Hierarchical Conditional Category (HCC) Practice Test

In HCC coding, when two codes conflict (trump), which code's score is used in the RAF?

All codes are included in the RAF The code with the lowest severity is used The code with the highest severity is included in the RAF, the other is left out Codes cancel each other out

Correct Answer:

The code with the highest severity is included in the RAF, the other is left out

Explanation:

In HCC coding, when two codes conflict, the one with the higher severity is the one that counts in the RAF. This approach prevents double-counting similar or overlapping conditions and ensures the risk adjustment reflects the patient’s greatest level of risk. So, the more severe code is included in the RAF and the other is left out. This is why choosing the higher-weight code is the correct approach. The idea isn’t to include all codes or to cancel them out; it’s to apply the trump rule and use the most impactful condition for risk scoring.

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