A Detail Guid on HCC coding  
                     
A Detailed Guide On HCC Coding
 
In 2004, the Centers for Medicare and Medicaid Services (CMS) launched the 
Hierarchical Condition Category (HCC) code set. While approaching its 20th 
anniversary, HCC coding is becoming more common as healthcare shifts to value-
based payment models, a change that has been actively pursued over the last 
decade. 
HCC codes are directly related to ICD-10 coding – approximately 10,000 ICD-10 
diagnosis codes out of 70,000 diagnoses are directly related to at least one of the 
86 HCCs. HCC coefficients vary depending on the patient category.
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An Overview of the HCC Model
Based on the patient’s demographics and diagnoses, the HCC model assigns a Risk Adjustment Factor 
(RAF) score, which is a relative measure of how expensive that patient is expected to be. As healthy 
patients have a lower-than-average RAF score, revenue from insurance premiums is transferred from 
healthy patients to patients with higher-than-average RAF scores.
According to the “American Academy of Family Physicians,” “
hierarchical condition category coding helps communicate patient complexity and paint a picture 
of the whole patient,” allowing for appropriate quality and cost performance measurement.
How does it function?
One of the concepts that must be followed for the HCC risk adjustment model is having an accurate 
problem list. For years, healthcare organizations have filled EMRs with data, resulting in a large amount 
of data and, most likely, an inaccurate problem list. To ensure an accurate problem list, remove 
duplicate and inactive diagnoses and identify key areas for assigning HCC codes and RAF values.
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Why is HCC coding important ?
Hierarchical condition category coding is designed to help determine patient care and long-
term health complexity while also “painting a picture” of the entire patient. Painting a 
complete picture of a patient’s health necessitate more than just codes and technology, but 
also expertise and analysis.
Healthcare professionals, for instance, should be persuaded to review the entire patient record, 
looking for any potential social determinants of health (SDoH) that could affect the value of the 
care provided (as in value-based care).
HCCs use data collected from patient encounters that have been notated and coded to 
estimate predicted costs for individuals over time — in insurance, this could be the next year 
or more of coverage. These projections are based on the previous 12 months.
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How can 24/7 Medical Billing 
Services assist you?
Capturing HCC diagnoses across the continuum of care to reflect the total disease burden of a 
patient population benefits not only the patient but also physicians and payers. To achieve 
this goal, providers and medical coders must stay current on best practices and be educated 
on HCC. When done correctly, HCC streamlines the process, resulting in clean claims and 
quick reimbursements.
24/7 Medical Billing Services  holds a team of well-trained and experienced HCC coders who 
are responsible for assigning appropriate diagnosis codes and CDI specialized to review all 
clinical documentation for completeness and accuracy. They also ensure thorough risk 
adjustment evaluation for each record in the best interests of the patient, provider, and payer.
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Call us Today :
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24/7 Medical Billing Services,
28405 Osborn Road,
 Cleveland, OH, 44140
Tel: + 1 -888-502-0537
Email: [email protected]
Website: https://www.247medicalbillingservices.com/