HCC (Hierarchal Condition Categories) Coding Assistant* Updated: 2/2012*
HCC Blue Highlighted ICD9 Codes are in the CMS-HCC Part C Medicare Risk Adjustment Model KEY: White Highlighted ICD9 Codes are in the CMS-HCC RX Part D Medicare Risk Adjustment Model
Red Highlighted ICD9 Codes not in CMS Risk Adjustment Model
Yellow Highlighted Text *Instructional Notes and/or Needs additional ICD-9-CM code
Added to Part D - *HCC Codes have had no major changes due to impending ICD 10 implementation – date TBD
“Code all documented conditions that coexist at the time of the encounter/visit, and require or affect patient care, treatment or management” ICD-9-CM Official Coding Guidelines, Section IV, K Chronic conditions may not always be listed in the provider ’s final assessments—they are often hidden in the initial assessment or examination. It is important to always read the provider ’s entire documented note and code all conditions that are listed throughout. The following are some documentation examples.
For more information on Medicare Advantage/HCC coding please click on the following link:
http://www.cms.gov/MedicareAdvtgSpecRateStats/06_Risk_adjustment.asp
*This is a reference tool and is not representative of all ICD-9 codes – Please refer to the 2012 ICD-9 Coding Books for Coding Guidelines as well as the AHA/CMS/WHO
DX CONDITIONS – ALPHABETICALLY HCC TYPE/HIERARCHY/CONDITION CATEGORY 584.9 Acute renal failure, NOS C 131 Renal Failure
255.9 Adrenal gland disorder, NOS D 19 Pituit./Adrenal/Other Endo/Metab. Dis.
255.41 Adrenal Insuff. (Addison's disease) D 19 Pituit./Adrenal/Other Endo/Metab. Dis.
305.00 Alcohol abuse None NA
303.91 Alcohol dependence chronic C 52 Drug/Alcohol Dependence
303.90 Alcohol dependence, unspec. C 52 Drug/Alcohol Dependence
303.93 Alcohol dependent remission C 52 Drug/Alcohol Dependence
571.3 Alcoholic Liver Damage, Unspecified C 26 Cirrhosis of Liver
331.0 Alzheimer's disease D 54 Alzheimer's Disease
V49.71 Amputation - great toe status C 177 Amp Stat, Lower Limb/Amp Comp
V49.70 Amputation lower limb status, NOS C 177 Amp Stat, Lower Limb/Amp Comp
V49.74 Amputation Status Ankle, disarticulation C 177 Amp Stat, Lower Limb/Amp Comp
997.69 Amputation Stump Complication NEC C 177 Amp Stat, Lower Limb/Amp Comp
997.60 Amputation Stump Complication NOS C 177 Amp Stat, Lower Limb/Amp Comp
997.62 Amputation Stump Infection C 177 Amp Stat, Lower Limb/Amp Comp
V49.72 Amputation -toe(s) status C 177 Amp Stat, Lower Limb/Amp Comp
V49.76 Amputation-above knee/leg status C 177 Amp Stat, Lower Limb/Amp Comp
V49.75 Amputation-below knee status C 177 Amp Stat, Lower Limb/Amp Comp
V49.73 Amputation-foot status C 177 Amp Stat, Lower Limb/Amp Comp
284.9 Anemia aplastic unspec. C 44 Severe Hematological Disorders
284.89 Anemia, aplastic, other C 44 Severe Hematological Disorders
285.29 Anemia, chronic disease, other None NA
285.21 Anemia, chronic kidney disease None NA
285.22 Anemia, chronic neoplastic disease None NA
281.2 Anemia, foliate deficiency None NA
280.9 Anemia, iron defic. unspec. None NA
281.9 Anemia, NOS, (chronic, megaloblastic) None NA
281.1 Anemia, other B12 deficiency None NA 284.1 Anemia, pancytopenia C 44 Severe Hematological Disorders
281.0 Anemia, pernicious None NA
282.60 Anemia, sickle cell, NOS C 44 Severe Hematological Disorders
285.0 Anemia, sideroblastic D 50 Significant Blood Disorders 285.9 Anemia, unspec. None NA
441.4 Aneurysm Aorta Abdom. w/o rupture (AAA) C 105 Vascular Disease
441.9 Aneurysm Aorta unspec C 105 Vascular Disease
442.9 Aneurysm site unspec. C 105 Vascular Disease
441.2 Aneurysm, thoracic C 105 Vascular Disease
413.9 Angina equivalent C 83 Angina Pectoris/Old MI
413.9 Angina unspec. C 83 Angina Pectoris/Old MI
411.1 Angina unstable C 82 Unstbl Ang/Oth Acute IHD
720.0 Ankylosing spondylitis C 38 Rh Arthritis and Inflam Conn Disease
307.1 Anorexia nervosa Added to Part D CY2011 D 61 Anxiety, Personality, & Behavior Disorders
V58.61 Anticoagulant therapy, long term None NA
generalized disorder (GAD) Added to Part D CY2011 D 63 C 105 sclerosis None NA disorder/insuff/regurg/stenosis None NA None NA Appendico-vesicostomy C 176 dysrhythmia, NOS None NA
Cardiac , other None NA or thrombosis unspec. C 104
D 97 temporal/Giant cell C 38
C 105
Rheumatoid C 38 inflammatory/inflammatory polyarthritis unspec C 38 status unspec. C 176
None NA
D 89 obstructive C 108
D 104
None NA cerebral D 97 aorta C 105 coronary D 89 extrm. unspec. C 105 unspec. None NA
C 92
C 92 disorder, NOS or inattentive type D 61 disorder, w/ hyperactivity D 61
(3rd degree) C 92 unspec/incomplete/partial None NA deficiency (excludes deficiency anemias) None NA
Lumbar None NA
None NA
D 33
C 38 unspec. / Manic-depressive C 55 None NA
40.0-44.9, Adult Added to Part D CY2011 D 21
45.0-49.9, Adult Added to Part D CY2011 D 21
50.0-59.9, Adult Added to Part D CY2011 D 21
60.0-69.9, Adult Added to Part D CY2011 D 21
70 and over, Adult Added to Part D CY2011 D 21 to disease/DM None NA
NOS C 37 syndrome C 92
None NA
None NA
or persistent or chronic C 92 mass None NA
D 105 asthmatic D 104
C 108 obstructive C 108
unspec. None NA
None NA
Block, Left NOS None NA
Block, Right None NA
C 21
CAD/ASHD/Atherosclerosis coronary D 89 syndrome C 10 arrhythmia/dysrhythmia unspec None NA
other None NA
None NA dilated or non-ischemic C 80 ischemic D 89
NOS C 80 disease (ASCVD) None NA occlusion/stenosis D 97
None NA disease/gluten intolerance/sprue C 32 occlusion unspec. D 97
Atherosclerosis D 97
D 97 intermittent, NOS D 97
NOS C 101 thrombosis D 97 disease or lesion NOS Added to Part D CY2011 D 97
Tooth disease C 71
None NA
None NA
Heart Failure C 80 or chronic None N/A
(gallstone), NOS None NA
Disease 1 (GFR>90) (code only if kidney damage) C 131 Disease 2 (Mild-GFR 60-89) (code only if kidney C 131
Disease 3 (Mod-GFR 30-59)* C 131
Disease 4 (Severe GFR 15-29) C 131
Disease 5 (GFR less than 15) C 131 syndrome None NA
Respiratory Failure C 79 related C 26
C 26 renal insuff unspec* C 131 renal disease (ESRD) C 131
C 105
Lymphoid Leukemia C 9 *Excludes abnormal INR, PT, and PTT. Removed defects or deficiency unspec.* None NA from Part D for CY2011 Abnormal (Out of Range INR, PT, PTT) None NA
NOS C 33
Colitis/Gastroenteritis unspec. None NA
C 38 vertebra NOS (pathologic) C 157
None NA
C 176
Vertebra NOS C 157 spinal cord (not fracture) C 69 unspec. None NA disease, unspec. C 38 unspec. None NA
C 108
Pulmonale/Chronic Pulmonary Heart Dis C 80 stenosis D 89 insuff., NOS D 19
None NA
NOS C 33 late effects) None NA
Hemiplegia/hemiparesis C 100 effects (not specifically stated) None NA
NOS C 107
None NA
None NA unspec. C 176 uncomplicated D 55 delirium D 55 D 55 w/ delirium D 55 w/ delusional features D 55 with depressive features D 55 uncomplicated D 55 w/ delirium D 55 w/ delusions D 55 w/ depressed mood D 55 uncomplicated D 55 Alcohol, NOS C 52 NOS C 52 *Excludes long term prescribed use Opioid, NOS* C 52 (V58.69) Anxiety D 62 recurring C 55 single episode or unspec C 55 unspec. D 62 (Eczema) unspec. None NA nephrogenic D 18 C 130 None NA Limbs C 101 Prosthesis* *Code also V43.64 C 164 traumatic C 158 None NA None NA hyperosmolarity C 17 ketoacidosis C 17 manifestations* *Code also Polyneuropathy 357.2, C 16 gastroparesis 536.3, or other neuro manifestation manifestations* *Code also Retinopathy 362.01 or Prolif. C 18 Retinopathy 362.02 specific manif* *Code also manifestation C 16 circ disorder* *Code also PVD 443.81, gangrene 785.4, or C 15 other manifestation manifestations* *Code also CKD/CRI 585.9, Nephropathy C 15 583.81, or Nephrosis 581.81 complications C 19 complications C 19 unspec. C 52 unspec, lower ext.* *Unspecified vessel C 105 lower extremity C 105 proximal lower extremity C 105 ext. (brachial, radial, ulnar vein) C 105 lower extremity C 105 ext., NOS* *Unspecified vessel C 105 proximal lower extremity C 105
ext. (brachial, radial, ulnar vein) C 105
None NA
None N/A
None NA urination None NA
Aorta C 105 unspecified site C 105
Aorta C 105 Thoracoabdominal Aorta C 105
None NA
NOS None NA hypertension None NA triglycerides D 23
Embolism/Thrombosis of Superficial vessels lower extremity None NA
Embolism/Thrombosis vein unspec. None NA
Embolism/Thrombosis, Acute, axillary vein C 105
Embolism/Thrombosis, Acute, internal jugular vein C 105
Embolism/Thrombosis, Acute, other thoracic vein C 105
Embolism/Thrombosis, Acute, subclavian vein C 105
Embolism/Thrombosis, Acute, upper extremity vein NOS None NA
Embolism/Thrombosis, aorta abdominal C 104
Embolism/Thrombosis, aorta thoracic C 104
Embolism/Thrombosis, arteries of lower extremity C 104
Embolism/Thrombosis, arteries of upper extremity C 104
Embolism/Thrombosis, artery unspec C 104
Embolism/Thrombosis, Chronic , upper extremity vein NOS None NA
Embolism/Thrombosis, Chronic, axillary vein C 105
Embolism/Thrombosis, Chronic, other thoracic vein C 105
Embolism/Thrombosis, Chronic, pulmonary artery C 104
Embolism/Thrombosis, Chronic, internal jugular vein C 105
Embolism/Thrombosis, Chronic,subclavian vein C 105
Embolism/Thrombosis, History of None NA
Embolism/Thrombosis, renal vein C 105 unspec. C 108 hepatic C 25
NOS/Seizure Disorder C 74
(nonorganic) None NA
(organic)* *If caused by DM add 250.80 None NA
456.0 Esophageal varices w/ bleeding 25 End-Stage Liver Disease
456.1 Esophageal varices w/o bleeding 25 End-Stage Liver Disease
530.10 Esophagitis, NOS 33 Esophageal Disorders
780.79 Fatigue NA
560.32 Fecal impaction 31 Intestinal Obstructn/Perforatn 780.60 Fever NA 821.00 FX femur closed unspec. 158 Hip Fracture/Dislocation
820.8 FX hip closed/FX neck of femur 158 Hip Fracture/Dislocation FX Lumbar vertebra closed NOS without spinal cord injury, 805.4 * not pathologic 157 Vertebral Fract w/o Spinal Inj traumatic * 808.8 FX pelvic NOS closed 158 Hip Fracture/Dislocation
807.00 FX Rib(s) closed NA
805.00 FX vertebra cervical NOS closed 157 Vertebral Fract w/o Spinal Inj FX vertebra closed NOS without spinal cord injury, 805.8 * not pathologic 157 Vertebral Fract w/o Spinal Inj traumatic* 733.13 FX vertebra pathologic/vertebra collapse/compression 157 Vertebral Fract w/o Spinal Inj
733.96 FX, stress of femoral neck NA
733.98 FX, stress of pelvis NA
785.4 Gangrene* *Can code w/ DM w/ PVD 250.70+443.81 104 Vascular Disease with Complica
535.50 Gastritis/Gastroduodenitis unspec. NA
536.3 Gastroparesis* *Can code w/ DM 250.60 NA
536.40 Gastrostomy Complication, NOS 176 Artif Opening-Feeding/Elimin
V44.1 Gastrostomy status 176 Artif Opening-Feeding/Elimin
530.81 GERD 33 Esophageal Disorders
V44.4 GI opening unspec. 176 Artif Opening-Feeding/Elimin
277.4 Gilbert's cholemia NA
271.3 Glucose intolerance NA
579.0 Gluten intolerance/sprue/Celiac disease 32 Pancreatic Disease
240.9 Goiter unspec. 20 Thyroid Disorders
357.4 Gouty neuritis* *Code in addition to 274.89 71 Polyneuropathy
242.00 Graves’ disease 20 Thyroid Disorders
245.2 Hashimoto's disease 20 Thyroid Disorders 784.0 Headache NA 389.9 Hearing loss unspec. (Deaf) NA
429.9 Heart disease NOS /Ventricular dysfunction NA
428.40 Heart failure, combined, unspec. 80 Congestive Heart Failure
428.30 Heart failure, diastolic, unspec. 80 Congestive Heart Failure
428.20 Heart failure, systolic, unspec. 80 Congestive Heart Failure
28.9 Heart failure, unspec 80 Congestive Heart Failure
785.2 Heart murmur, NOS NA
V42.1 Heart transplant status 174 Major Organ Transplant Status
342.91 Hemiplegia dmnt side unspec. 100 Hemiplegia/Hemiparesis
342.92 Hemiplegia non-dmnt unspec. 100 Hemiplegia/Hemiparesis
342.90 Hemiplegia side unspec. 100 Hemiplegia/Hemiparesis
438.20 Hemiplegia/Hemiparesis from CVA, side unspec. 100 Hemiplegia/Hemiparesis
432.9 Hemorrhage Intracranial, NOS 95 Cerebral Hemorrhage
455.6 Hemorrhoids, NOS NA
070.1 Hepatitis A infectious NA
070.30 Hepatitis B acute or unspec. NA
070.32 Hepatitis B chronic 27 Chronic Hepatitis
070.51 Hepatitis C acute NA
070.54 Hepatitis C chronic 27 Chronic Hepatitis
070.70 Hepatitis C unspecified NA
571.40 Hepatitis chronic unspec. 27 Chronic Hepatitis
070.90 Hepatitis viral, NOS NA
573.3 Hepatitis, unspec. NA
553.9 Hernia site unspec. NA
053.10 Herpes Zoster w/ Unspecified Nervous system 83 Trigeminal and Postherpetic Neuralgia complication 053.9 Herpes zoster/shingles NA
553.3 Hiatal hernia NA
V58.69 High-risk medication, long-term use *Long term use of opioids/pain killers. NA
V08 HIV asymptomatic 1 HIV/AIDS
042. HIV symptomatic 1 HIV/AIDS
201.90 Hodgkin's disease unspec. 9 Lymph,Hd/Neck, Brain,OthMaj CA
429.82 Hyper kinetic heart NA 782.4 Hyperbilirubinemia/Jaundice NA
272.0 Hypercholesterolemia pure 23 Disorders of Lipoid Metabolism
289.81 Hypercoagulable state, primary 50 Significant Blood Disorders
790.29 Hyperglycemia NA
272.2 Hyperlipidemia mixed (elev chol + elev trigly) 23 Disorders of Lipoid Metabolism
272.4 Hyperlipidemia/Dyslipidemia NOS 23 Disorders of Lipoid Metabolism
252.00 Hyperparathyroidism, NOS 19 Pituit./Adrenal/Other Endo/Metab. Dis.
401.1 Hypertension, benign 88 Hypertension
401.0 Hypertension, malignant 88 Hypertension
572.3 Hypertension, portal 25 End-Stage Liver Disease
416.8 Hypertension, pulmonary 80 Congestive Heart Failure
416.8 Hypertension, pulmonary, secondary 80 Congestive Heart Failure
401.9 Hypertension, unspec 88 Hypertension
403.90 Hypertensive CKD I - IV, or unspec* *Use add'l code 585.1-585.4 or 585.9 125 CKD Stage 1.2. or Unspecified
403.91 Hypertensive CKD V or ESRD* *Use add'l code 585.5 or 585.6 131 Renal Failure
404.91 Hypertensive Heart & CKD I-IV or unspec w/ H F * *Use add'l codes 585.9 + 428.0 80 Congestive Heart Failure
404.90 Hypertensive Heart & CKD I-IV or unspec w/out HF* *Use add'l code 585.1-585.4 or 585.9 125 CKD Stage 1.2. or Unspecified
404.93 Hypertensive Heart & CKD V-ESRD w/ H F * *Use add'l codes 585.5 or 585.6 + 428.0 131 Renal Failure
404.92 Hypertensive Heart & CKD V-ESRD w/out HF* *Use add'l code 585.5 or 585.6 131 Renal Failure
402.91 Hypertensive Heart Dz w/ Heart Failure* *Use add'l code 428.0 CHF 80 Congestive Heart Failure
402.90 Hypertensive Heart Dz w/out heart failure 88 Hypertension
242.90 Hyperthyroidism/Thyrotoxicosis 20 Thyroid Disorders
251.2 Hypoglycemia unspec.* *if mentioned with DM code 250.80 instead NA
780.99 Hypokinesis NA
458.9 Hypotension, NOS NA
458.0 Hypotension, orthostatic NA
244.9 Hypothyroidism unspec. 20 Thyroid Disorders
799.02 Hypoxemia/Hypoxia/Anoxia 79 Cardio-Respir Failure/Shock
V44.2 Ileostomy status 176 Artif Opening-Feeding/Elimin
560.1 Ileus/Paralysis of intestine or colon 31 Intestinal Obstructn/Perforatn
279.3 Immunity deficiency/disorder unspec. 45 Disorders of Immunity 380.4 Impacted cerumen NA
560.30 Impaction of intestine/colon unspec. 31 Intestinal Obstructn/Perforatn
790.21 Impaired Fasting Glucose NA
607.84 Impotence organic NA
714.9 Inflammatory Polyarthropathy, NOS 38 Rh Arthritis and Inflam Conn Disease
487.1 Influenza w/ URI symptoms NA
780.52 Insomnia unspec. NA
V58.67 Insulin long term use (same as DM) 19 Diabetes without Complication
579.9 Intestinal malabsorption unspec. 32 Pancreatic Disease
560.9 Intestinal obstruction unspec. 31 Intestinal Obstructn/Perforatn
564.1 Irritable bowel syndrome (IBS) NA
437.1 Ischemic cerebrovascular disease 97 CVD, Except Hemorrhage or Aneurysm
414.9 Ischemic heart disease, chronic, NOS 89 Coronary Artery Disease
701.1 Keratosis, unspec NA
586 Kidney failure, NOS 131 Renal Failure
V42.0 Kidney transplant status
386.30 Labrynthitis, NOS
464.00 Laryngitis acute
208.92 Leukemia in relapse
208.91 Leukemia in remission
208.90 Leukemia unspec.
571.8 Liver fatty or atrophic, nonalcoholic
V42.7 Liver transplant status
518.89 Lung disease, NOS
710.0 Lupus
785.6 Lymph nodes enlarged
289.3 Lymphadentis unspec. 202.80 Lymphoma unspec.
579.9 Malabsorption syndrome
780.79 Malaise/Fatigue unspec.
263.9 Malnutrition, NOS
569.62 Mechanical Complication Colostomy/Enterostomy
996.47 Mechanical Complication Prosthetic Joint Implant, Other
386.00 Menieres disease, NOS
225.2 Meningioma, unspec
627.2 Menopause symptoms
319 Mental retardation, NOS
209.31 Merkel cell carcinoma, face
277.7 Metabolic syndrome/insulin resistance*
412 MI Old
346.90 Migraine unspec.
424.0 Mitral valve disorder (regur., insuff)
075 Mononucleosis infectious
438.40 Monoplegia from CVA lower limb, side unspec.
438.30 Monoplegia from CVA upper limb, side unspec.
344.40 Monoplegia/Paralysis, arm
344.30 Monoplegia/Paralysis, leg
296.90 Mood Disorder
296.99 Mood Swings
278.01 Morbid Obesity
041.12 MRSA
340 Multiple sclerosis
359.1 Muscular dystrophy, NOS
358.00 Myasthenia Gravis, NOS
238.75 Myelodysplastic syndrome, unspec.
203.00 Myeloma, multiple, not stated as in remission or relapsed
203.02 Myeloma, Mutiple in relapse
336.9 Myelopathy/Cord compression *Refer to ICD-9-CM 410.92 Myocardial infarction, NOS, subsequent up to 8 weeks* location 410.72 Myocardial infarction, NSTEMI, subsequent up to 8 weeks
429.1 Myocarditis degeneration
429.0 Myocarditis unspec. 359.6 Myopathy in disease* *Code also underlying
359.9 Myopathy unspec.
359.29 Myotonic disorders, other
787.01 Nausea with vomiting
733.40 Necrosis, avascular, of bone
239.6 Neoplasm Brain, unspecified nature
196.9 Neoplasm secondary malignant Lymph Node NOS
196.8 Neoplasm secondary malignant Lymph Node-Multiple
198.5 Neoplasm secondary site Bone/Bone marrow
198.3 Neoplasm secondary site Brain
197.7 Neoplasm secondary site Liver
197.0 Neoplasm secondary site Lung
196.9 Neoplasm secondary site Lymph node(s), NOS
V10.90 Neoplasm, history of - unspec type or location
V10.3 Neoplasm, history of, Breast
V10.05 Neoplasm, history of, Colon
V10.46 Neoplasm, history of, Prostate
194.0 Neoplasm, malignant Adrenal
188.9 Neoplasm, malignant Bladder, NOS
170.9 Neoplasm, malignant Bone, NOS
191.9 Neoplasm, malignant Brain, NEC
174.9 Neoplasm, malignant Breast - female, NOS
175.9 Neoplasm, malignant Breast - male
153.9 Neoplasm, malignant Colon, NOS
171.9 Neoplasm, malignant Connective & soft tissue, NOS
150.9 Neoplasm, malignant Esophagus, NOS
155.0 Neoplasm, malignant Liver, primary
162.9 Neoplasm, malignant Lung/Bronchus, NOS
183.0 Neoplasm, malignant Ovarian
158.9 Neoplasm, malignant Peritoneum, NOS
185 Neoplasm, malignant Prostate
154.1 Neoplasm, malignant Rectal
189.0 Neoplasm, malignant Renal
165.9 Neoplasm, malignant Respiratory tract, NOS
172.9 Neoplasm, malignant Skin, Melanoma, NOS
173.9 Neoplasm, malignant Skin, NOS
186.9 Neoplasm, malignant Testis 189.9 Neoplasm, malignant Urninary, NOS
580.9 Nephritis/Nephropathy acute
582.9 Nephritis/Nephropathy chronic
284.1 Pancytopenia
560.1 Paralysis of intestine or colon/Ileus
438.50 Paralytic syndrome other unspec.
297.9 Paranoid disorder unspec.
344.1 Paraplegia
332.0 Parkinson's disease
730.30 Periostitis w/o osteomyelitis
337.1 Periph. Autonomic Neuropathy in Diabetes* *Must be Autonomic.
337.00 Periph. Autonomic Neuropathy, Idiopathic *Must be Autonomic
443.9 Peripheral arterial disease (PAD)
356.9 Peripheral neuropathy
443.9 Peripheral vascular disease, unspec *Code also underlying 443.81 Peripheral vascular/angiopathy in disease* diabetes, etc. 567.9 Peritonitis NOS
353.6 Phantom limb syndrome
462 Pharyngitis acute
451.83 Phlebitis arm deep vein
451.11 Phlebitis leg femoral vein
451.19 Phlebitis leg other deep
451.9 Phlebitis site unspec.
511.0 Pleurisy w/o Pulmonary effusion
511.1 Pleurisy/Pulmonary effusion
482.9 Pneumonia bacterial unspec.
482.82 Pneumonia E. Coli
486 Pneumonia NOS
482.89 Pneumonia Other Specified Bacteria
481 Pneumonia pneumococcal
517.1 Pneumonia rheumatic* *Code also 390
482.40 Pneumonia staphylococcus, NOS
482.30 Pneumonia streptococcus, NOS 480.9 Pneumonia viral unspec.
486 Pneumonia, unspec.
512.8 Pneumothorax, other or NOS
446.0 Polyarteritis Nodosa
714.9 Polyarthropathy, inflammatory, NOS
714.89 Polyarthropathy, inflammatory, Other specified
725 Polymyalgia rheumatica
710.4 Polymyositis
356.9 Polyneuropathy and peripheral neuropathy, NOS
357.2 Polyneuropathy and peripheral neuropathy in diabetes* *Code also 250.60
357.5 Polyneuropathy or peripheral neuropathy alcoholic* *Code also alcohol
357.1 Polyneuropathy or peripheral neuropathy due to collagen vascular dis* *Code also SLE,
053.13 Polyneuropathy, Post Herpatic D
277.1 Porphyria/Hematoporphyria D
572.3 Portal Hypertension C
053.13 Post Herpetic polyneuropathy D
053.12 Post Herpetic Trigeminal neuralgia D
309.81 Post Traumatic Stress Disorder PTSD Added to Part D CY2011 D
714.4 Postrheumatic Arthropathy, Chronic C
427.60 Premature beats, contractions,systoles, ectopic beats None
427.61 Premature supraventricular beats, atrial beats, contractions (PACs), systoles None
427.69 Premature ventricular beats, contractions (PVCs), systoles None
601.9 Prostatitis unspec. None
263.9 Protein calorie malnutrition unspec. (alb<2.5) C
791.0 Proteinuria None
790.93 PSA elevated None
696.1 Psoriasis except arthropathic D
696.0 Psoriatic arthropathy D
428.1 Pulmonary edema acute C
V12.51 Pulmonary embolism H/O None
415.19 Pulmonary embolism (PE) C
416.2 Pulmonary embolism chronic C
515 Pulmonary Fibrosis D
416.9 Pulmonary heart disease chronic unspec. C
416.8 Pulmonary Hypertension, NOS C
427.1 PVT Paroxysmal ventricular tachycardia* *Must be Paroxysmal. C 344.00 Quadriplegia unspec. C
780.72 Quadriplegia, funct (due to fraility) C
724.4 Radiculitis/Neuritis, Thoracic or Lumbosacral None
569.3 Rectal bleed None
337.20 Reflex sympathetic dystrophy (RSD) unspec C
555.9 Regional Enteritis, NOS C
V45.11 Renal dialysis status C
584.9 Renal failure acute C
440.1 Renal stenosis C
593.81 Renal vascular disorder/renal thrombosis or embolism C
518.81 Respiratory failure, acute or NOS C
518.83 Respiratory failure, chronic C
362.01 Retinopathy in Diabetes, NOS* *Code also 250.50 D
362.03 Retinopathy in Diabetes, non-prolif* *Code also 250.50 D
362.04 Retinopathy, mild non prolif in Diabetes* *Code also 250.50 D
362.05 Retinopathy, moderate non prolif in Diabetes* *Code also 250.50 D
362.02 Retinopathy, prolif in Diabetes* *Code also 250.50 C
398.90 Rheumatic heart disease unspec. None
720.0 Rheumatoid Arthritis of Spine C
714.0 Rheumatoid Arthritis* *Code also manifestation 359.6 or 357.1 C
720.2 Sacroiliitis unspec. C
295.90 Schizophrenia unspec. C
710.1 Scleroderma/Systemic disease/CRST Syndrome C
706.2 Sebaceous Cyst None
345.90 Seizure Disorder, NOS C
780.39 Seizures NOS C
038.9 Septicemia C
053.9 Shingles None
053.19 Shingles w/ other Nervous system complication D
786.05 Shortness of breath None Sinoatrial node dysfunction/SSS/Tachycardia-Bradycardia *Code if no pacemaker, or pacemaker 427.81 C syndrome* AND meds 427.89 Sinus bradycardia None
461.9 Sinusitis acute unspec. None
710.2 Sjogrens syndrome C
710.0 SLE (Lupus) C
724.02 Spinal Stenosis, Lumbar NOS None
724.01 Spinal Stenosis, Thoracic None 334.9 Spinocerebellar disease unspec. C
720.9 Spondylitis/inflammatory spondylopathy unspec. C
034.0 Streptococcal sore throat None HCC SPECIFIC CODING GUIDELINES* CARDIAC DYSRHYTHMIA
427.9 Arrhythmia/Cardiac dysrhythmia, NOS None N/A
427.89 Arrhythmias/Rhythm Disorders, Other None N/A
427.31 Atrial fibrillation C 92 Specified Heart Arrhythmias
427.32 Atrial flutter C 92 Specified Heart Arrhythmias
427.89 Bradycardia None NA
427.81 Bradycardia, severe or persistent or chronic C 92 Specified Heart Arrhythmias
427.60 Premature beats, contractions, systoles, ectopic beats None NA
427.61 Premature supraventricular beats, atrial beats, contractions (PACs), systoles None NA
427.69 Premature ventricular beats, contractions (PVCs), systoles None NA *Code if no pacemaker, or pacemaker 427.81 Sinoatrial node dysfunction/SSS/Tachycardia-Bradycardia syndrome* C 92 Specified Heart Arrhythmias AND meds 785.0 Tachycardia, NOS None NA
427.89 Tachycardia: atrial, AVT, SVT, sinus, nodal None NA
426.89 Tachycardia, nonparoxymsal atrioventricular None NA
427.0 Tachycardia Paroxysmal: PSVT, PAT, PAVT, junctional, nodal* *Must be Paroxysmal. C 92 Specified Heart Arrhythmias *Must be Paroxysmal. Ok to code with 427.1 Tachycardia, Paroxysmal ventricular* C 92 Specified Heart Arrhythmias AICD/defibrillator 427.1 Tachycardia, Ventricular* * Ok to code with AICD/defibrillator. C 92 Specified Heart Arrhythmias
427.41 Ventricular fibrillation Acute condition C 79 Cardio-Respir Failure/Shock
427.42 Ventricular flutter Acute condition C 79 Cardio-Respir Failure/Shock
CHRONIC KIDNEY DISEASE/RENAL FAILURE (*Review labs for GFR - start coding CKD when 2 labs, 3 months apart, GFR<60 and physician indicates a documented review of results)*use addit’l code for Dialysis – V45.11/V42.0
STAGE DESCRIPTION GFR (ml/min/1.73m2) I Kidney damage with normal or high GFR > or equal to 90 II Kidney damage with mild decrease in GFR 60-89 III Moderate decrease in GFR 30-59 IV Severe decrease in GFR 15-29 V Kidney Failure >15 VI ESRD Chronic ialysis /Transplant
584.9 Acute renal failure C 131 Renal Failure 585.1 Chronic Kidney Disease 1 (GFR>90) (code only if kidney damage) C 131 Renal Failure 585.2 Chronic Kidney Disease 2 (Mild-GFR 60-89) (code only if kidney damage) C 131 Renal Failure 585.3 Chronic Kidney Disease 3 (Mod-GFR 30-59)* C 131 Renal Failure 585.4 Chronic Kidney Disease 4 (Severe GFR 15-29) C 131 Renal Failure 585.5 Chronic Kidney Disease 5 (GFR less than 15) C 131 Renal Failure 585.9 CKD / CRI chronic renal insuff unspec* C 131 Renal Failure 585.6 CKD End stage renal disease (ESRD) C 131 Renal Failure V45.11 Renal dialysis status C 130 Dialysis Status 586 Uremia/Renal failure NOS C 131 Renal Failure 585.9 Uremia, chronic C 131 Renal Failure
CVA, STATUS POST (Code as "History of" unless there are late effects and then it is an active chronic condition)
V12.54 CVA history of (no late effects) None N/A 438.20 CVA s/p with Hemiplegia/hemiparesis C 100 Hemiplegia/Hemiparesis 438.30 CVA s/p with monoplegia of upper limb C 101 Cerebral Palsy/Paralytic Syndromes 438.40 CVA s/p with monoplegia of lower limb C 101 Cerebral Palsy/Paralytic Syndromes
Fifth Digits: Category 250 (250.0x through 250.9x) requires the use of a fifth digit and When coding diabetes with a manifestation an additional code is needed for the manifestation code, which follows the primary DM code(250.xx). Type 2 or unspecified type, not stated as uncontrolled, even if the patient requires insulin Type 1, not stated as uncontrolled Juvenile Type 2 or unspecified type, uncontrolled, even if the patient requires insulin Type 1, uncontrolled Juvenile
DIABETES MELLITUS ( Code additional manifestation if present and document relationship i.e.: "due to DM", "secondary to DM" "DM with" and the specific anifestation
249.00 DM Secondary C 19 Diabetes without Complication 250.00 DM 2 w/o complications C 19 Diabetes without Complication 250.40 DM 2 w/ renal manifestations* *Code also CKD/CRI 585.9, Nephropathy C 15 DM w/ Renal or Periph Circ Man 583.81, or Nephrosis 581.81 250.50 DM 2 w/ ophth manifestations* *Code also Retinopathy 362.01 or Prolif. C 18 DM w/ Ophth or Unspec Manifest Retinopathy 362.02 250.60 DM 2 w/ neuro manifestations* *Code also Polyneuropathy 357.2, C 16 DM w/ Neurologic or Oth Manif gastroparesis 536.3, or other neuro manifestation 250.70 DM 2 w/ peripheral circ disorder* *Code also PVD 443.81, gangrene 785.4, or C 15 DM w/ Renal or Periph Circ Man other manifestation 250.80 DM 2 w/ other specific manif not stated * Code also manifestation, such as: Ulcerations C 16 DM w/ Neurologic or Oth Manif 707.10-707.9, hypoglycemia 251.2, bone chgs 731.8; ED 607.84
EMBOLISM/THROMBOSIS/DVT (DOCUMENT THE ACUITY OF THE DVT, IF KNOWN) Acute DVT of lower extremities – 453.4X (does not usually occur in the physician office setting) Chronic DVT of lower extremities – 453.5X / History of DVT -V12.51 - (not under any current treatment such as Coumadin)
V12.51 Embolism/Thrombosis, History of NA 453.6 Embolism/Thrombosis of Superficial vessels lower NA 453.9 Embolism/Thrombosisextremity vein unspec. NA 453.84 Embolism/Thrombosis, Acute, axillary vein 105 Vascular Disease 453.83 Embolism/Thrombosis, Acute, upper extremity vein NOS NA 444.22 Embolism/Thrombosis, arteries of lower extremity 104 Vascular Disease with Complica 444.21 Embolism/Thrombosis, arteries of upper extremity 104 Vascular Disease with Complica 444.9 Embolism/Thrombosis, artery unspec 104 Vascular Disease with Complica 453.73 Embolism/Thrombosis, Chronic , upper extremity vein NOS NA 453.74 Embolism/Thrombosis, Chronic, axillary vein 105 Vascular Disease 416.2 Embolism/Thrombosis, Chronic, pulmonary artery 104 Vascular Disease with Complica 453.3 Embolism/Thrombosis, renal vein 105 Vascular Disease
453.40 DVT Acute or unspec, lower ext.* *Unspecified vessel 105 Vascular Disease
453.42 DVT Acute, distal lower extremity 105 Vascular Disease
453.41 DVT Acute, proximal lower extremity 105 Vascular Disease
453.82 DVT Acute, upper ext. (brachial, radial, ulnar vein) 105 Vascular Disease
453.52 DVT Chronic, distal lower extremity 105 Vascular Disease
453.50 DVT Chronic, lower ext., NOS* *Unspecified vessel 105 Vascular Disease
453.51 DVT Chronic, proximal lower extremity 105 Vascular Disease
453.72 DVT Chronic, upper ext. (brachial, radial, ulnar vein) 105 Vascular Disease
HYPERTENSIVE KIDNEY AND/OR HEART DISEASE
165.9 Neoplasm, malignant Respiratory tract, NOS C 9 Lymph,Hd/Neck, Brain,OthMaj CA
172.9 Neoplasm, malignant Skin, Melanoma, NOS C 10 Brst,Prst,Clrectal,Oth CA/TU
173.9 Neoplasm, malignant Skin, NOS None NA
186.9 Neoplasm, malignant Testis C 10 Brst,Prst,Clrectal,Oth CA/TU
189.9 Neoplasm, malignant Urninary, NOS C 10 Brst,Prst,Clrectal,Oth CA/TU