You can know a patient has diabetes. You can see the medication list. You can read the lab results. But if the provider’s note doesn’t show how they monitored, evaluated, assessed, or treated that diabetes during the encounter, you can’t code it.
That’s the reality of MEAT criteria coding. And it’s where risk adjustment revenue is won or lost.
MEAT stands for Monitor, Evaluate, Assess, and Treat. CMS requires at least one of these elements to be documented in the clinical note for every HCC you code. No MEAT evidence, no defensible code. It doesn’t matter what you know about the patient’s condition. It matters what’s written in the note.
What Actually Counts as MEAT
Monitoring is the provider tracking the condition over time. Lab values like “A1C 7.8” or “GFR 42” count. Symptom tracking like “patient reports increased shortness of breath this week” counts. Vital signs tied to a condition count. The key is that the provider is paying attention to the condition and documenting its current status.
Evaluation means the provider is making clinical judgments about the condition. Phrases like “heart failure appears compensated today” or “diabetes control is worsening despite medication compliance” show evaluation. The provider is thinking about the condition and documenting what they observe.
Assessment often appears in the assessment and plan section, but it needs substance. “Continue current management” tied to a specific condition qualifies. Just listing “DM2” on the problem list without context doesn’t.
Treatment is usually the easiest to find. Medication orders, dosage adjustments, therapy referrals, patient education, or lifestyle counseling all count. “Increased Lasix to 40mg twice daily” or “counseled patient on carbohydrate counting” are clear treatment documentation.
The Coding Workflow
Read the entire note first. Don’t jump straight to the assessment section. MEAT evidence often appears in the history of present illness, review of systems, physical exam, or plan. You need to see the whole picture before making coding decisions.
For each chronic condition in the assessment, scan the note for corresponding MEAT criteria. Build a mental (or physical) checklist: did the provider document monitoring, evaluation, assessment, or treatment for this condition? If yes, you can code with confidence. If no, you have a decision to make.
When MEAT evidence is missing, you have three options. First, don’t code it. This is the safest approach but leaves potential revenue on the table. Second, query the provider. This takes time but can recover legitimate HCCs. Third, code it anyway and accept the audit risk. This is rarely the right choice.
Common Mistakes
The biggest error is treating the problem list as sufficient evidence. A condition appearing in the assessment section doesn’t mean it meets MEAT criteria. You need documentation in the body of the note showing the provider addressed that condition.
Another common mistake is coding based on historical information without current relevance. “Patient had stroke in 2019” doesn’t support an HCC unless the note also documents current effects, ongoing treatment, or active monitoring. History alone isn’t MEAT.
Coders also miss embedded MEAT evidence sometimes. A note might not mention diabetes in the assessment but document “checked blood sugar today, reading 142, acceptable for this patient.” That’s monitoring for diabetes. The HCC is codable even if the provider didn’t list it in their assessment.
Condition-Specific Challenges
Certain conditions create recurring problems. Chronic kidney disease requires a current GFR or creatinine plus stage documentation. Cancer needs evidence of current treatment or active disease, not just history. Heart failure requires documented symptom management or ongoing therapy. Mental health conditions need evidence the provider addressed the condition during the encounter, not just medication continuation.
Each of these conditions has specific documentation patterns that coders need to recognize. Build familiarity with what good MEAT documentation looks like for your highest-volume HCCs. This speeds up your review and improves consistency.
The Bottom Line
MEAT criteria coding isn’t about finding loopholes or making aggressive assumptions. It’s about accurately identifying documented evidence that supports the codes you assign. When the evidence is there, code it. When it’s not, don’t guess.
Your coding accuracy determines your organization’s revenue integrity and audit defensibility. Code exactly what the documentation supports, nothing more and nothing less. That’s the standard.