Medicare advantage patient

Reference no: EM133689465

Question

Examine the case scenario below presenting two HCCs for a Medicare Advantage patient. Which HCC (Hierarchical Condition Category) value will be used in the risk score calculation for this patient and why? In March, a patient was treated for diabetes without complications. This ICD-10-CM code is grouped to CMS-HCC19, diabetes without complications, the lowest risk category for diabetes. In August, another claim was submitted for the same patient. The documentation specified a more severe condition: diabetes type 2 with peripheral vascular disease. This ICD-10-CM code is grouped to CMS-HCC18, diabetes with chronic complications, the next highest risk category for diabetes. Question 198 options: CMS-HCC18 will be used in the HCC risk score in risk score calculation. The risk value of the more severe category is used. CMS-HCC18 will be used in the HCC risk score calculation. The code for the most recent encounter is used. CMS-HCC19: the risk value of the more severe category is used in the HCC risk score calculation. CMS-HCC19: the code for the first patient encounter is used in the HCC risk score calculation.

Reference no: EM133689465

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