A patient’s record supports two related chronic diagnoses that fall under an HCC hierarchy. What should the physician-office coder do regarding reporting and hierarchy application?
Select an answer to reveal the explanation.
Short Explanation
Your job is to code what the doctor documented—not to play traffic cop for the HCC hierarchy. Report the supported diagnoses and let the model apply hierarchy rules. Hand-dropping codes “to look clean” creates a false chart.
Full Explanation
Coders should assign all clinically supported diagnoses that meet coding guidelines. HCC hierarchies are applied by the risk-adjustment model; manually suppressing a supported related diagnosis, reporting only the less severe condition, or splitting claims to force separate payments is inappropriate. Accurate reporting preserves clinical integrity while payment logic handles hierarchy interactions.