What is the best approach when severity for a high-weight HCC is unclear?

• A. Escalate to supervisor for review
• B. Seek targeted documentation improvement and query the clinician for specifics
• C. Code only what is definitively supported
• D. Proceed with a default assumption of high weight

Answer: (B)

When the severity of a high-weight HCC isn’t clear, the priority is to obtain precise documentation from the clinician that supports the weight. This is done through targeted documentation improvement and a clinical query that asks for specifics—details about severity, stability, complications, or treatment response—that would justify assigning the higher weight. By clarifying exactly what the chart documents, you ensure the coding matches what’s actually documented and avoid guessing or making assumptions.

Escalating to a supervisor isn’t the first step to resolve ambiguity; it’s something you might do if you can’t obtain the needed details after your request. Coding only what is definitively supported is a baseline, but when the severity is unclear you should seek the specifics to determine whether the high weight is truly supported. Never default to high weight without documented evidence.