B19.20 ICD-10-CM Code: Unspecified viral hepatitis C without hepatic coma
HCC Buddy Code Card
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FY 2026 Apr update / Certain infectious and parasitic diseases (A00-B99) / Viral hepatitis (B15-B19)
B19.20
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceUnspecified viral hepatitis C without hepatic coma
A viral infection of the liver caused by hepatitis C virus where the specific subtype is unknown, without severe liver failure complications.
Buddy Insight
Unspecified viral hepatitis C without hepatic coma is used when a patient has hepatitis C but the documentation does not clarify whether the infection is acute or chronic.
CMS-HCC V28
00
RAF 0
CMS-HCC V24
00
RAF 0
ACA/HHS
00
RAF 0
ESRD/PACE
00
RAF 0
RXHCC
MappedHCC 55
RAF 0.0
Code Trumping
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Code Book Path
Inclusion Terms
Official- Viral hepatitis C NOS
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for B19.20 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for B19.20 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for B19.20 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for B19.20 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for B19.20 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for B19.20 in this effective period.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.
Is B19.20 an HCC code?
No. B19.20 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
HCC Category Mapping
RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.
Work B19.20 in the Code Book — tabular path, V28 RAF, and MEAT checklist →
MEAT Criteria for B19.20
For B19.20to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically, it has to be re-documented and supported each calendar year.
- MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
- EEvaluate: test results, medication response, or physical findings reviewed by the provider
- AAssess: explicit mention in the assessment or plan with acknowledgment of status
- TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis
Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed B19.20 during that encounter, not just copy-forwarded from a problem list.
Coder workflow notes
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What This Code Means
B19.20 is the ICD-10-CM diagnosis code for unspecified viral hepatitis c without hepatic coma. A viral infection of the liver caused by hepatitis C virus where the specific subtype is unknown, without severe liver failure complications. B19.20 sits in the ICD-10-CM chapter for certain infectious and parasitic diseases (a00-b99), within the section covering viral hepatitis (b15-b19).
B19.20 is a billable ICD-10-CM code but does not map to a payment HCC under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can be reported on Medicare Advantage encounter data submissions but it does not contribute to a beneficiary's RAF score and therefore does not affect risk-adjusted payments to the plan.
Maps only to RxHCC 55 (Substance Use Disorder, Mild) with RAF 0.0. This code does NOT map to any V28 or V24 community HCC. This is critical to understand: specifying the infection as chronic (B18.2) changes the HCC mapping to HCC 65 (V28, RAF 0.472) or HCC 29 (V24, RAF 0.245). Always query for chronicity.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for B19.20 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
Clinical Significance
Unspecified viral hepatitis C without hepatic coma is used when a patient has hepatitis C but the documentation does not clarify whether the infection is acute or chronic. This code should prompt a provider query to determine chronicity, as chronic hepatitis C (B18.2) carries significantly higher risk adjustment value.
Documentation Requirements
- ✓Positive hepatitis C testing (anti-HCV antibody and/or HCV RNA)
- ✓Documentation of hepatitis C diagnosis without acute or chronic specification
- ✓Absence of hepatic coma/encephalopathy documented
- ✓Liver function tests
- ✓Query documentation for acute vs. chronic determination
Commonly Confused Codes
- •B18.2 (Chronic viral hepatitis C): If chronic status is documented, use this more specific code which carries higher HCC value
- •B17.10 (Acute hepatitis C without hepatic coma): If acute status is documented, use this code
- •B19.21 (Unspecified viral hepatitis C with hepatic coma): Same unspecified hepatitis C but with hepatic coma present