Maximizing Risk Adjustment Accuracy: Best Practices for Capturing HCC Codes During the Medicare Annual Wellness Visit

Why HCC Coding Matters

Hierarchical Condition Category (HCC) coding is more than a compliance requirement—it’s the backbone of accurate risk adjustment in Medicare Advantage and other value-based care models. Capturing every relevant diagnosis during the Medicare Annual Wellness Visit (AWV) ensures two critical outcomes:

1. Appropriate Reimbursement – Aligns payment with the patient’s true disease burden.
   
2. Better Patient Care – Informs proactive care plans and chronic disease management.
   

Since HCC codes reset annually, a missed diagnosis this year means lost revenue and an incomplete patient risk profile next year.
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The AWV: An Ideal Time for HCC Capture

The AWV, designed for prevention and care planning, provides a structured, yearly touchpoint with Medicare patients. While it’s not a problem-oriented visit, it offers a unique opportunity to review, update, and code all chronic conditions that affect patient care.
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Best Practices for Capturing HCC Codes in the AWV

1. Pre-Visit Chart Review

• Pull Last Year’s Diagnoses – Identify all chronic conditions coded in the prior 12 months.
  
• Flag Missing HCCs – Compare EHR data with claims reports to spot gaps.
  
• Prioritize Active Conditions – Only code conditions that are monitored, evaluated, assessed, or treated (MEAT) during the visit.
  

2. Use MEAT Documentation Standards

Every HCC diagnosis must be supported by clear evidence in the note:

• M – Monitored (e.g., blood pressure readings, lab results)
  
• E – Evaluated (e.g., review of symptoms, specialist notes)
  
• A – Assessed (e.g., stability, progression, or status of disease)
  
• T – Treated (e.g., medication management, referrals, lifestyle counseling)
  

Example:
Instead of: “Diabetes – stable”
Use: “Type 2 diabetes without complication – controlled on metformin; A1c 6.8%, continue current regimen and monitor quarterly.”

3. Incorporate HCC Review into AWV Workflow

• Frontload Coding Tasks – Assign coders or medical assistants to prep patient charts with suspected HCC conditions before the visit.
  
• Provider Checklists – Use condition-specific prompts in the EHR to ensure nothing is overlooked.
  
• Mid-Visit Review – As part of the health risk assessment, confirm chronic conditions with the patient.
  

4. Avoid “Historical” or “Inactive” Coding

Only code active conditions addressed during the AWV. Chronic conditions should be re-captured yearly only if they are still present and relevant to patient care.

5. Leverage Technology

• EHR Alerts – Set automated reminders for unresolved chronic conditions.
  
• AI-Assisted Coding Tools – Some platforms flag missing HCCs in real time based on chart content.
  
• Data Integration – Pull external claims, pharmacy, and specialist data into the AWV encounter.
  

6. Train Your Team

• Provide annual coding refreshers for physicians, NPs, PAs, and coders.
  
• Emphasize the link between coding, patient care, and organizational revenue.
  
• Use case studies showing how accurate coding changes patient risk scores and resource allocation.
  
  

Compliance Reminder

• ICD-10 Specificity – Always code to the highest level of specificity (e.g., E11.9 vs. E11.65).
  
• Audit Readiness – Maintain documentation that supports each coded diagnosis.
  
• No Upcoding – Only code conditions supported by the visit documentation and MEAT criteria.
  
  

The Bottom Line

The Medicare Annual Wellness Visit is more than a preventive care checklist—it’s a strategic moment to ensure your patient’s health story is fully and accurately captured in the risk adjustment model. By combining pre-visit planning, MEAT-based documentation, EHR tools, and ongoing training, providers can improve both care quality and financial performance.

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