How are HCCs categorized?

Hierarchical Condition Categories (HCCs) are primarily categorized based on diagnosis groups. This classification system organizes patient diagnoses into specific categories that reflect the severity and complexity of a patient's health conditions. Each HCC represents a clinical condition that impacts the risk score, thereby affecting reimbursement in risk adjustment models used by Medicare and other payers.

By categorizing HCCs into diagnosis groups, healthcare providers can assess the risk and resource needs of a patient population more effectively. This grouping relates to how certain conditions can lead to more significant healthcare costs and indicate the overall health status of a patient, thus demonstrating the value of accurately coding these conditions for proper payment and care management.

Understanding that HCCs focus on diagnosis groups allows organizations and healthcare professionals to effectively navigate risk adjustment methodologies, ensuring that healthcare claims reflect the true complexity of their patient populations.