Using lab data to support coding for new patient panels
Laboratory testing plays a critical role in patient care, impacting nearly 70% to 80% of clinical decisions. It’s used to more efficiently and effectively diagnose and monitor high-prevalence conditions.
Many of those conditions affect HCC coding, including diabetes, chronic kidney disease (CKD), autoimmune and cardiovascular disease. For new patient panels, lab data can provide a historical view of health beyond the confines of payer plans or participating provider EHRs.
By comparing lab test results to actual patient coding, you can identify and resolve discrepancies, ensuring more accurate and comprehensive coding. Working together with large provider networks, Labcorp has found coding for diabetes is generally well documented but still misses 20% to 30% of patients, leaving much room for improvement. In contrast, CKD is poorly diagnosed, with 70% or more of CKD patients going uncoded and/or aren’t accurately coded for the appropriate stage.
Using lab data, you can quickly assess these types of patients and provide an actionable patient list to work with providers in correcting coding discrepancies.
Navigating the transition to the V28 HCC coding model
The Centers for Medicare & Medicaid Services (CMS) is transitioning from the V24 HCC model to a revised V28 model over the next two years. This change has raised concerns among many provider organizations, particularly regarding its impact on risk adjustment factor (RAF) scoring.
CMS's objective with this transition is to focus on conditions and related coding that have a true impact on healthcare costs. As a result, there’s been a reduction in the number of ICD-10 codes associated with HCC and a decrease in RAF scores for some HCC-coded conditions.
One major concern expressed by large provider organizations is the potential impact on RAF scoring for diabetic patients with complications. While it's true many provider organizations may experience a reduced rate for diabetes overall, there’s a significant overlapping population with CKD that may help offset this impact.
V28 RAF score changes for diabetes and CKD