HCC Coding Corner | Vascular HCC categories that are relevant to the ...
HCC Coding Corner | Vascular
HCC categories that are relevant to the Vascular specialty: ? HCC 106: Atherosclerosis of Extremities with Ulceration or Gangrene ? HCC 107: Vascular Disease with Complications ? HCC 108: Vascular Disease ? HCC 161: Chronic Ulcer of Skin, Except Pressure ? HCC 189: Amputation Status, Lower Limb/Amputation Complications
What Providers Should Do: ? Code for all conditions that affect or influence patient care, treatment or management. ? Code to the highest specificity including any complications
ICD-10 Coding scenarios associated with these conditions:
Example: A 90 year old male presents with peripheral vascular disease including an ulcer of the left ankle limited to the breakdown of the skin.
ICD-10 Code Not coded
ICD-10 Code I73.9
ICD-10 Code I70.243, L97.321
Description- No Conditions Coded Peripheral vascular disease
Demographic Risk Factor (Community, Non Dual, Aged):
Total Score: PMPM Payment: Medicare expects this patient to cost: Description- Partial Coding Peripheral vascular disease, unspecified
Demographic Risk Factor (Community, Non Dual, Aged): Total Score:
PMPM Payment: Medicare expects this patient to cost: Description- Coding Highest Specificity Atherosclerosis of native arteries of left leg with ulceration of ankle limited to breakdown of skin Demographic Risk Factor (Community, Non Dual, Aged):
Total Score: PMPM Payment: Medicare expects this patient to cost:
HCC Weight 0.00 0.841 0.841 $672.80 $8,073.60 HCC Weight 0.288 0.841 1.129 $903.20 $10,838.40 HCC Weight 1.488
0.841 2.329 $1,863.20 $22,358.40
Coding Tip: Coding Peripheral Vascular Disease to the Highest Specificity The codes in this category, I70 Atherosclerosis, are classified by type of vessel, by site, and by the severity. Code at the highest level of severity when a patient has multiple symptoms of lower extremity atherosclerosis. The hierarchy from most severe to least severe is as follow:
? Gangrene, with tissue necrosis ? Ulceration, with non-healing wound ? Rest pain, with chronic ischemia ? Intermittent claudication, with ischemia upon exertion
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