HCC SESSION-4

28/09/2024
Correct Provider Speciality Type
CMS identifies a list of approved physician speciality types for CMS-HCC risk adjustment coding. This list
includes providers such as:
• Medical Doctor (MD)
• Doctor of Osteopathic Medicine (DO)
• Advanced Practice Registered Nurse (APRN/APN)
• Nurse Practitioner (NP)
• Acute Care Nurse Practitioner (ACNP)
• Physician’s Assistant (PA)
• Physical therapist (PT)
• Registered Nurse (RN)-dictating as a scribe for MD
• phD (Psychology notes only)
Certified Nurse Midwives (CNM)

Certified Registered Nurse Anesthetist (CRNA)

Clinical Nurse Specialists (CNS)

Advanced Registered Nurse Practitioner (ARNP)

Adult Nurse Practitioner (ANP)

Advanced Oncology Certified Nurse Practitioner (AOCNP)

Licensed Clinical social worker (LCSW)

Chiropractor (DC)
Examples of Acceptable EMR
Authentication Statements
Accepted by Digitized signature Sealed by
Acknowledged by Electronically approved by Signature derived from controlled
access password
Approved by Electronically authored by Signature on file (with typed name)
Authenticated by Electronically signed by signed
Authored by Entered by Signed by
Authorized by Entered data sealed by Signed before import by
Charted by Finalized by Supervised by
Completed by Performed by Validated by
Confirmed by Read by Verified by

Digital Signature Released by/reviewed by Written by

Examples of unacceptable ENR
Authentication statements
• Notes with the below authentication will still be coded when provider name is present. Using the ‘No valid
provider signature’ error comment on each diagnosis from that DOS.

• Administratively signed

• Dictated but not read

• Dictated but not signed

• Electronically signed by agent of provider

• Filled by

• Signature on file

• Signed but not read

ACCEPTABLE PROVIDER
SIGNATURES
Types of acceptable physician signatures and credentials
TYPE ACCEPTABLE
Hand written signature or initials, Mary C .Smith, MD or MCS. MD
including credentials
Electronic signature, Including credentials Requires authentication by the
responsible provider (for example but not
limited to “approved by”, “signed by”,
“Electronically signed by”)

Must be password protected and used

exclusively by the individual physician
UNACCEPTABLE PROVIDER
SIGNATURES
TYPE UNACCEPTABLE unless..
Typed name Authenticated by the provider
Non-physician or non- physician extender (eg. Medical C0-signed by acceptable physician
student)
Provider of services signature without credentials Name is linked to the provider credentials or name on
physician stationery
SUBSTANTIATION GUIDE (proof notes) MEAT-
Monitor, Evaluate, Assess/Address, Treat
• Coding a condition depends on where it is found in the chart note and
whether it has MEAT. Please see below for further instructions.
ACUTE CHRONIC
CC Y w/MEAT Y w/MEAT
HPI Y w/MEAT Yes
ROS Y w/MEAT Y w/MEAT
PMH Y w/MEAT Yes
PL Y w/MEAT Y w/MEAT
PE Y w/MEAT Yes
Assessment Y w/MEAT Yes
Plan Y w/MEAT Yes
Med List Yes, Chronic conditions
found only in the med list
may be captured
• Cancers such as Leukemia and Lymphoma should be coded based on
ICD-10-guidelines.
MEAT TAMPER
Monitor Treatment
Evaluate Assessment
Assess Monitoring/ Medicate
Treat Plan
Evaluate
Referral
MEAT- Monitor, Evaluate,
Assess/Address, Treat

Depending on where the condition is found in the chart note it may need substantiation confirming the

condition is still present. The concept of substantiation is also expressed through the acronym MEAT. Below are

examples of substantiation, this is not an all-inclusive list.

MEAT (only 1 is required)
Monitor Noting signs or symptoms of the disease
that are present.
Noting disease regression or progression.
Commonly found in HPI, ROS and/or
Physical exam

Evaluate Reviewing lab, pathology, radiology results.

Diagnostic testing that is performed within
the past 12 months can be considered
support for the condition.
Discussion of progress towards health goal
Findings in the physical exam

Assess/ Address The condition may be addressed in a

narrative HPI by the provider.
The condition may be assessed in the
physical exam.
Diagnostic tests/labs, orders do not need to
be directly correlated to the condition.
Follow up is scheduled

Treat Physical occupational therapy.

Patient refusal of treatment for a condition.
Referral to a specialist
Medication (see medication section of
guidelines)
Where is the MEAT?
Dx: Atrial Fibrillation, hyperlipidemia
Meds
• Crestor for hyperlipidemia
• coumadin for anticoagulation for AFIB
Dx: Diabetes type 2, Morbid obesity
Meds
• Insulin-DM not well-controlled
• Lasix
BMI-42.0
Plan
• Refer to Endocrinologist about DM
• Discussed with patient need to lose weight through reduced calories and exercise.
TAMPER
• Treatment- Surgery, Procedures, Therapy, Order DME

• Assessment: Condition is stable, improving

• Monitor/Medicate: Order/review lab results

• Order medication/ DM2 is well-controlled with insulin

• PLAN: Decide how to manage the condition

• Evaluate: Physical exam

• Referral : Refer patient to specialist

Points to remember
• Correct Patient
• DOS within Data collection period
• Face to Face Encounter
• Complete Note
• Acceptable provider type
• Acceptable provider signature
• Acceptable place of service
• Code the diagnoses
• Map codes
• Check for TAMPER if required
• Add FLAGS if needed
How to code HCC • Date of visit: 9/29/2018

• CC: Patient says that her lower extremity swelling continues to bother her. SUBJECTIVE

Patient Name: Suzie sunshine • HPI: Patient is here today for evaluation of her bilateral lower extremity swelling. The
swelling responded to hydrochlorothiazide.
DOB: 9/23/1947

• OBJECIVE
Data Collection Period:
1/1/2018-12/31/2019 • DATA REVIEW: I reviewed her lab and echocardiogram. The patient does have
moderate pulmonary hypertension.
Medicare HCC/ RxHCC
• Exam: Patient in no acute distress

• ASSESSMENT:
Complete Note:
1. Bilateral lower extremity swelling. This has resolved with diuretics; it may be
Subjective secondary to problem #2
Objective 2. Pulmonary hypertension: Etiology is not clear at this time, will work up and
Assessment possibly refer to a pulmonologist.

Plan PLAN: Will evaluate pulmonary hypertension. Patient will be scheduled for a sleep study.

Electronically signed by MARCUS MD 11/01/2018

Where is the MEAT?
Dx: Moderate Pulmonary • DATE: 10/29/2018
• CC: Follow-up pf lower extremity swelling
Hypertension • HPI: Patient is here today for follow up of bilateral lower
extremity swelling. The swelling responded to
hydrochlorothiazide.
MEAT • DATA REVIEW: I reviewed her lab and echocardiogram. The
patient does have moderate pulmonary hypertension.
DATA REVIEW: The patient does have • EXAM: Patient is in no acute distress.
ASSESSMENT:
pulmonary HTN 1. Bilateral lower extremity swelling. This has resolved with
ASSESSMENT: “.. Will work up and diuretics; it may be secondary to problem #2.
2. Pulmonary hypertension: Etiology is not clear at this
possibly refer to a pulmonologist” time; will work up and possibly refer to a pulmonologist.
PLAN: Will evaluate the pulmonary hypertension. Patient will
be scheduled for sleep study.
PLAN: Will evaluate the pulmonary
Electronically signed by Marcus Green MD 11/01/2018
HTN
HCC CODING EXERCISE 1:
Mrs. Greene, a 42 year old female, is seeing her medical oncologist for the first time since her diagnosis of
breast cancer. The physician reviewed the pathology report which confirmed carcinoma of the lower-inner
quadrant of her right breast. She has already undergone surgery, but the doctor recommends that she now
receive adjuvant chemotherapy. He discusses the treatment, the risks and side effects with Mrs. Greene. The
patient consents to the chemo treatment.

DIAGNOSIS CODE

Breast cancer, right lower- inner C50.311

quadrant female
HCC CODING EXERCISE 2:
DATE OF ENCOUNTER: 9/14/2019
CC: Chest pain
HPI: Patient has been experiencing intermittent chest pain for the last week, but says she is otherwise fine
PMH:
Hyperlipidemia
Diabetes Type 2
Cataracts, corrected surgically 2017
EKG: Done in office today: shows no indication of history of a heart attack
EXAM:
CV: Normal rate and rhythm
ASSESSMENT:
Angina ANGINA I20.9
Hyperlipidemia, mixed HYPERLIPIDEMIA, MIXED E78.2
DM2, well controlled DM2, well-controlled E11.9
PLAN:
Order nitroglycerin to be used PRN for angina; instructed patient on its use
Order lipid panel to be done prior to next office visit
THANK YOU