As a data analytics company, Talix analyzes, well, a lot of data. So, it’s not surprising that we’re often asked what our Coding InSight application tells us are the top missed HCC (Hierarchical Condition Category) codes.
We’ve seen macro trends across our customer base, which encompasses a range of different healthcare institutions. Based on data from our Coding InSight application, here are the top five actively managed conditions and documented status codes that are most frequently either un-coded or inaccurately coded by clinicians:
These codes are missed for a variety of reasons. A huge stumbling block for risk-bearing organizations, particularly those that are new to risk adjustment, is the shift to value-based care. This shift requires clinicians and coders to switch from coding acute or chronic conditions related to the patient’s reason for the visit or what was diagnosed/treated to reviewing, documenting and coding all of a patient’s chronic conditions and statuses – regardless of whether or not they are related to the reason for the visit or chief compliant. It’s a significant departure from the current coding practices of most organizations and a primary reason why, in spite of documenting the presence of severe health status conditions, providers typically fail to code them.
Other reasons include the increased specificity of Diabetes coding and the introduction of more complex guidelines, particularly for combination codes. And, of course, clinicians are grappling with having to do more with less time. They have access to more data, such as specialist notes and claims from other institutions, but many struggle with balancing the need to analyze and apply it all while simultaneously trying to meaningfully engage with their patient during the often short appointment window.
No matter the reason, missed codes have a huge impact on both the quality of care patients are getting and on a provider’s bottom line. It’s important for organizations to implement processes and/or solutions that enable them to accurately identify, document and manage all high-risk conditions.
Here are some quick tips for improving coding accuracy and efficiency: