While reviewing ambulatory diagnoses for risk adjustment, a new coder assumes every ICD-10-CM code maps to an HCC. Which statement corrects that misconception?
Select an answer to reveal the explanation.
Short Explanation
Not every diagnosis gets an HCC jersey. Plenty of everyday codes never enter a risk category. Learn which families are HCC-relevant instead of assuming the whole ICD book pays risk.
Full Explanation
CMS-HCC models include only designated diagnosis mappings; numerous ICD-10-CM codes do not map to any HCC. It is incorrect that all codes map, that only R-codes map, or that CPT Category II codes are the HCC source. Coders should recognize HCC-relevant versus non-HCC diagnoses when educating providers and validating risk-adjustment capture.