What data source is primarily used for HCC coding?

The primary data source used for HCC (Hierarchical Condition Category) coding is diagnosis codes from the ICD (International Classification of Diseases). ICD codes provide a standardized method for coding and classifying diseases and health conditions, which is essential for risk adjustment in healthcare. HCC coding relies heavily on these diagnosis codes to assess the health status of patients accurately and to determine the appropriate risk scores for reimbursement purposes.

The use of ICD codes allows for the identification of specific chronic conditions and comorbidities that impact a patient’s health and the resources required for their care. This is crucial in the HCC model, as it helps to predict healthcare costs based on patients’ conditions. Accurate coding using ICD is therefore essential in reflecting the complexity of a patient's health, ensuring that healthcare providers receive appropriate compensation for the level of care they provide.

In contrast, although the other options—Current Procedural Terminology, Electronic Health Records, and Patient Surveys—play roles in healthcare documentation and management, they do not serve as the primary source for HCC coding. Current Procedural Terminology pertains to procedures rather than diagnoses. Electronic Health Records contain a variety of data, but it is the diagnosis codes specifically that drive HCC coding. Patient Surveys may capture patient-reported outcomes