Hepatitis C HCC Coding Guide
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.
Quick Facts
HCC Categories
HCC 6 — Chronic Hepatitis
RAF Weight Range
0.193
Community, non-dual, aged (V28)
Model
CMS-HCC V28 (PY2026 — 100% phase-in)
2 ICD-10 codes map to payment HCCs
Overview
Chronic hepatitis C affects approximately 2.4 million Americans and is a payment HCC under CMS-HCC V28. Hepatitis C maps to HCC 1 (HIV/AIDS) when complicated or to HCC 6 (Chronic Hepatitis) depending on the specific clinical context. The key coding distinction is between acute hepatitis C (B17.10-B17.11), chronic hepatitis C (B18.2), and personal history of hepatitis C after sustained virologic response. Chronic hepatitis C requires documentation of treatment status — whether the patient is treatment-naive, on active antiviral therapy, or has achieved sustained virologic response (SVR/cure). Post-SVR patients should be coded with Z86.19 (personal history) rather than the active infection code, which significantly impacts HCC capture.
ICD-10 to HCC Mapping
| ICD-10 Code | Description | Billable | HCC Mapping |
|---|---|---|---|
| B18.2 | Chronic viral hepatitis C | Yes | HCC 6 |
| B17.10 | Acute hepatitis C without hepatic coma | Yes | No HCC |
| B17.11 | Acute hepatitis C with hepatic coma | Yes | No HCC |
| B19.20 | Unspecified viral hepatitis C without hepatic coma | Yes | No HCC |
| K74.60 | Unspecified cirrhosis of liver | Yes | Separate HCC |
| K74.69 | Other cirrhosis of liver | Yes | Separate HCC |
| B19.21 | Unspecified viral hepatitis C with hepatic coma | Yes | No HCC |
| Z86.19 | Personal history of other infectious and parasitic diseases | Yes | No HCC |
| K70.30 | Alcoholic cirrhosis of liver without ascites | Yes | Separate HCC |
| C22.0 | Liver cell carcinoma (hepatocellular) | Yes | HCC 22 |
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.
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
V28 maps chronic hepatitis C to HCC 6 (Chronic Hepatitis), a new category that consolidates chronic viral hepatitis conditions. Under V24, chronic hepatitis C mapped to HCC 29 (Chronic Hepatitis). The V28 recalibration adjusted the RAF weight and narrowed the category definition. With the widespread availability of direct-acting antiviral (DAA) cures for hepatitis C, the population of patients with active chronic hepatitis C is declining, making accurate coding of active vs. cured status increasingly important for risk adjustment accuracy.
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