Hierarchical Condition Category (HCC) is a term that describes the grouping of similar diagnoses into one related category to be used in a risk adjustment model

2025 Provider HCC Risk Adjusted Diagnoses Correct Coding Guide in the inpatient and outpatient settings. Please consider that most of the acute condition codes (designated with red type) …

Oct 24, 2024 · Risk adjusment models and parameters for Medicare Advantange rates and Prescription Drug rates.

Each HCC is mapped to an ICD-10-CM code. Along with demographic factors such as age and gender, insurance companies use HCC coding to assign patients a risk adjustment factor …

For these reasons, it is important for health centers to have an HCC coding strategy to ensure patient diagnoses are documented thoroughly and to the highest specificity possible. This …

Oct 13, 2025 · Comprehensive HCC coding guidelines for risk adjustment and medical coding, helping providers ensure accurate documentation, compliance, and optimal reimbursement.

Mar 12, 2025 · HCCs (Hierarchical Condition Categories) are designated groups of diagnoses used to assess a patient's disease burden and predict future healthcare costs. There are …

Using the most specific HCC codes to establish medical necessity when ordering tests, sending referrals to specialists, and sending prescriptions to the pharmacy ultimately ensures that the …

properly capture and report HCC diagnoses. In addition, inpatient coders may not routinely assign codes for chronic conditions that do not qualify as a complication or comorbidity (CC) or a …

Streamline HCC coding with this quick guide detailing the top incorrectly documented conditions to boost accuracy, reduce errors and support quality care.