Q&A: CC/MCC capture and mortality indexing in PEPPER reports

Q: I have a question about Program for Evaluating Payment Patterns Electronic Reports (PEPPER). How does a high volume of cases with a single CC or MCC affect the mortality index?

A: While many diagnoses classified as MCCs may affect mortality scores, mortality indexing remains a distinct and separate process from the assignment as a CC or MCC for payment purposes. You can read more about the various mortality and quality indexes on CMS.gov and places like 3M’s website on APR-DRGs (depending on which index you are looking for). However, cases with a single CC or MCC do show on PEPPER reports as areas of potential errors, audit targets, vulnerabilities, etc., though.

The main goal is to make sure all reportable chronic diseases which are actively being managed get reported, and all acute conditions which affect immediate patient care also get reported. Some of the individual mortality indexes, such as the Universal Health Coverage (UHC) index require a much more in-depth discussion and is almost a dedicated topic unto itself.

Remember, PEPPER data is simply presented as target areas where you may need to do some validation. It is possible that on review, you will find the flagged cases were reported correctly. PEPPER simply helps you focus your review efforts on areas that are more likely to be problematic.

Editor’s note: Allen Frady, RN, BSN, CCDS, CCS, CRC, CDI education specialist for HCPro in Middleton, Massachusetts, answered this question. Contact him at AFrady@hcpro.com. For information regarding CDI Boot Camps visit http://hcmarketplace.com/clinical-doc-improvement-boot-camp-1. Please note that the first quarter 2018 PEPPER for short-term acute care facilities was recently released. Read more here.