SCAN Health Plan

How Payments are Made with a Disease Heirarchy — EXAMPLE: If a beneficiary triggers HCCs 148 (Decubitus Ulcer of the Skin) and 149 (Chronic Ulcer of Skin, Except Decubitus), then HCC 149 will be dropped. In other words, payment will always be associated with the HCC in column 1 if a HCC in column 3 also occurs during the same collection period. Therefore, the MA organization’s payment will be based on HCC 148 rather than HCC 149.

If the disease group is listed in the HCC column, then drop the associated disease group(s) listed in the Eliminate column.

HCC	Description	Eliminate
100	Hemiplegia/Hemiparesis	101
104	Vascular Disease with Complications	105, 149
107	Cystic Fibrosis	108
111	Aspiration and Specified Bacterial Pneumonias	112
130	Dialysis Status	131, 132
131	Renal Failure	132
148	Decubitus Ulcer of Skin	149
15	Diabetes with Renal or Peripheral Circulatory Manifestation	16, 17, 18, 19
154	Severe Head Injury	75, 155
16	Diabetes with Neurologic or Other Specified Manifestation	17, 18, 19
161	Traumatic Amputation	177
17	Diabetes with Acute Complications	18, 19
18	Diabetes with Ophthalmologic or Unspecified Manifestation	19
25	End-Stage Liver Disease	26, 27
26	Cirrhosis of Liver	27
5	Opportunistic Infections	112
51	Drug/Alcohol Psychosis	52
54	Schizophrenia	55
67	Quadriplegia/Other Extensive Paralysis	68, 69, 100, 101, 157
68	Paraplegia	100, 101, 157, 69
69	Spinal Cord Disorders/Injuries	157
7	Metastatic Cancer and Acute Leukemia	8, 9, 10
77	Respirator Dependence/Tracheostomy Status	78, 79
78	Respiratory Arrest	79
8	Lung, Upper Digestive Tract, and Other Severe Cancers	9, 10
81	Acute Myocardial Infarction	82, 83
82	Unstable Angina and Other Acute Ischemic Heart Disease	83
9	Lymphatic, Head and Neck, Brain, and Other Major Cancers	10
95	Cerebral Hemorrhage	96