how many types of hcc are there

Full Answer

How many HCC codes are there in the US?

HCC codes represent costly chronic health conditions, as well as some severe acute conditions. As of 2020, there are 86 HCC codes, arranged into 19 categories. These 86 codes are comprised of 9,700 ICD-10-CM codes, each representing a singular medical condition.

What are the different types of hepatocellular carcinoma (HCC)?

Microscopically, the four architectural and cytological types (patterns) of hepatocellular carcinoma are: fibrolamellar, pseudoglandular (adenoid), pleomorphic (giant cell), and clear cell. In well-differentiated forms, tumor cells resemble hepatocytes, form trabeculae, cords, and nests, and may contain bile pigment in the cytoplasm.

What are the demographics of HCC?

Demographics include the person’s age, gender, and, for the CMS-HCC model, the place of residence (in a community or skilled nursing facility), and enrollment in Medicare and/or Medicaid. Within the CMS-HCC risk adjustment model, there are two risk segments – the community model and the institutional model ( AAFP, 2016).

What are the different types of HCC risk adjustment models?

There are two different Hierarchical Condition Category (HCC) models used to calculate risk adjustments: the CMS-HCC model and the HHS-HCC model. Does your facility know how and when to use them? In addition, our detailed quick guide to HCC risk adjustment models infographic explains the differences and usages for each HCC model.

How many HCC categories are there in 2021?

For 2021, there are over 71,000 ICD-10-CM diagnosis codes in 86 categories for the CMS-HCC Version 24 risk adjustment model. HCCs reflect hierarchies among related disease categories.

How are HCC categorized?

HCC coding relies on ICD-10-CM coding to assign risk scores to patients. Each HCC is mapped to an ICD-10-CM code. Along with demographic factors such as age and gender, insurance companies use HCC coding to assign patients a risk adjustment factor (RAF) score.

How many CMS-HCC categories are there for 2022?

There are 19 different HCC categories with 86 total HCC codes.

How many HCC ICD 10 codes are there?

Of the approximately 70,000 ICD-10-CM codes, about 9,500 map to 79 HCC categories. The diagnoses must be documented by the physicians who provide care.

What is HCC risk score?

The CMS-HCC risk score for a beneficiary is the sum of the score or weight attributed to each of the demographic factors and HCCs within the model. The CMS-HCC model is normalized to 1.0. Beneficiaries would be considered relatively healthy, and therefore less costly, with a risk score less than 1.0.

What is HCC coding stand for?

Hierarchical Condition CategoryRisk Adjustment and Hierarchical Condition Category (HCC) coding is a payment model mandated by the Centers for Medicare and Medicaid Services (CMS) in 1997.

What is the difference between CMS HCC and HHS HCC?

Prediction Year—The CMS-HCC risk adjustment model uses base year diagnoses and demographic information to predict the next year's spending. The HHS-HCC risk adjustment model uses current year diagnoses and demographics to predict the current year's spending.

What is HCC weight?

The correct HCC weighting is 0.309+0.250+0.302=0.861. This correct coding would result an increase of $7258 to the annual budget for this patients care. Risk adjustment resets each calendar year, so each chronic condition associated with an HCC needs to be re-documented and coded each calendar year.

What is HCC depression?

In ICD‐10‐CM, codes to indicate major depressive disorder, single episode, are found in category F32. Code category F33 (HCC 59) indicates major depressive disorder, recurrent. Both of these code categories require fourth digits to indicate the severity or provide remission status.

What are the most commonly missed HCC codes?

Providers need to determine whether the patient has transplant status or a transplant complication.Transplant Status Codes: (not an all-inclusive list)Z94.0 Kidney transplant status.Z94.1 Heart transplant status.Z94.2 Lung transplant status.Z94.81 Bone marrow transplant status.More items...•

Which code set is used for HCC coding?

ICD-10 code setBut, what is HCC medical coding? Hierarchical condition category (HCC) medical coding utilizes the ICD-10 code set. This is used to identify risks for each patient and assign risk values, or RAF scores, in value-based care models.

What is sepsis HCC?

Sepsis is an extreme reaction to an infection that can lead to death if untreated. PSS is a pathophysiological response to sepsis that affects up to 50 percent of sepsis survivors. Intensive care unit patients carry a much higher risk.

What is CMS HCC model category V22?

This model is largely V22, but CMS modified or added new hierarchical condition categories (HCCs) for moderate to severe substance abuse, minor substance abuse, reactive and unspecified psychosis, personality disorder, and Stage 3 chronic kidney disease.

What does HCC mean in epic?

Hierarchical Condition CategoriesPosted at 00:59h in Epic, Optimization, Population Health, Quality Measures by Contineo Health 0 Comments. HCCs (Hierarchical Condition Categories) are Medicare's risk-adjustment methodology to estimate projected costs for Medicare beneficiaries based on their disease burden & demographic risk.

What is a RAF score?

The risk adjustment factor (RAF) score is the risk score assigned to each patient in a risk adjustment payment model. Risk Adjustment Models account for multiple factors to calculate a RAF score which is the combination of both the demographic risk score and the disease risk score.

What is HCC weight?

The correct HCC weighting is 0.309+0.250+0.302=0.861. This correct coding would result an increase of $7258 to the annual budget for this patients care. Risk adjustment resets each calendar year, so each chronic condition associated with an HCC needs to be re-documented and coded each calendar year.

What are the HCCs for cancer?

There are five HCCs for cancer and metastatic cancer diagnoses: HCC 8 Metastatic Cancer and Acute Leukemia, HCC 9 Lung and Other Severe Cancers, HCC 10 Lymphoma and Other Cancers, HCC 11 Colorectal, Bladder and Other Cancers and HCC 12 Breast, Prostate and Other Cancers or Tumors. HCC 8 is the highest category within this hierarchy. A patient with colon cancer with metastasis to the liver will have HCC diagnoses within both HCC 11 and HCC 8, but only the diagnosis within HCC 8 for the metastasis will impact risk adjustment.

What are the HCCs for diabetes?

A great example of this is the diagnosis of diabetes. There are three HCCs for diabetes: HCC 17 Diabetes with Acute Complications, HCC 18 Diabetes with Chronic Complications, and HCC19 Diabetes without Complications. HCC 17 is the highest category in the hierarchy for diabetes, as it includes the most clinically severe diagnoses related to diabetes. Diagnoses of Type 1 DM with ketoacidosis without coma and Type 2 DM with hypoglycemia with coma are examples of diagnoses in HCC 17.

How does HCC risk adjustment work?

An important concept of the HCC risk adjustment model is capturing a patient’s chronic conditions year over year through documentation and coding. A patient’s risk adjustment factor (RAF) score is reset to zero every January 1, so it’s essential to documenting and coding HCC diagnoses yearly to reflect an accurate health status. A patient’s diagnosis of Type 1 diabetes with peripheral vascular disease and history of below knee amputation doesn’t just go away on December 31! Not only do these diagnoses need to be captured year over year, but the provider should consider: whether the diabetes is progressing or are there other complications of the diabetes that need to be addressed, documented and coded?

When was CMS HCC enacted?

With the Medicare Prescription Drug, Improvement and Modernization Act (MMA) enactment on December 8, 2003, the CMS-HCC model was selected as a new risk adjustment payment methodology for payments to Medicare Advantage Organizations (MAO) beginning in 2004. The CMS-HCC model includes diagnoses on professional, inpatient and outpatient claims. This model more accurately captures the risk of beneficiaries with varying health statuses and reduces the incentive for biased selection of patients in Medicare’s risk-based payment program.

Why is specificity important for HCC?

Specificity is so important for HCC diagnosis documentation! Specificity can impact whether a diagnosis is an HCC and the category to which the diagnosis is assigned. For example, major depression unspecified is not an HCC diagnosis but major depression, mild, single episode is an HCC diagnosis. Another example is a patient with dementia. If a patient with dementia has behavioral disturbances and this is documented in the record, the diagnosis will fail into a higher severity HCC. CDI specialists can educate physicians on documentation best practices including concepts of cause and effect relationships, linking complications and manifestations of a disease process and documenting “history of” diagnoses only when they no longer exist and are resolved.

Where is HCC most common?

HCC is one of the most common tumors worldwide. The epidemiology of HCC exhibits two main patterns, one in North America and Western Europe and another in non-Western countries, such as those in sub-Saharan Africa, Central and Southeast Asia, and the Amazon basin. Males are affected more than females usually, and it is most common between the ages of 30 and 50, Hepatocellular carcinoma causes 662,000 deaths worldwide per year about half of them in China.

What are the most common causes of HCC?

It occurs in the setting of chronic liver inflammation, and is most closely linked to chronic viral hepatitis infection ( hepatitis B or C) or exposure to toxins such as alcohol, aflatoxin, or pyrrolizidine alkaloids. Certain diseases, such as hemochromatosis and alpha 1-antitrypsin deficiency, markedly increase the risk of developing HCC. Metabolic syndrome and NASH are also increasingly recognized as risk factors for HCC.

What is the most common type of liver cancer?

Hepatocellular carcinoma ( HCC) is the most common type of primary liver cancer in adults and is currently the most common cause of death in people with cirrhosis. HCC is the third leading cause of cancer-related death worldwide. It occurs in the setting of chronic liver inflammation, and is most closely linked to chronic viral hepatitis infection ...

What are the four architectural and cytological types of hepatocellular carcinoma?

Microscopically, the four architectural and cytological types (patterns) of hepatocellular carcinoma are: fibrolamellar, pseudoglandular ( adenoid ), pleomorphic (giant cell), and clear cell. In well-differentiated forms, tumor cells resemble hepatocytes, form trabeculae, cords, and nests, and may contain bile pigment in the cytoplasm. In poorly differentiated forms, malignant epithelial cells are discohesive, pleomorphic, anaplastic, and giant. The tumor has a scant stroma and central necrosis because of the poor vascularization. A fifth form – lymphoepithelioma like hepatocellular carcinoma – has also been described.

What causes hepatocellular carcinoma?

Hepatocellular carcinoma, like any other cancer, develops when epigenetic alterations and mutations affecting the cellular machinery cause the cell to replicate at a higher rate and/or result in the cell avoiding apoptosis.

What are the features of a staging system for HCC?

A number of staging classifications for HCC are available; however, due to the unique nature of the carcinoma to fully encompass all the features that affect the categorization of the HCC, a classification system should incorporate tumor size and number, presence of vascular invasion and extrahepatic spread, liver function (levels of serum bilirubin and albumin, presence of ascites, and portal hypertension) and general health status of the patient (defined by the ECOG classification and the presence of symptoms).

How to detect HCC?

alpha-fetoprotein and des-gamma carboxyprothrombin levels), evaluation requires imaging of the liver by CT or MRI scans. Optimally, these scans are performed with intravenous contrast in multiple phases of hepatic perfusion to improve detection and accurate classification of any liver lesions by the interpreting radiologist. Due to the characteristic blood flow pattern of HCC tumors, a specific perfusion pattern of any detected liver lesion may conclusively detect an HCC tumor. Alternatively, the scan may detect an indeterminate lesion and further evaluation may be performed by obtaining a physical sample of the lesion.

What are the two main types of liver cancer?

There are two main types of liver cancer: primary liver cancer, which originates in the liver , and secondary liver cancer , which spreads to the liver after developing in another area of the body.

What is the most common form of liver cancer?

Hepatocellular carcinoma – The most common form of primary liver cancer, hepatocellular carcinoma develops in liver tissues and occurs primarily in individuals with a chronic liver disease, such as cirrhosis or hepatitis B or C.

Where does hepatic angiosarcoma originate?

Hepatic angiosarcoma – An uncommon and aggressive malignancy, hepatic angiosarcoma originates in the blood vessels of the liver.

How many ICD-10 codes are there?

Of the approximately 70,000 ICD-10-CM codes, about 9,500 map to 79 HCC categories. The diagnoses must be documented by the physicians who provide care. A Risk Adjustment Factor is assigned to each HCC category. Additionally, risk factors are assigned for gender, age, living situation and Medicaid eligibility. The risk factors serve to scale payments to be reflective of the risks associated with the patient. CMS uses the HCCs to risk adjust the payments it makes to Medicare Advantage (MA) plans and for care provided via some demonstration projects. Typically, MA plans receive a capitated amount of money from CMS which they use to pay claims for the care that their policy holders receive. The HCC score is applied prospectively to the capitated rate, using the diagnostic information from a past period to forecast the plan’s costs for a future period. Note: MA plans typically offer physician payment at Medicare FFS rates.

Do CPT codes need to be exact?

Physicians and physician coders are used to being very exact when selecting a CPT code. They need to take that same amount of care when selecting the ICD-10-CM codes they report. Hospital coders are more accustomed to a focus on the ICD-10-CM codes included in a patient’s record since those codes contribute to the Medicare Severity-Diagnosis Related Group (MS-DRG) assignment used in determining the hospital payments. Just as these complex diagnosis effect hospital payments, they may also help physicians document a need for higher professional FFS payment.

How many HCC categories are there in CMS?

The CMS risk adjustment model includes 79 HCC categories for chronic illnesses, and here are the most common ( Formativ Health, 2018):

What is HCC in Medicare?

Department of Health and Human Services (HHS) oversees the HHS-HCC risk adjustment model 2020, which covers commercial payers of all ages and determines risk payments for the current year. The Centers for Medicare and Medicaid Services (CMS) uses the CMS-HCC model for the Medicare Advantage program and those who qualify for Medicare or patients 65 and older, calculating risk payments for the next year ( Wolters Kluwer, 2016).

How does the CMS-HCC Risk Adjustment Model 2020 work?

Demographics include the person’s age, gender, and, for the CMS-HCC model, the place of residence (in a community or skilled nursing facility), and enrollment in Medicare and/or Medicaid.

What is RAF score in HCC?

Both HCC models use a risk adjustment factor (RAF) score to calculate expected future health costs for each patient. Instead of providing one base payment for every patient, the risk adjustment model allows for more accurate payments for expected costs based on health status and demographics of every enrollee.

What is the M.E.A.T. in HCC?

To help properly code patient diagnoses and assign RAF scores, healthcare organizations use the M.E.A.T. (monitoring, evaluation, assessment, and treatment ) criteria application.

Does HIM Consulting offer HCC?

YES HIM Consulting employs a qualified team of experienced coding and auditing specialists who can consult your organization on the HCC risk adjustment models, as well as provide assistance with HCC coding. If you’re interested in our consulting services, education, and training, or other valuable programs, contact YES today!

What is the HCC cell?

HCC starts in the main type of liver cells, called hepatocellular cells. Most cases of HCC are the result of infection with hepatitis B or C, or cirrhosis of the liver caused by alcoholism. Fibrolamellar HCC is a rare type of HCC that is typically more responsive to treatment than other types of liver cancer.

How many cases of liver cancer are caused by HCC?

HCC is thought to account for about three-fourths of all liver cancer cases.

What are the different types of liver cancer?

Liver cancer has several types, each based on the type of cells that becomes cancerous. They include: 1 Hepatocellular carcinoma (HCC), also called hepatoma, is the most common type of liver cancer, accounting for approximately 75 percent of all liver cancers. HCC starts in the main type of liver cells, called hepatocellular cells. Most cases of HCC are the result of infection with hepatitis B or C, or cirrhosis of the liver caused by alcoholism. 2 Fibrolamellar HCC is a rare type of HCC that is typically more responsive to treatment than other types of liver cancer. 3 Cholangiocarcinoma ( bile duct cancer) occurs in the small, tube-like bile ducts within the liver that carry bile to the gallbladder. Cholangiocarcinomas account for 10-20 percent of all liver cancers. Intrahepatic bile duct cancer begins in ducts located in the liver. Extrahepatic bile duct cancer develops in ducts outside the liver. 4 Angiosarcoma, also called hemangiocarcinoma, accounts for about 1 percent of all liver cancers. Angiosarcomas begin in the blood vessels of the liver and grow quickly. They are typically diagnosed at an advanced stage. 5 Secondary liver cancer, also known as a liver metastasis, develops when primary cancer from another part of the body spreads to the liver. Most liver metastases originate from colon or colorectal cancer. More than half of patients diagnosed with colorectal cancer develop secondary liver cancer.

How many people get bile duct cancer each year?

About 8,000 patients are diagnosed with bile duct cancer each year in the United States, according to the ACS .

What percentage of hepatocellular carcinomas are fibrolamellar?

About 1 percent of all hepatocellular carcinomas are fibrolamellar HCC, according to the American Cancer Society (ACS) .

Is liver cancer considered primary?

Secondary liver cancer is considered part of your primary cancer. For example, if the cancer started in the lungs then spread to the liver, your secondary liver cancer would still be treated as lung cancer.

Is fibrolamellar HCC more responsive to treatment than other types of liver cancer?

Fibrolamellar HCC is a rare type of HCC that is typically more responsive to treatment than other types of liver cancer. Fibrolamellar cancer is treated similarly to HCC.

How many HCCs are there in Medicare?

With 86 HCCs, it would be overwhelming to try and remember each and every condition tagged as an HCC. But focusing on a few common chronic conditions can still have a major impact on the risk score of a population and help insure appropriate reimbursement. Below is a discussion of several common conditions that provide reasonable starting points because of their prevalence in the Medicare population, the negative impact they have on the overall patient health, and the high cost associated with their presence. Correct coding is also important as it alerts other providers to existing complications. This helps support appropriate management, such as prescribing an ACE inhibitor or ARB for patients with diabetes complicated by nephropathy.

Why are HCCs often underreported?

There are several HCCs that occur frequently but are often underreported because the documentation is incomplete. Recognizing and documenting these conditions so that they can be appropriately coded will have a large impact on patient risk scores.

Overview

Diagnosis

Signs and symptoms

Risk factors

Pathogenesis

Prevention

Treatment

Prognosis