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