Status codes are used alongside HCC codes in healthcare management to help calculate a risk adjustment score. Scoring is used to determine the potential costs of providing appropriate treatments, education, and interventions for healthcare recipients.
For example, an advanced data collection tool gathering patient data from across providers and practitioners might identify a status code that indicates a patient carries a specific disease or has undergone an organ transplant in the past.
Unlike HCC codes, status codes do not have a defined HCC value, although a growing proportion of payers now require healthcare services and providers to include status codes within their reporting. These status codes may impact the healthcare a physician or clinician deems appropriate or the treatments they are eligible for.
The key objective of a status code is to notify any medical professional, consultant, or payer of underlying factors that may impact the future healthcare given.
These codes can be subdivided into status codes that inform healthcare services and insurance providers of a previous medical encounter, diagnosis, or disease. Others are related to circumstances that are not necessarily medical but can impact their access to or engagement with medical services.
There are multiple types of status codes, including Z codes, which could signify the following:
HCC codes, while often used concurrently, are part of a risk adjustment approach, which predicts and attempts to quantify the healthcare costs for a patient for the year ahead. Although Z codes are not universally incorporated into risk adjustment modeling and do not have an HCC scoring value, they can provide important information, whether self-reported or included within patient medical records.
History and status codes should not be confused. The former refers to a previous status, condition, or piece of data that is not now present, such as when a patient has presented with a disease that has now been treated.
Status codes refer to ongoing indications or scenarios representing a persistent condition or circumstance that could affect the healthcare provided, recommended, or deemed appropriate for the individual. However, history codes are still reportable, particularly where a condition may potentially recur or require long-term monitoring to expedite medical interventions should a previously resolved condition return.
Family history codes also indicate that a family member–normally a direct relative–has a specific illness, disease, or condition that means the person may be at an elevated risk of contracting the same disease. Personal history codes are a further inclusion, often logged within medical records alongside family history codes and follow-up codes. A personal history code could signify that a patient requires a certain preventative procedure, screen, or test against a specified condition or illness where other status codes make this necessary.
While HCC codes were first introduced in 2004 and are now widely used across the scope of medical services and healthcare provision, they have been criticized for excluding other related and relevant factors that could impact the health, treatment, and programs offered to a patient. Although social risk is difficult to quantify or accurately measure due to discrepancies between the validity and completeness of data captured, payers often require practices and service providers to include all status codes, including Z codes, within their reports.
