The scenario of ventilator dependence presumes a chronic state. Most patients requiring long-term ventilator support have a tracheostomy. Therein lies the HCC severity weight which augments the physician’s quality metrics. Simply noting ventilator dependence gains no severity weight to the physician but increases the severity weight for the facility (CC).
All the trachea-related ICD-10 codes are complications, except Z43.0: Encounter for attention to tracheostomy. It still provides large HCC relative weight to the clinician but does not add to facility metrics.
Simply noting that the patient has a tracheostomy gains no severity weight. Some description of attention to the tracheostomy is required. When specific complication codes do not apply, document as: well healed, irritated, eroded, normally functioning, clean, leaking, not leaking, comfortable, not comfortable, replacement not required, replaced, well cared for by RT, etc.—anything that notes you addressed the tracheostomy. Make sure coders are aware.
As the hierarchies of HCCs work, when HCC 82 is credited, HCC 84 (and its relative weight) is dropped. HCC 84 includes acute, chronic, and acute on chronic respiratory failure.
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