A 67-year-old male patient has been seen by a PCP multiple times this year.

The patient’s RAF is calculated by adding the applicable HCC weights plus the demographic factor, but only after applying the HCC model’s hierarchy rules. In outpatient risk adjustment education (as emphasized in ACDIS-based training), certain condition groups are hierarchical—meaning multiple related diagnoses in the same hierarchy do not “stack.” Instead, only the highest-ranked HCC in that disease group contributes to the RAF. Here, “diabetes with nephropathy” and “diabetes with retinopathy” both carry the same HCC weight (0.166) and fall within the diabetes complication hierarchy, so they do not add together; only one 0.166 value is counted. Atrial fibrillation contributes separately (0.299), and the demographic risk factor contributes (0.332). Therefore, the final RAF is 0.166 + 0.299 + 0.332 = 0.797. This illustrates why outpatient CDI focuses on documenting all clinically supported conditions for care accuracy, while understanding that some related diagnoses won’t increase RAF beyond the highest applicable HCC in that hierarchy.