HCC Best Practice Advisory: Ostomies

To assist you in identifying patients with a potential ostomy (HCC188) diagnosis, OHN’s Clinical Documentation Excellence (CDE) team, in collaboration with clinical leaders, have created a logic model within the HCC Best Practice Advisory (BPA) tool. The model uses billed CPT codes for supplies in Epic to identify potential diagnoses and present these within the BPA to you, the clinician.

You can find information regarding suspected diagnoses within the Epic “probable condition logic” hyperlink in the BPA, including the information listed below.

HCC 188—Ostomy Logic Process Explained

Due to lack of specificity as to the type of ostomy suspected to be present, you will be given the ability to specify the diagnosis in the HCC BPA and document the diagnosis using the steps below. Please be as specific as possible when coding a diagnosis.

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3. 1. In the BPA below, the suspecting condition can be identified by the gray bar, which reads “Artificial opening status, unspecified.”

1. 2. To specify the ostomy type, click the “Change Dx” hyperlink.

1. 3. Select the appropriate diagnosis from the Epic IMO search bar. In this example, gastrostomy is used. The other most common ostomies include, but are not limited to, urostomy, colostomy and ileostomy.  

1. 4. After you have chosen the appropriately specified diagnosis, add your assessment and plan note in the BPA. Once your documentation is complete, click "Accept" to close the BPA.

HCC 188 – Logic for Ostomy (Artificial Opening Status)

A potential ostomy (HCC 188) diagnosis will be triggered if one of the following CPT Codes was billed internally or externally in the last three years.

a. A4379 OSTOMY POUCH, URINARY, WITH FACEPLATE ATTACHED, PLASTIC, EACH

b. A4380 OSTOMY POUCH, URINARY, WITH FACEPLATE ATTACHED, RUBBER, EACH

c. A4381 OSTOMY POUCH, URINARY, FOR USE ON FACEPLATE, PLASTIC, EACH

d. A4382 OSTOMY POUCH, URINARY, FOR USE ON FACEPLATE, HEAVY PLASTIC, EACH

e. A4383 OSTOMY POUCH, URINARY, FOR USE ON FACEPLATE, RUBBER, EACH

f. A4391 OSTOMY POUCH, URINARY, WITH EXTENDED WEAR BARRIER ATTACHED (1 PIECE), EACH

g. A4392 OSTOMY POUCH, URINARY, WITH STANDARD WEAR BARRIER ATTACHED, WITH BUILT-INCONVEXITY (1 PIECE), EACH

h. A4393 OSTOMY POUCH, URINARY, WITH EXTENDED WEAR BARRIER ATTACHED, WITH BUILT-INCONVEXITY (1 PIECE), EACH

i. A4431 OSTOMY POUCH, URINARY; WITH BARRIER ATTACHED, WITH FAUCET-TYPE TAP WITHVALVE (1 PIECE), EACH

j. A4432 OSTOMY POUCH, URINARY; FOR USE ON BARRIER WITH NON-LOCKING FLANGE, WITHFAUCET-TYPE TAP WITH VALVE (2 PIECE), EACH

k. A4433 OSTOMY POUCH, URINARY; FOR USE ON BARRIER WITH LOCKING FLANGE (2 PIECE), EACH

l. A4434 OSTOMY POUCH, URINARY; FOR USE ON BARRIER WITH LOCKING FLANGE, WITHFAUCET-TYPE TAP WITH VALVE (2 PIECE), EACH

m. A5071 OSTOMY POUCH, URINARY; WITH BARRIER ATTACHED (1 PIECE), EACH

n. A5072 OSTOMY POUCH, URINARY; WITHOUT BARRIER ATTACHED (1 PIECE), EACH

o. A5073 OSTOMY POUCH, URINARY; FOR USE ON BARRIER WITH FLANGE (2 PIECE), EACH

p. S9340 Home infusion therapy enteral nutrition per diem

q. S9342 Home infusion therapy enteral via pump per diem

r. S9343 Home infusion therapy enteral bolus

s. A4361OSTOMY FACEPLATE, EACH

t. A4362 SKIN BARRIER; SOLID, 4 X 4 OR EQUIVALENT; EACH

u. A4363 OSTOMY CLAMP, ANY TYPE, REPLACEMENT ONLY, EACH

v. A4366 OSTOMY VENT, ANY TYPE, EACH

w. A4367 OSTOMY BELT, EACH

x. A4368 OSTOMY FILTER, ANY TYPE, EACH

y. A4371 OSTOMY SKIN BARRIER, POWDER, PER OZ

z. A4372 OSTOMY SKIN BARRIER, SOLID 4 X 4 OR EQUIVALENT, STANDARD WEAR, WITH BUILT-IN CONVEXITY, EACH

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