Which of the following is NOT true about HCC coding?

The statement that HCCs replace the need for ICD-10-CM coding is not true because Hierarchical Condition Categories (HCC) coding does not eliminate the requirement for standard ICD-10-CM coding. HCCs are a risk adjustment model used primarily in Medicare Advantage plans to quantify the risk associated with patient populations, ultimately affecting reimbursement rates. However, accurate coding with ICD-10-CM is still necessary, as it provides the detailed clinical information needed to support and document the HCC codes.

While HCCs are indeed used for risk adjustment and must have clinical validation, they must also be recaptured annually to ensure that the patient’s health status is accurately reflected for ongoing risk assessment. Therefore, the relationship between HCC coding and ICD-10-CM is complementary; proper ICD-10-CM coding provides the necessary foundation for the assignment of HCCs but does not get replaced by them.