Outpatient HCCs

Often DM is coded without complication (even when patients have manifestations of their DM)

·        Uncomplicated DM has only 1/3 the HCC relative weight of DM with any complication

·        Consider Diabetes (type 1 or 2) with hyper- or hypoglycemia*

0.106

0.307

HCC relative weight is available with specificity of describing pneumonia

·        Unspecified Pneumonia, CAP, HAP, HCAP all without HCC RW)

·        Lobar – Localize with a stethoscope or a chest X-ray

·        Aspiration

0.000

0.164

0.612

·        Home Oxygen Use

·        Chronic respiratory failure – Supplemental oxygen use⁺

0.000

0.314

·        Acute bronchitis has no HCC RW

·        Chronic bronchitis has the same RW as COPD

0.000

0.335

Alcohol use, abuse and dependency

·        Alcohol abuse

·        Alcohol dependency has HCC weight

·        Alcohol dependency in remission (“on the wagon” in recovery) is HCC RW for life

0.000

0.368

0.368