Question from an HCC coding test.

[Becky Curtis]

I was given a test for a remote HCC coding position and this was one of the questions on the test. I found it to be confusing and wanted to see what the CCO team would do with it, especially the HCC coders. I did not get called in for an interview for this job so not sure if I did very well on this quiz, but the next week I got my other job.

Patient presents to the office for a follow-up for history of breast cancer. Patient is status post right mastectomy on June 10, 2011 and has had no recurrence of the breast cancer. She also has a history of seizure disorder for which she takes Dilantin. Her current medications include insulin, the blood pressure medication lisinopril and the prophylactic hormonal medication Tamoxifen for the breast cancer. Assign the codes for these conditions

 

[Carolyn Heath]

Here is how I would code for the question:
Diabetes: 250.00 because the patient is taking insulin
Insulin: V58.67 because the insulin is currently in use and patient is still taking it
hypertension: 401.9 because the patient is taking medication for high blood pressure
breast cancer: 174.9 because the patient is taking medication for the breast cancer

 

[Luna]

I had written a list of codes I thought might be appropriate to this case too. I have the first three Carolyn has listed. For the breast cancer one, my thinking was a little different on it. I was unsure what direction to go with it. I probably went the wrong way. I reported it as a "history of" because I believed the Tamoxifen (nearly two years without recurrence of cancer), was being applied more as a preventative measure than a treatment to past cancer. Also I added a code for the seizures, and long term drug use for the Dilantin, Tamoxifen, and lisinopril.
So my list is:
250.00 DM unspecified
V58.67 Long term use insulin
401.9 Hypertension unspecified
??? (I guess I have not found a code for the use of lisinopril- will have to look some more)
345.90 Epilepsy unspecified
V58.69 Long term use Dilantin (??doubting myself here??)
V10.3 Personal history breast cancer
V07.51 for the Tamoxifen

PS. I'm an early student, and there is much room for my understanding to grow. I could be way off base on most of these. But thank you for posting your question. These challenges give me opportunity to dig and apply what I am learning. Plus, they give insight on what job-seeking is going to entail once I get out there.

Edit: Looking at the V07.5 category it does instruct to code first, if applicable the malignant neoplasm. It also instructs to Use additional code, if applicable, to identify estrogen receptor positive status ....and personal history of breast cancer V10.3. So I'm still leaning toward sticking with that.

 

[Carolyn Heath]

Luna, in HCC coding, some of the V codes do not apply. You have to go with current medication that the patient is taking at the time. Remember: In HCC coding, you are only coding for chronic conditions only. Very few V codes are used in HCC Coding, but the ones you put in are not in use for HCC Coding. The only V code you would use is the insulin, V58.67. The other two V codes--personal history, long term use for Dilantin and Tamoxifen--will not be used for HCC Coding. Becky gave us a good example of an HCC Coding question.

 

[Luna]

Oh, did not know that about HCC coding. I'm a hyper student going full guns with whatever I can code. Thank you for the info.

 

[Becky Curtis]

Thank you for your responses Carolyn and Luna! I have never coded in HCC and judging from your response Carolyn I can see how I missed the mark on the test. I even called my instructor but she was viewing it more from a billing perspective and not a chronic condition perspective.

I have more questions I can post from this test but this was the most difficult one for me.

 

[Becky Curtis]

Carolyn, when you did your contract work as an HCC coder did you have to take a test like this prior to being hired?

 

[crank]

I didn't came across HCC coding. I'm learning the basics of coding. I have gained some knowledgeable info.

 

[Carolyn Heath]

Becky, I did take a test for HCC coding and pass the exam.

 

[Brian Jude]

This is what I would have done:

Insulin: V58.67
Breast cancer: 174.9 (still on med)
Seizure Disorder: 345.90 (says history, but still on med)

Instructions say "Assign the codes for these conditions."
Insulin, Breast cancer and Seizure disorder are the only HCCs documented.
I wouldn't have coded the Hypertension because it is not documented. Lisinopril can also treat CHF, and several other conditions.
I wouldn't have coded Diabetes because it is also not documented. People with Hypoglycemia but no Diabetes could also be prescribed insulin.

You can't assume diagnoses that are not documented. If possible, you could query provider for clarification.

 

[Alicia Scott]

Don't forget there are more then one type of HCC. You have RxHcc and PAFHCCs. HTN 401.9 is a RxHCC.
You always have to have support for any HCC. It mus be a f/f visit and can not just say HTN. Now there are a lot of ways to get support. That is why it is easier to work if you have an actual encounter. You have the ROS and HPI etc....to use for support.