For a diagnosis code to be counted in the current CMS HCC model, it must meet which criteria?

A diagnosis code must be included in the CMS-Hierarchical Condition Category (CMS-HCC) to be counted in the current CMS HCC model. This is because the CMS HCC model is specifically designed to adjust risk based on certain health conditions that are recognized and categorized to reflect the risk level associated with patients. Inclusion in this category indicates that the diagnosis has been analyzed and deemed relevant for determining the healthcare costs and resources expected for a population, particularly in Medicare Advantage.

The other options do not fit the criteria established by the CMS-HCC model. History codes are generally not counted as they do not reflect the current health status that the model aims to capture for risk adjustment. A diagnosis that has never been reported would also not be counted, as it lacks the necessary documentation and coding history to be relevant. Finally, while acute conditions are important in patient care, not all acute conditions may be categorized within the existing CMS-HCC framework, thus only supporting a subset of the conditions that can be utilized for risk adjustment.