Major complication and comorbidity (MCC) - RCM Glossary | MD Clarity (2024)

Major Complication and Comorbidity (MCC) is a term used in healthcare revenue cycle management (RCM) and medical coding to describe significant medical conditions or complications that affect a patient's treatment, prognosis, and resource utilization. MCCs are conditions that require additional resources, such as extended hospital stays, increased nursing care, or specialized treatments. These conditions are often associated with higher healthcare costs and can impact the reimbursem*nt rates for healthcare providers.

MCCs are identified and documented through medical coding systems, such as the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM). These codes provide a standardized way to classify and report diagnoses and procedures in healthcare settings. MCCs are assigned specific codes that indicate the presence of significant medical conditions or complications that impact patient care and resource utilization.

To better understand the concept of MCC, it is essential to differentiate it from other similar terms used in healthcare coding and reimbursem*nt. Two terms that are often confused with MCC are Complication and Comorbidity (CC).

Let's explore the differences between these terms:

1. Complication: A complication refers to an additional medical condition or problem that arises during the course of a patient's illness or treatment. It is an unexpected event or occurrence that may prolong the patient's hospital stay, require additional treatment, or increase the level of care needed. Complications can range from minor issues to severe medical conditions that significantly impact patient outcomes. Unlike MCCs, complications do not necessarily require additional resources or affect resource utilization.

2. Comorbidity: Comorbidity refers to the presence of one or more additional medical conditions or diseases in a patient who already has a primary diagnosis. These additional conditions may or may not be related to the primary diagnosis but can impact the patient's overall health and treatment plan. Comorbidities can affect the severity of the primary diagnosis, complicate treatment, and influence patient outcomes. However, not all comorbidities are considered MCCs. MCCs are a subset of comorbidities that have a significant impact on resource utilization and reimbursem*nt rates.

In summary, while complications and comorbidities are broader terms that encompass a wide range of medical conditions, MCCs specifically refer to significant complications or comorbidities that require additional resources and impact resource utilization.

To provide a clearer understanding of MCCs, here are a few examples of conditions that are commonly classified as MCCs:1. Acute Myocardial Infarction (AMI) with Cardiogenic Shock: When a patient experiences a heart attack (AMI) and develops cardiogenic shock, it is considered an MCC. Cardiogenic shock is a severe condition where the heart cannot pump enough blood to meet the body's needs. Treating this condition requires specialized interventions, such as mechanical circulatory support or emergency revascularization, which significantly impact resource utilization.

2. Sepsis with Acute Organ Dysfunction: Sepsis is a life-threatening condition caused by the body's response to an infection. When sepsis leads to acute organ dysfunction, such as acute kidney injury or acute respiratory distress syndrome (ARDS), it becomes an MCC. Treating sepsis with acute organ dysfunction often requires intensive care, prolonged hospital stays, and specialized interventions, resulting in increased resource utilization.3. Stroke with Hemiplegia: When a patient experiences a stroke and develops hemiplegia, which is paralysis on one side of the body, it is considered an MCC. Treating stroke patients with hemiplegia involves extensive rehabilitation, specialized therapies, and long-term care, all of which impact resource utilization.

These examples illustrate how MCCs represent significant medical conditions or complications that require additional resources and impact patient care and reimbursem*nt rates.

In conclusion, Major Complication and Comorbidity (MCC) is a term used in healthcare revenue cycle management (RCM) to describe significant medical conditions or complications that affect patient treatment, prognosis, and resource utilization. MCCs are identified through medical coding systems and have specific codes assigned to them. It is important to differentiate MCCs from complications and comorbidities, as MCCs specifically refer to conditions that require additional resources and impact resource utilization. Understanding MCCs is crucial for accurate medical coding, appropriate reimbursem*nt, and effective healthcare management.