2011 HCC Model- 87 HCC codes (up from 70)
Wow, after looking at the 2011 Advance Notice and the prelim 3,090 ICD-9 codes in the 2011 HCC model it is apparent that there are several new HCCs for 2011. The diabetes group is curtailed from 5 HCCs down to 3. Dementia HCCs were added. Pressure Ulcer HCCs (4 of them) were added.
Here are some prelim files for your information – final 2011 model to be finalized in April.
CMS-HCC Model 2011 (PDF – shows HCC revisions)
2011_HCC_ICD9 (XLS – shows 3090 ICD9s mapped to HCC, second tab is the 87 HCCs in the 2011 model- I created this file by crosswalking the 3,090 ICD9s in the prelim model to their English descriptions for 2010 ICD-9 codes. The second tab is an excel I extracted from the 2011 Advance Notice pdf.
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By j7912, March 15, 2010 @ 12:53 PM
Not only that but the disease interactions have been changed pretty significantly as well.
The real head-scratcher to me is that category numbers have been shifted around all over the place. For example: “Metastatic Cancer and Acute Leukemia” which is currently HCC7 is going to be changed to HCC8 (currently Lung cancer). In fact, when all is said and done, only HCC1, HCC2, and HCC21 will retain their current category number in the new model. Technical issues aside (and they are not exactly insignificant), this is going to complicate discussions about disease categories. When I talk HCC8 I now have to qualify whether I’m talking about old HCC8 or new HCC8. Other things like tracking the past existence of an HCC for a patient just became more complicated as well.
I would love to hear a good reason for why they did this.
By mtokos, March 15, 2010 @ 9:59 PM
Thanks for doing the xls. We’re all gonna have to learn and teach our providers the new categories. Thanks again. M
By acdasneves, March 16, 2010 @ 2:52 PM
Hi,
I have a question not really related to this topic. where can I find the coeffecients for New Enroollees in the 2010 CMS-HCC Model?
By j7912, March 17, 2010 @ 9:31 AM
@acdasneves They last recalibrated the model in 2009 so you can find those coefficients in the 2009 Announcement letter (page 31). http://www.cms.hhs.gov/medicareadvtgspecratestats/downloads/announcement2009.pdf
By Kimberley, March 17, 2010 @ 12:08 PM
Hello,
I have a question somewhat related to this topic. Where can I find information regarding HCCs and gunshot wounds not self-inflicted?
By ragnut, March 23, 2010 @ 11:45 AM
Matt, does this mean that old MI HCC 83 coded now in 2010 will still be RAF counted/paid in 2011?
Likewise if morbid obesity (future HCC 23) is coded now, I assume it won’t be paid in 2011 (but if coded in 2011 it would be paid 2012).
By Georgecoder, March 23, 2010 @ 3:05 PM
What great information we are getting. I am anxious to hear how the new Diabetes codes will work, esp in regards to the Chronic and Acute manifestations. That is a big change as the previous codes were so specific.
By J. Matt Yuill, M.D., CPC, March 29, 2010 @ 9:54 AM
Great idea for a blog topic, I will try to do a review of the diabetes codes when they are finalized soon.
By J. Matt Yuill, M.D., CPC, March 29, 2010 @ 9:57 AM
I don’t recall seeing any gunshot wound E codes that map to HCCs in the model- any particular ICD-9 code you are looking for?
By Julie King, March 30, 2010 @ 1:09 PM
Hi, I am not working with HCCs in coding or revenue optimization but I write clinical content around HCCs. I am trying to figure out how new vs old codes will be treated in a database HCC code load. j7921 stated above “Other things like tracking the past existence of an HCC for a patient just became more complicated as well”. Is there any information on this from CMS or other sites on how to handle the HCC data? Any help is appreciated!
By Julie King, April 7, 2010 @ 1:33 PM
I am on a CMS call that is saying the Part C model will not change but Part D will according to final call letter