Wiki Risk Adjustment

Couple of questions: Does a patient with hypertension on medication and is now blood pressure is controlled, Do I continue to code htn code or does the patient still have hypertension or is it history of?
A patient that has had a cancerous mole removed( over a year ago), and didn't receive treatment, When does it become history of?

#1, if they're on medication, then the condition is current and you code it, as long as it was addressed at the visit.
#2, if there's no evidence of cancer currently, then you'd code 'history of'.

Not to be a pain in the a$$, but both of these questions are answered in the instructional notes in ICD-10-CM. If you're coding for risk adjustment, you should have a book and/or excellent software, so ask your employer to make sure you have the tools you need.

Official Guidelines, Section IV Diagnostic Coding and Reporting Guidelines for Outpatient Services
I. Chronic Diseases. Chronic diseases treated on an ongoing basis may be coded and reported as many times as the patient receives treatment and care for the condition(s).

Official Guidelines: Chapter 21
4. History (of): Personal history codes explain a patient's past medical condition that no longer exists and is not receiving any treatment, but that has the potential for recurrence, and therefore may require continued monitoring.

Hello Pam,

No, you're not a pain in the aXX I'm so new at this, and I plan on taking a course in the immediate future. I do appreciate you taking the time to answer my questions.

Crystal

I agree with Pam on both conditions.

For pure coding purposes, the hypertension is receiving treatment (the T in MEAT, which you will learn more about in Risk Adjustment) with medication. The melanoma appears to be excised and removed, thus no longer considered active or current, which would suggest a History of - condition.

Your ICD-10 guidelines will be your friend. Coding Clinics by AHA is next.

For Risk Adjustment purposes, hypertension does not risk adjust in the current HCC or HHS model, however it does in the Rx model. Lots to learn when it comes to Risk Adjustment, however it is a pretty interesting and specialized subset of coding!

Crystal Olson said:

Couple of questions: Does a patient with hypertension on medication and is now blood pressure is controlled, Do I continue to code htn code or does the patient still have hypertension or is it history of?
A patient that has had a cancerous mole removed( over a year ago), and didn't receive treatment, When does it become history of?

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Hypertension would be coded. Often you see statements in the RoS stating "not depressed", or "no gerd" and the condition would still be coded as long as medication is found. Squamous cell and basal cell carcinoma do not hold HCC values and gerd no longer risk adjusts. Someone could, however, have had breast cancer years ago with a mastectomy. If an anti-neoplastic medication such as arimidex/anastrazole appeared in the medication list this would be coded.