Certified Risk Adjustment Coder (CRC)

What is best described by the term "Disease Hierarchy" within the context of HCC coding?

1. Core information submitted by MA organizations for each diagnosis

2. Payments adjusted for a beneficiary using the CMS-HCC dialysis model

3. A combination of multiple ICD-9-CM/ICD-10-CM diagnosis codes addressing levels of severity

4. Three to five digit codes describing the clinical reason for a patient's treatment

The correct answer is: A combination of multiple ICD-9-CM/ICD-10-CM diagnosis codes addressing levels of severity

The term "Disease Hierarchy" in the context of Hierarchical Condition Categories (HCC) coding refers to a structured framework where multiple diagnosis codes are categorized based on the severity and complexity of a patient's conditions. This hierarchy helps in determining which diagnosis codes are most pertinent for risk adjustment purposes, ensuring that the patients are appropriately stratified according to their health status. When multiple diagnoses are present, the hierarchy prioritizes conditions to address the patient's highest severity level, thus impacting risk adjustment calculations for Medicare Advantage plans. By using a combination of ICD-9-CM/ICD-10-CM codes, the coding reflects the complexity of a patient's health, allowing the Centers for Medicare & Medicaid Services (CMS) to adjust payments more accurately based on the risk associated with that patient population. This organization of codes is critical because it directly influences reimbursement rates and ensures that healthcare providers are compensated appropriately for the patients they manage, particularly those with multiple or complex health issues.