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HCC Values

CMS-HCC v22:  17 - Diabetes with Acute Complications

CMS-HCC v24:  17 - Diabetes with Acute Complications

CMS-HCC v28:  36 - Diabetes with Severe Acute Complications

ESRD-HCC v21:  17 - Diabetes with Acute Complications

ESRD-HCC v24:  17 - Diabetes with Acute Complications

Rx-HCC v08:  30 - Diabetes with Complications

HHS-HCC v07:  19 - Diabetes with Acute Complications

Stats

Coding Tips:  ~5

Medicare Policies (LCD/NCD):  25

Newsletter Articles:  3

PCS Codes in Same Section

Stats

Non-Facility CCI Edits:  Yes

Facility CCI Edits:  Yes

Global Days:  XXX - Global Concept Does Not Apply

Non-Facility RVU/Fee:  2.16 / $69.87

Facility RVU/Fee:  1.4 / $45.29

Coding Tips:  ~16

Medicare Policies (LCD/NCD):  5

Newsletter Articles:  928

Common Language Description (CLD)

Evaluation and Management (E/M) codes are used to report face-to-face encounters between a patient and a physician or other qualified healthcare providers (QHPs). Selection of the code category depends on the service location (eg, office, hospital, critical care, home) or type of service (consultation, prolonged services, admission, discharge) and patient status (new/initial or established/subsequent).

Within the code category, the level of service is determined by the provider's documentation of:

• Three key components (history, exam, medical decision making)
• Medical necessity (the level of severity or complexity associated with the presenting problem rated as straightforward, low, moderate, or high severity)
• Time (spent counseling and/or coordinating care with and for the patient, face-to-face, at the bedside, or on the patient's unit/floor)

Office or Other Outpatient Services New Patient category includes five codes (99202-99205) which represent four levels of complexity:  99202 requires documentation identifying

• Expanded problem focused history
• Expanded problem focused examination
• Straightforward decision making
• Presenting problem(s) low to moderate in severity
• Typical provider-to-patient, face-to-face time around 20 minutes 

Stats

Non-Facility CCI Edits:  None

Facility CCI Edits:  None

Coding Tips:  ~16

Medicare Policies (LCD/NCD):  2

Newsletter Articles:  13

Common Language Description (CLD)

Oxygen systems come with the components necessary to provide oxygen from the oxygen container to the patient: regulator, flowmeter, humidifier, tubing, cannula and/or mask. There are a few options available:

• Gaseous; liquid; or concentrated
• Portable or stationary
• For rent or purchase

The following components may be included in the system rented/purchased: refill adapter, container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing. A few systems may include other components, so be sure to check for a complete list of components for the system prescribed.

AMA CPT® Assistant - 2022 Issue 11 (November)

Full Article

Document Information

excision

[ex·ci·sion] (ek-sizh´ən)

• removal of a portion or all of an organ or other structure. Called also resection and ectomy.

Stats

MCC or CC:  MCC - major complication or comorbidity