A new juggling act is poised to begin for those who deal with clinical documentation, specifically the documentation of Hierarchical Condition Categories (HCCs). As announced in March, the Centers for Medicare & Medicaid Services (CMS) has decided to clinically reclassify their HCC model from the current ICD-9-CM-based foundation to one grounded in ICD-10-CM. Use of the new system will be phased in over three years, beginning in 2024.
Implementing the transition from HCC Version 24 to Version 28 will be a significant undertaking and planning for the switch should be a priority for healthcare organizations across the country. In our latest guide, IMO’s Vice President of Global Clinical Services, June Bronnert, MHI, RHIA, CCS, CCS-P, takes a closer look at what’s driving the model modifications, the differences between the versions – and the challenges they pose, along with concrete steps that can be taken to prepare for the upcoming changes.
For an excerpt from HCC evolution: Preparing for the shift from Version 24 to Version 28, keep scrolling, or to skip right to the guide, click the button below.
What’s so different in V28?
The switch to ICD-10-CM codes as the foundational logic for V28 has resulted in a number of model changes including:
- Additional hierarchical condition categories (HCCs)
- Revisions of HCC category titles
- Renumbering of HCCs
- Deletions of selective conditions as represented by ICD-10-CM codes
- Changes in the HCC RAFs
It is important to look closer at each of these areas since even the smallest modifications can impact the payments providers receive for certain patient populations.
New HCC numbers and names
In V28, there are 115 payment HCCs – an increase of 29 compared to V24. This is the result of both newly-created HCCs and the splitting of several existing HCCs due to the additional specificity of ICD-10-CM codes as compared to their ICD-9-CM counterparts. As a result, most of the HCC numbers and names have changed between V24 and V28.
The Liver Disease Group of HCCs in the table above provides an effective illustration. V24 has three HCCs while V28 has a total of five. V24 HCC numeric identifications are 27 to 29, while 62 to 68 are the numeric identifications in V28. This HCC group also shows where titles remained the same, such as Chronic Hepatitis, and where titles changed – for example, End-Stage Liver Disease is now Chronic Liver Failure/End-Stage Liver Disorders. In addition, this chart shows newly-added HCCs, such as HCC 62, Liver Transplant Status/Complication.
Now you HCC it. Now you don’t
While the overall number of HCCs has increased between versions, the total number of ICD-10-CM codes represented within those HCCs has decreased significantly. V24 contains 9,797 codes while V28 has 7,770. In certain instances, removal of the ICD-10-CM codes also resulted in removal of an HCC all together. For example, HCC 21 Protein-Calorie Malnutrition was removed from V28 along with the associated 10 ICD-10-CM codes.