly, proper documentation and coding validate and substantiate the cost of care, a critical component of value-based care that is under constant scrutiny by the Centers for Medicare & Medicaid Services (CMS) and private payers. Value-Based Care Brings HCC Coding to the Forefront Chronic conditions are the driving force in determining healthcare outcomes and costs in today’s value-based world.

• Consequently, there is much interest in the Hierarchical Condition Category (HCC) coding payment model.
• HCCs are disease groups organized into body systems or similar disease processes.
• CMS HCC Medicare Advantage (MA) is a reimbursement framework specifically designed by CMS as a way of giving weight to chronic conditions to make appropriate and accurate payments for enrollees with differences in expected costs of care.

The goal of risk adjustment is to pay Medicare Advantage and prescription drug programs accurately and fairly by adjusting payments for enrollees based on demographics and health status. Patients with chronic conditions are assigned a risk score based on their overall health status, relative risk that the condition will worsen, and various demographic characteristics.

This risk adjustment factor (RAF) is a statistical tool that predicts speculated healthcare cost by reported ICD-10 diagnosis codes that identify future risk. Potential risk could include hospital admissions for a chronic condition exacerbation, costly treatments, or ongoing medications that may require consistent funding.

With the HCC payment model, providers should annually report all chronic conditions and co-morbidities to the highest level of specificity. The more chronic conditions a patient has, the more care may be required, so yearly reporting is crucial to ensure quality of care as well as proper funding.

• If providers do not report all conditions, money funded for a certain patient could be put into a negative balance, creating difficulties for the provider, payer, and patient.
• A closer look at a few examples may provide insight into why accurate documentation is so critical.
• For breast cancer patients, for example, initial treatment may include surgery, radiation, and chemotherapy.

The patient may also take medication as a precautionary measure to prevent reoccurrence. Once the initial treatment is completed, the physician may document the patient’s condition as “history of breast cancer.” However, since the patient is still on medication, which must be funded, this does not accurately reflect the patient’s status, nor does it follow ICD-10 risk adjustment guidelines for reporting current diagnoses or history of diagnoses.

• If the patient is taking medications, then we as educators must collaborate with and guide providers on appropriate documentation to support current versus history.
• Several years later, say this same patient is diagnosed with metastatic breast cancer that has spread to the lungs.
• The oncologist documents that the patient was seen for metastatic breast cancer, but neglects to indicate it has metastasized to the lungs.

From the payer’s perspective, the patient has stable metastatic breast cancer, since the provider did not report the HCC code for metastatic disease that has progressed to other organs, a chronic condition CMS recognizes as requiring more funding. The true risk factor would probably be a 3.2, representing a more accurate picture of the real burden of illness, alerting the payer that adjustment in funding will need to accommodate the new severity of illness.

1. In another example, if a patient has a history of below-the-knee amputation, the physician may not view this as a chronic condition.
2. However, the amputation may have been caused by vascular disease, a chronic condition that should be documented.
3. Providers should focus on care that might be needed in the future, even if the care is related to past conditions.

Risk adjustment payment methodologies are being used across a variety of federal and state programs, as well as private and commercial insurance plans. While there are differences in these models, they basically all embrace the same methodology as the CMS HCC plan.

Whatever the model, providers can ensure that they are getting credit for quality outcomes by consistently performing key activities that support quality care, such as engaging with patients, coordinating care with other providers, assessing, documenting, and reporting any diagnosis that affects the outcome of the patient’s visit or care plan; discussing any diagnosis relating to whether the condition is chronic or not; and closely monitoring chronic conditions.

Providers should think about possible exacerbations or anything in the patient’s condition that may require future funding, and document each condition to the highest level of specificity. The chronic conditions providers should be following are listed in the Medicare HCC list, and all providers should be familiar with that information.

All pertinent information should be included in the provider’s progress notes. Report everything from the office visit that affects the plan of care for the chronic condition. Chronic conditions must be coded annually with the highest level of specificity. Patients must be evaluated by a medical doctor, a DO, a nurse practitioner, or an advanced practice provider during a face-to-face visit. All chronic conditions should be discussed and documented when meeting with a new patient. If the condition does not affect the patient’s care six months from the initial visit, there is no need to report it again. Document only confirmed diagnoses, not suspected conditions. Do not cut and paste the patient’s problem list and transfer it into the progress notes. Providers must link the chronic condition with the care plan by evaluating, assessing, monitoring, or treating the condition in some way, documenting care they provided or plan to provide. If chronic conditions are not linked to the care plan and a data validation audit occurs, the code will be removed and not counted as part of the patient’s risk adjustment factor. Progress notes must be signed by the provider for chronic conditions to count for an office visit.

Keep Current and Have Processes in Place Practices must have policies and efficient processes in place to support providers in properly documenting and reporting diagnosis codes for chronic conditions. Staff should refer to Medicare’s website at regular intervals to stay current with the latest guidelines for appropriate coding of HCCs.

• Policies should be established to ensure that every office in the practice updates their CPT and ICD-10 code books annually.
• Ey personnel should become familiar with industry resources, not only for the HCC payment plan, but for similar models as well.
• Finally, a process should be developed to ensure that all information in the provider’s progress notes is reported to payers in a timely fashion.

Healthcare organizations that follow these best practices will master the art and science of documenting and coding chronic conditions, supporting high-quality, value-based care while optimizing revenue.