HCC Condition Coding Guides

In-depth coding guides for the top 20 HCC risk adjustment conditions. Each guide includes ICD-10 to HCC mapping, V28 RAF weights, documentation tips, and common coding mistakes.

Endocrine

Diabetes Mellitus (Type 2)

HCC 37HCC 38RAF 0.105–0.302

E11.9, E11.65, E11.22 and more

Morbid Obesity

HCC 48RAF 0.250

E66.01, E66.2 and more

Protein-Calorie Malnutrition

HCC 49RAF 0.455

E43, E44.0, E44.1 and more

Cardiovascular

Heart Failure

HCC 224RAF 0.369

I50.20, I50.22, I50.23 and more

Atrial Fibrillation

HCC 223RAF 0.242

I48.0, I48.11, I48.19 and more

Peripheral Vascular Disease

HCC 238RAF 0.288

I70.211, I70.212, I70.219 and more

Stroke and Cerebrovascular Disease

HCC 100RAF 0.272

I63.9, I63.50, I63.511 and more

Respiratory

Chronic Obstructive Pulmonary Disease (COPD)

HCC 280RAF 0.335

J44.0, J44.1, J44.9 and more

Renal

Chronic Kidney Disease

HCC 329HCC 330RAF 0.289

N18.4, N18.5, N18.6 and more

Mental Health

Major Depressive Disorder

HCC 155RAF 0.309

F32.0, F32.1, F32.2 and more

Dementia

HCC 149HCC 150RAF 0.316–0.637

F01.50, F01.511, F02.80 and more

Schizophrenia

HCC 154RAF 0.544

F20.0, F20.1, F20.2 and more

Cancer

Lung Cancer

HCC 21RAF 1.014

C34.10, C34.11, C34.12 and more

Breast Cancer

HCC 23RAF 0.316

C50.011, C50.012, C50.411 and more

Infectious Disease

Hepatitis C

HCC 6RAF 0.193

B18.2, C22.0 and more

HIV/AIDS

HCC 1RAF 0.433

B20, O98.7, O98.711 and more

Musculoskeletal

Rheumatoid Arthritis

HCC 40RAF 0.421

M05.79, M05.10, M06.09 and more

Amputation Status

HCC 253RAF 0.488

Z89.411, Z89.511, Z89.512 and more

Dermatologic

Pressure Ulcers

HCC 381HCC 382RAF 0.296–0.535

L89.154, L89.153, L89.014 and more

Transplant

Organ Transplant Status

HCC 186RAF 0.658

Z94.0, Z94.1, Z94.2 and more

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