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ACDIS CCDS-O Exam - Topic 4 Question 7 Discussion

A 75-year-old with a PMH of chronic foot ulcer, CKD, and depression is seen by his PCP for continued fatigue and decreased urination. Labs drawn on previous day are reviewed. Patient describes extreme fatigue and no motivation. Assessment and plan include: ''CKD 3 with renal failure - refer to nephrologist. Chronic nonpressure foot ulcer - home care for wound assessment. Depression - Rx for SSRI.'' Which of the following are the validated diagnoses that risk adjust and qualify as CMS-HCCs?
B) CKD 3; chronic non-pressure ulcer
A) Renal failure; CKD 3
C) Depression; renal failure
D) Chronic non-pressure ulcer; depression

ACDIS CCDS-O Exam - Topic 4 Question 7 Discussion

Actual exam question for ACDIS's CCDS-O exam
Question #: 7
Topic #: 4
[All CCDS-O Questions]

A 75-year-old with a PMH of chronic foot ulcer, CKD, and depression is seen by his PCP for continued fatigue and decreased urination. Labs drawn on previous day are reviewed. Patient describes extreme fatigue and no motivation. Assessment and plan include: ''CKD 3 with renal failure - refer to nephrologist. Chronic nonpressure foot ulcer - home care for wound assessment. Depression - Rx for SSRI.'' Which of the following are the validated diagnoses that risk adjust and qualify as CMS-HCCs?

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Suggested Answer: B

Under CMS-HCC methodology, risk adjustment is driven by ICD-10-CM diagnoses that map to HCC categories and are supported as active conditions addressed at the encounter. CKD stage 3 is a classic HCC-qualifying chronic condition because it represents ongoing kidney disease severity and expected resource use, and in this note it is actively assessed with labs reviewed and a nephrology referral. A chronic non-pressure foot ulcer is also typically HCC-qualifying when documented as ongoing and requiring management, which is supported here by home care/wound assessment planning. In contrast, ''depression'' (without specification such as major depressive disorder severity/status) commonly does not qualify for HCC in the way major depressive/bipolar categories do, making it less reliable as a risk-adjusting diagnosis. Likewise, ''renal failure'' is nonspecific and potentially conflicting with CKD stage 3; CDI best practice would be to clarify acuity/severity (acute kidney injury vs CKD stage vs ESRD) rather than assume ''renal failure'' as an HCC driver. Therefore, the validated HCC-qualifying pair is CKD 3 and chronic non-pressure ulcer.


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Fidelia
25 days ago
I think depression should be included too.
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Rickie
30 days ago
Definitely renal failure and CKD 3.
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Dyan
2 months ago
I’m leaning towards options A and C, but I’m not entirely confident about the chronic non-pressure ulcer being a valid diagnosis for risk adjustment.
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Kizzy
2 months ago
I practiced a similar question where we had to identify risk-adjusting diagnoses, and I feel like depression should be included too.
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Gilbert
2 months ago
I think renal failure is definitely a CMS-HCC, but I'm a bit confused about whether chronic non-pressure ulcers count as well.
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Sarah
2 months ago
I remember that CMS-HCCs focus on conditions that significantly impact health outcomes, but I'm not sure if all these options qualify.
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