Eight chronic-condition families to recheck against the applicable data period, eligible record, ICD-10-CM source, and CMS-HCC V28 mapping.

Risk scores use diagnosis data from the data-collection period CMS specifies for the payment year and submission window. A prior-year diagnosis does not automatically establish support in a later period. The eight condition families below are common review targets, but each diagnosis still needs an eligible record and the coding, program, and payer requirements that apply to the case.

This list is for coders working a recapture or annual-wellness pass who need to know which chronic diagnoses still earn an HCC under V28 and what holds up in a RADV review. Every code here was checked against the current CMS V28 payment mapping. Conditions that lost their HCC in the move from V24 to V28 (unspecified peripheral vascular disease, mild depression, plain angina) are not on the list, because recapturing a code that no longer maps captures nothing. See the V28 mappings coders should recheck for that side of the problem.

Current as of June 2026. CY2026 organizations other than PACE use CMS-HCC V28 at full weight, so every mapping below is the V28 result. PACE uses a separate blend.

Key takeaways

Do not carry a prior-period diagnosis or mapping into a new payment year without checking the applicable source and data window.
MEAT can organize documentation review, but it is not a CMS rule and one element does not make a diagnosis reportable.
The eight to know cold: diabetes, chronic heart failure, COPD, CKD at stage 3 or worse, recurrent major depression at moderate or severe, atrial fibrillation, dementia, and morbid obesity. All still carry a payment HCC under V28.
Specificity decides the HCC, so recapturing unspecified CKD or mild depression (neither maps under V28) captures nothing.

1. Diabetes mellitus

Type 2 diabetes is one of the most commonly recaptured HCCs, and an easy one to code on autopilot. Under V28, E11.9 (type 2 without complications) and E11.65 (with hyperglycemia) both map to HCC 38, the V28 category for diabetes with no, glycemic, or unspecified complications. Documented diabetic complications with linkage, like E11.22 (type 2 with diabetic chronic kidney disease), reach the higher HCC 37, diabetes with chronic complications.

Recapture catch worth knowing: E11.65 moved down a tier from V24 to V28. It used to sit with the chronic complications and now lands in HCC 38. Hyperglycemia still maps, just not as high as a coder working from V24 habits expects. If the chart supports a real diabetic complication, document the linkage and code it, because that is what reaches HCC 37.

One more trap: Z79.4 (long-term insulin use) is on the V28 diabetes-HCC list, but it is a secondary code. The Official Guidelines do not let you report it without the underlying diabetes diagnosis, so code and recapture the diabetes itself. The insulin code supports it. It does not replace it. See the diabetes HCC coding guide for the full complication picture.

2. Chronic heart failure

Heart failure is a recapture staple because it is chronic, common, and easy to leave at "CHF" in a busy note. Under V28, the chronic forms map to HCC 226: I50.22 (chronic systolic), I50.32 (chronic diastolic), and I50.42 (chronic combined). Even unspecified I50.9 lands at HCC 226.

The acute forms sit elsewhere, so watch the fifth character. Acute systolic, diastolic, or combined heart failure (I50.21, I50.31, I50.41) maps to HCC 225, and acute-on-chronic (for example I50.23) maps to HCC 224. Pull the ejection fraction off the echo, code the type and the acuity the record supports, and the recapture holds up far better than a bare I50.9.

3. COPD

Chronic obstructive pulmonary disease recaptures every year a patient is managed for it. J44.9 (COPD, unspecified) and J44.1 (COPD with acute exacerbation) both map to V28 HCC 280.

The recapture lives or dies on whether the note shows active management this year: a medication the patient is on, an assessment of control, an exacerbation worked up. "History of COPD" with nothing current is the version that fails a RADV review.

4. Chronic kidney disease, stage 3 and worse

CKD recaptures only when the stage is documented, and only at stage 3 or higher. Under V28, N18.30 and N18.31 (stage 3 and 3a) map to HCC 329, N18.32 (stage 3b) to HCC 328, N18.4 (stage 4) to HCC 327, and N18.5 (stage 5) to HCC 326. ESRD (N18.6) also maps to HCC 326 in the community model, but ESRD members are scored in CMS's ESRD context, so confirm the scoring model before you rely on it.

Two recapture traps. First, N18.9 (CKD, unspecified) and stages 1 and 2 carry no payment HCC, so a vague "CKD" recapture earns nothing. Second, GFR drifts between visits, so code the stage the provider documents at the current encounter, not last year's stage.

5. Recurrent major depression, moderate or severe

The depression family is a recapture minefield because severity decides everything. F33.1 (recurrent, moderate) and F33.2 (recurrent, severe without psychotic features) map to V28 HCC 155, the category for moderate or severe major depression without psychosis.

What does not recapture: F33.0 (recurrent, mild) and the unspecified F33.9 lost their HCC under V28. Recapturing "depression" without the severity, or carrying a mild code forward out of habit, captures nothing. The recapture has to show the provider documented recurrence and a moderate-or-worse severity this year.

6. Atrial fibrillation

Atrial fibrillation is chronic and recaptures cleanly when it is documented as active. I48.0 (paroxysmal), I48.20 (chronic, unspecified), and I48.21 (permanent) all map to V28 HCC 238.

The recapture point coders miss: a-fib managed with a rate or rhythm drug, or anticoagulation, is being treated, which supports the recapture. Make sure the current note ties the medication to the a-fib rather than leaving the diagnosis stranded on the problem list.

7. Dementia, including Alzheimer's

Dementia recaptures every year the patient is followed for it. G30.9 (Alzheimer's, unspecified) and F03.90 (unspecified dementia, without behavioral disturbance) map to V28 HCC 127.

Here is the V28 trap coders miss: the behavioral and psychotic specifiers do not raise the tier. F03.911 (dementia with agitation) and F03.92 (with psychotic disturbance) map to the same HCC 127 as the without-disturbance code. V24 split those into two different HCCs; V28 collapses them into one. So the recapture risk with dementia is not the specifier, it is omission. When the visit centers on something else and a caregiver does the talking, the dementia drops out of the note. If it was assessed or is being managed, it belongs on the claim this year.

8. Morbid obesity

Morbid obesity recaptures when the provider diagnoses it, not when the BMI is high. E66.01 (morbid obesity due to excess calories) maps to V28 HCC 48. The high-BMI Z codes (Z68.41 through Z68.45) map to the same HCC 48, but they are secondary codes. The guidelines only let you report a BMI code alongside a provider-documented obesity diagnosis, so it cannot stand in for E66.01 on its own.

The recapture has to come from provider documentation of morbid obesity, supported but not replaced by the BMI value. Coding E66.01 off a BMI number with no provider diagnosis is the overcoding side of the same coin.

At a glance

Condition	Code example	V28 HCC	What a clean recapture needs this year
Diabetes	E11.65 / E11.22	38 / 37	Active management, complication linkage for HCC 37
Chronic heart failure	I50.32	226	Type when supported; documented as chronic
COPD	J44.9	280	Current management, not "history of"
CKD, stage 3+	N18.4	327	Stage documented at this encounter
Recurrent major depression	F33.1 / F33.2	155	Recurrence plus moderate-or-worse severity
Atrial fibrillation	I48.20	238	Diagnosis tied to current treatment
Dementia / Alzheimer's	F03.90 / G30.9	127	Assessed or managed this year
Morbid obesity	E66.01	48	Provider diagnosis, not BMI alone

What a valid recapture actually needs

Recapture is operational shorthand, not an ICD-10-CM rule. CMS calculates risk scores from diagnosis and demographic data for specified collection and submission windows. Do not use prior-period data as current support without checking the applicable payment-year instructions and eligible record.

ICD-10-CM Official Guidelines Section IV.I says chronic diseases treated on an ongoing basis may be coded and reported as many times as the patient receives treatment and care. That is not a one-MEAT-element annual rule. Review the whole date-of-service record, classification, CMS program instructions, and payer policy.

Frequently asked questions

What does "recapture" mean in HCC coding?

Recapture is industry shorthand for documenting and reporting a condition again within an applicable risk-adjustment data period. The exact date window, eligible source, provider, and submission rules come from CMS payment-year instructions, not from the shorthand itself.

Why doesn't a diagnosis from last year carry forward?

CMS calculates payment-year risk scores from the applicable diagnosis and demographic data. A prior-period diagnosis does not by itself prove current support or eligibility; verify the stated collection and submission window.

Does the condition have to be on every visit?

There is no universal one-visit, one-MEAT-element rule. Verify the eligible record, provider and encounter source, date window, diagnosis support, coding guidance, and payer or program requirements for the submission.

Why are some chronic conditions missing from this list?

Some familiar chronic codes lost their payment HCC under V28, including unspecified peripheral vascular disease, mild depression, and plain angina. Recapturing a code that no longer maps earns nothing. Check the current CMS mapping before you rely on a code you have recaptured for years.

Disclaimer

This article is for professional and educational use only. It is not coding, billing, legal, or medical advice. Verify every code and HCC mapping against the current official CMS, ICD-10-CM, and AHA Coding Clinic guidance and your payer's policy before you assign it. Reading it creates no provider, patient, or advisory relationship.