What are the MEAT criteria in HCC coding?

MEAT stands for Monitoring, Evaluating, Assessing or Addressing, and Treating. Risk-adjustment teams use it as a documentation-review mnemonic. It is not an official ICD-10-CM rule, a CMS regulation, or a universal minimum for code assignment. Review the full record and apply the current coding, encounter, program, and payer requirements.

What counts as 'Monitoring' for MEAT purposes?

Monitoring can include documented review of labs, symptoms, vitals, imaging, or other findings linked to the condition. For example, an HbA1c trend may help show that diabetes was considered during an encounter. A result alone does not establish a diagnosis or make a code reportable; read it with the provider's documentation and the full record.

What are common MEAT documentation mistakes that cause HCC failures?

Copied text, an isolated problem-list entry, a medication with no documented indication, or specificity unsupported by the provider's statement are review signals. None is an automatic pass or failure by itself. Review the complete date-of-service record and the applicable official rules instead of counting MEAT words.

How do the MEAT criteria apply to risk adjustment coding specifically?

For a diagnosis submitted for risk adjustment, verify the ICD-10-CM code, medical-record support, date of service, provider and encounter eligibility, authentication, data-collection period, and payer or program requirements. MEAT can organize that review, but one element is not an automatic pass and its absence is not a standalone CMS deletion rule.

MEAT Criteria for HCC Coding: Documentation

Use MEAT as an optional documentation-review mnemonic. Learn its limits and apply the official ICD-10-CM and CMS rules to the full eligible record.

What Are the MEAT Criteria?

MEAT is an acronym for Monitoring, Evaluating, Assessing or Addressing, and Treating. It is an industry review mnemonic, not a CMS regulation or universal minimum. Apply the full record, official classification, and current encounter, program, and payer requirements.

A problem-list or history entry is a review lead. Its location, or the absence of a MEAT phrase, does not automatically decide reportability. Review the full eligible record under the applicable rules.

Breaking Down Each Element

Monitoring

The provider is actively monitoring the condition through:

Ordering or reviewing lab results related to the condition

Tracking vital signs or symptoms over time

Scheduling follow-up visits specifically for the condition

Reviewing imaging or diagnostic test results

Example: A provider reviews an HbA1c result of 7.2% for a patient with Type 2 Diabetes Mellitus. This demonstrates monitoring of the diabetic condition.

Evaluating

The provider is evaluating the current status or progression of the condition:

Noting whether the condition is stable, improving, or worsening

Comparing current findings to previous encounters

Assessing for complications or related conditions

Documenting symptom changes

Example: "Patient's COPD is stable on current medication regimen. No exacerbations since last visit." This shows evaluation of the COPD status.

Assessing

The provider documents their clinical assessment or impression:

Including the condition in the assessment and plan section

Providing a clinical impression of the condition's severity

Documenting the condition's impact on overall health

Noting any differential diagnoses considered

Example: "Assessment: Major depressive disorder, moderate, currently well-controlled on sertraline 100mg." This provides a clinical assessment of the condition.

Treating

The provider is actively treating the condition through:

Prescribing, continuing, or adjusting medications

Ordering therapies or treatments

Making referrals to specialists

Providing patient education about managing the condition

Recommending lifestyle modifications

Example: "Continue metformin 1000mg twice daily. Increase lisinopril to 20mg for better blood pressure control." This shows active treatment.

Common MEAT Documentation Mistakes

Problem-list entries, Check their accuracy, date, and consistency with the full eligible record

Copied text, Check whether the carried-forward diagnosis remains supported

Location within the note, Do not require a diagnosis to appear in one particular section

Medication lists, A drug can prompt review but does not establish its indication or a diagnosis

How MEAT Applies to HCC Coding

For risk adjustment, every HCC-mapped condition must be:

1. Supported by an eligible medical record under the applicable program instructions

2. Coded with the appropriate ICD-10-CM code

3. Supported by the full eligible medical record under the applicable audit instructions

4. From an encounter with a qualified provider type

Do not use the presence or absence of a MEAT element as a coding threshold. The Official Guidelines govern code assignment, and CMS RADV checks medical-record support under the applicable audit instructions.

Tips for Coders

Read the full note, MEAT elements can appear anywhere in the documentation, not just the Assessment and Plan

Review medication context, A refill may prompt review, but do not infer a diagnosis, complication, or reportability from the medication alone

Query when needed, If documentation is ambiguous, a coder query to the provider can clarify whether a condition was addressed

Use Ask Buddy for reference questions, Check the returned sources and scope; it does not determine whether a medical record supports submission

Ask Buddy at hccbuddy.com/encoder, ask it any MEAT criteria question.

MEAT Criteria for HCC Coding: Documentation Requirements

What Are the MEAT Criteria?

Breaking Down Each Element

Monitoring

Evaluating

Assessing

Treating

Common MEAT Documentation Mistakes

How MEAT Applies to HCC Coding

Tips for Coders

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