Hepatitis C HCC Coding Guide
Hepatitis C (e.g. K74.60) maps to HCC 64 (Cirrhosis of Liver) under the CMS-HCC V28 risk adjustment model, with a community, non-dual, aged RAF weight of 0.447; V28 reached 100% phase-in for payment year 2026. B17.10, acute hepatitis c without hepatic coma, is non-HCC under V28. It can also map to HCC 20 (Lung and Other Severe Cancers) and HCC 65 (Chronic Hepatitis) when the documentation supports those manifestations.
Complete HCC coding guide for Hepatitis C (B18.2) including ICD-10 to HCC mapping, V28 RAF weights, treatment status documentation, and chronic vs. acute coding.
Medically reviewed by Jess P., CPC · Reviewed: May 9, 2026 · Updated for CMS-HCC V28 and FY2026 ICD-10-CM
Quick Facts
HCC Categories
HCC 20, Lung and Other Severe Cancers
HCC 64, Cirrhosis of Liver
HCC 65, Chronic Hepatitis
RAF Weight Range
0.185 to 1.136
Community, non-dual, aged (V28)
Model
CMS-HCC V28 (PY2026, 100% phase-in)
5 ICD-10 codes map to payment HCCs
What HCC category does Hepatitis C map to under V28?
Chronic hepatitis C is a payment condition under CMS-HCC V28. The code that actually drives risk adjustment is B18.2 (chronic viral hepatitis C), which maps to HCC 65 (Chronic Hepatitis) at a community RAF of about 0.185. Acute hepatitis C (B17.10, B17.11) and unspecified hepatitis C (B19.20, B19.21) carry no HCC, so the word "chronic" in the documentation is what unlocks capture. When chronic hepatitis C progresses, the complications code separately to their own categories: cirrhosis (K74.60, K74.69, K70.30) maps to HCC 64 (Cirrhosis of Liver, RAF about 0.447), and liver cell carcinoma (C22.0) maps to HCC 20 (Lung and Other Severe Cancers, RAF about 1.136). After a documented cure (SVR), report Z86.19 (personal history) instead of an active infection code.
ICD-10 to HCC Mapping
| ICD-10 Code | Description | Billable | HCC Mapping |
|---|---|---|---|
| B18.2 | Chronic viral hepatitis C | Yes | HCC 65 |
| B17.10 | Acute hepatitis C without hepatic coma | Yes | No HCC (not risk-adjusting under V28) |
| B17.11 | Acute hepatitis C with hepatic coma | Yes | No HCC (not risk-adjusting under V28) |
| B19.20 | Unspecified viral hepatitis C without hepatic coma | Yes | No HCC (not risk-adjusting under V28) |
| K74.60 | Unspecified cirrhosis of liver | Yes | HCC 64 |
| K74.69 | Other cirrhosis of liver | Yes | HCC 64 |
| B19.21 | Unspecified viral hepatitis C with hepatic coma | Yes | No HCC (not risk-adjusting under V28) |
| Z86.19 | Personal history of other infectious and parasitic diseases | Yes | No HCC (not risk-adjusting under V28) |
| K70.30 | Alcoholic cirrhosis of liver without ascites | Yes | HCC 64 |
| C22.0 | Liver cell carcinoma (hepatocellular) | Yes | HCC 20 |
RAF weights are community, non-dual, aged base coefficients from the CMS-HCC V28 model (PY2026). Verify against the latest CMS rate announcement for payment calculations.
HCC Buddy maps Hepatitis C from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Documentation Tips
Document 'chronic hepatitis C' explicitly, the word 'chronic' is required to support B18.2 rather than an unspecified or acute code.
Record the treatment status: treatment-naive, on current DAA therapy, or achieved sustained virologic response (SVR).
If the patient has been cured (SVR), use personal history code Z86.19, do not continue coding active chronic hepatitis C.
Document any hepatic complications: cirrhosis, hepatocellular carcinoma, portal hypertension, these code separately and may map to additional HCCs.
Include the most recent viral load result and date to support the active vs. cured determination.
Note the genotype when documented, as it may influence treatment documentation.
Common Coding Mistakes
Continuing to code B18.2 (chronic hepatitis C) after the patient has achieved sustained virologic response (SVR/cure).
Coding B19.20 (unspecified hepatitis C) instead of B18.2 (chronic) when the provider has documented chronic infection.
Failing to code hepatic cirrhosis (K74.x) separately when it is documented as a complication of chronic hepatitis C.
Not distinguishing between acute hepatitis C (B17.1x) and chronic hepatitis C (B18.2), only chronic maps to an HCC.
V24 to V28 Changes
Under V28, chronic hepatitis C (B18.2) maps to HCC 65 (Chronic Hepatitis), and the same diagnosis carried an HCC in the older V24 model as well. V28 recalibrated the RAF weight and tightened the category, so the community factor now sits near 0.185. The bigger coding lesson is that one patient often spans several HCCs: the hepatitis itself sits in HCC 65, while cirrhosis lands in HCC 64 (Cirrhosis of Liver) and hepatocellular carcinoma lands in HCC 20 (Lung and Other Severe Cancers). With direct-acting antiviral cures now common, the active chronic population is shrinking, so HCC Buddy users should code active versus cured (Z86.19) status precisely and never let a complication ride on the hepatitis code alone.
Related Conditions
Related references
Sources
RAF weights are community, non-dual, aged base coefficients from the CMS-HCC V28 model (PY2026). Verify against the latest CMS Rate Announcement for payment.
Verified current to CMS-HCC V28, payment year 2026 — last reviewed May 9, 2026.
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