Billing & Eligibility
ICD-10 Codes for
Care Management.
CMS publishes no list of ICD-10 codes that qualify a patient for RPM, CCM, PCM, BHI or RTM. Eligibility turns on the condition and on documented medical necessity. This directory lists every billable ICD-10-CM code for the conditions those programs manage, taken from the official FY2026 code set, and shows which programs each condition can realistically support.
2,125 codes · 80 conditions · ICD-10-CM FY2026
Read This First
There is no CMS-approved ICD-10 list.
It is worth being blunt about this, because a lot of published material implies otherwise. CMS has never issued a list of diagnosis codes that make a patient eligible for remote patient monitoring or chronic care management, and there is no national coverage determination that restricts these services to particular codes. Any page that hands you a definitive list of qualifying codes is describing a convention, not a rule.
What CMS does define is the condition criteria for each program, and those are the real test. The diagnosis code does two separate jobs: it documents the condition being managed so that medical necessity is visible on the claim, and it determines whether the encounter earns risk-adjustment credit.
RPM
One or more conditions with a physiologic parameter that an FDA-cleared device can measure and transmit. Since CY2026 the device-supply code follows the number of days of data: 99445 for 2 to 15 days, 99454 for 16 to 30 days in a 30-day period.
CCM
Two or more chronic conditions expected to last at least 12 months, placing the patient at significant risk of death, exacerbation, or functional decline.
PCM
One high-risk chronic condition expected to last at least 3 months that places the patient at significant risk of hospitalization, exacerbation, or functional decline.
BHI
One or more behavioral health conditions (depression, anxiety, PTSD, substance use disorders, etc.) requiring structured care management in a primary care setting.
RTM
Musculoskeletal or respiratory conditions requiring ongoing therapeutic monitoring: pain management, physical therapy adherence, respiratory therapy outcomes.
Specificity is where code choice has real consequences. N18.9, chronic kidney disease unspecified, maps to no HCC. N18.30 through N18.6 map to HCC 329. E11.9 maps to HCC 38, while E11.22 maps to HCC 37, which carries more weight. The tables below flag every unspecified code whose own family does risk-adjust, so the cases where a better code exists are visible rather than assumed.
The Directory
Every code, by condition.
2,125 billable ICD-10-CM codes across 80 conditions, 64 of which are categories CMS itself treats as chronic. 1,031 carry CMS-HCC V28 risk adjustment and 71 are flagged where a more specific code is available. Open any condition to see its codes.
2,125 codes listed
Cardiovascular
Essential hypertension
I101 codesrpmccmpcmHome blood pressure readings, typically twice daily, reviewed against a target set in the care plan.
Essential hypertension
I101 codesrpmccmpcmCMS chronic condition · CCW category: Hypertension · Devices: Blood pressure cuff
| Code | Official ICD-10-CM description | Programs | Risk adjustment |
|---|---|---|---|
| I10 | Essential (primary) hypertension | rpmccmpcm | not risk adjusted |
Hypertensive heart and kidney disease
I11, I12, I13, I15, I1616 codesrpmccmpcmBlood pressure plus daily weight, since fluid status drives both the cardiac and the renal picture.
Hypertensive heart and kidney disease
I11, I12, I13, I15, I1616 codesrpmccmpcmCMS chronic condition · CCW category: Hypertension · Devices: Blood pressure cuff, Connected weight scale
I13 codes combine heart and kidney involvement and require the CKD stage to be coded alongside.
| Code | Official ICD-10-CM description | Programs | Risk adjustment |
|---|---|---|---|
| I11.0 | Hypertensive heart disease with heart failure | rpmccmpcm | HCC 226 · Heart Failure, Except End-Stage and Acute |
| I11.9 | Hypertensive heart disease without heart failure | rpmccmpcm | not risk adjusted |
| I12.0 | Hypertensive chronic kidney disease with stage 5 chronic kidney disease or end stage renal disease | rpmccmpcm | HCC 326 · Chronic Kidney Disease, Stage 5 |
| I12.9 | Hypertensive chronic kidney disease with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney diseaselow specificity | rpmccmpcm | not risk adjusted |
| I13.0 | Hypertensive heart and chronic kidney disease with heart failure and stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease | rpmccmpcm | HCC 226 · Heart Failure, Except End-Stage and Acute |
| I13.10 | Hypertensive heart and chronic kidney disease without heart failure, with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney diseaselow specificity | rpmccmpcm | not risk adjusted |
| I13.11 | Hypertensive heart and chronic kidney disease without heart failure, with stage 5 chronic kidney disease, or end stage renal disease | rpmccmpcm | HCC 326 · Chronic Kidney Disease, Stage 5 |
| I13.2 | Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or end stage renal disease | rpmccmpcm | HCC 226 · Heart Failure, Except End-Stage and Acute |
| I15.0 | Renovascular hypertension | rpmccmpcm | not risk adjusted |
| I15.1 | Hypertension secondary to other renal disorders | rpmccmpcm | not risk adjusted |
| I15.2 | Hypertension secondary to endocrine disorders | rpmccmpcm | not risk adjusted |
| I15.8 | Other secondary hypertension | rpmccmpcm | not risk adjusted |
| I15.9 | Secondary hypertension, unspecified | rpmccmpcm | not risk adjusted |
| I16.0 | Hypertensive urgency | rpmccmpcm | not risk adjusted |
| I16.1 | Hypertensive emergency | rpmccmpcm | not risk adjusted |
| I16.9 | Hypertensive crisis, unspecified | rpmccmpcm | not risk adjusted |
Heart failure
I5023 codesrpmccmpcmDaily weight is the primary signal, since a two to three pound overnight gain precedes decompensation. Blood pressure and pulse oximetry support diuretic titration.
Heart failure
I5023 codesrpmccmpcmCMS chronic condition · CCW category: Heart Failure and Non-Ischemic Heart Disease · Devices: Connected weight scale, Blood pressure cuff, Pulse oximeter
Read the heart failure monitoring guide
| Code | Official ICD-10-CM description | Programs | Risk adjustment |
|---|---|---|---|
| I50.1 | Left ventricular failure, unspecified | rpmccmpcm | HCC 226 · Heart Failure, Except End-Stage and Acute |
| I50.20 | Unspecified systolic (congestive) heart failure | rpmccmpcm | HCC 226 · Heart Failure, Except End-Stage and Acute |
| I50.21 | Acute systolic (congestive) heart failure | rpmccmpcm | HCC 225 · Acute Heart Failure (Excludes Acute on Chronic) |
| I50.22 | Chronic systolic (congestive) heart failure | rpmccmpcm | HCC 226 · Heart Failure, Except End-Stage and Acute |
| I50.23 | Acute on chronic systolic (congestive) heart failure | rpmccmpcm | HCC 224 · Acute on Chronic Heart Failure |
| I50.30 | Unspecified diastolic (congestive) heart failure | rpmccmpcm | HCC 226 · Heart Failure, Except End-Stage and Acute |
| I50.31 | Acute diastolic (congestive) heart failure | rpmccmpcm | HCC 225 · Acute Heart Failure (Excludes Acute on Chronic) |
| I50.32 | Chronic diastolic (congestive) heart failure | rpmccmpcm | HCC 226 · Heart Failure, Except End-Stage and Acute |
| I50.33 | Acute on chronic diastolic (congestive) heart failure | rpmccmpcm | HCC 224 · Acute on Chronic Heart Failure |
| I50.40 | Unspecified combined systolic (congestive) and diastolic (congestive) heart failure | rpmccmpcm | HCC 226 · Heart Failure, Except End-Stage and Acute |
| I50.41 | Acute combined systolic (congestive) and diastolic (congestive) heart failure | rpmccmpcm | HCC 225 · Acute Heart Failure (Excludes Acute on Chronic) |
| I50.42 | Chronic combined systolic (congestive) and diastolic (congestive) heart failure | rpmccmpcm | HCC 226 · Heart Failure, Except End-Stage and Acute |
| I50.43 | Acute on chronic combined systolic (congestive) and diastolic (congestive) heart failure | rpmccmpcm | HCC 224 · Acute on Chronic Heart Failure |
| I50.810 | Right heart failure, unspecified | rpmccmpcm | HCC 226 · Heart Failure, Except End-Stage and Acute |
| I50.811 | Acute right heart failure | rpmccmpcm | HCC 225 · Acute Heart Failure (Excludes Acute on Chronic) |
| I50.812 | Chronic right heart failure | rpmccmpcm | HCC 226 · Heart Failure, Except End-Stage and Acute |
| I50.813 | Acute on chronic right heart failure | rpmccmpcm | HCC 225 · Acute Heart Failure (Excludes Acute on Chronic) |
| I50.814 | Right heart failure due to left heart failure | rpmccmpcm | HCC 226 · Heart Failure, Except End-Stage and Acute |
| I50.82 | Biventricular heart failure | rpmccmpcm | HCC 226 · Heart Failure, Except End-Stage and Acute |
| I50.83 | High output heart failure | rpmccmpcm | HCC 226 · Heart Failure, Except End-Stage and Acute |
| I50.84 | End stage heart failure | rpmccmpcm | HCC 222 · End-Stage Heart Failure |
| I50.89 | Other heart failure | rpmccmpcm | HCC 226 · Heart Failure, Except End-Stage and Acute |
| I50.9 | Heart failure, unspecified | rpmccmpcm | HCC 226 · Heart Failure, Except End-Stage and Acute |
Cardiomyopathy and myocarditis
I42, I43, I40, I41, I51.717 codesrpmccmpcmWeight and blood pressure trending, with rhythm capture where arrhythmia is part of the picture.
Cardiomyopathy and myocarditis
I42, I43, I40, I41, I51.717 codesrpmccmpcmCMS chronic condition · CCW category: Heart Failure and Non-Ischemic Heart Disease · Devices: Connected weight scale, Blood pressure cuff, Single-lead ECG
Effective 2026-10-01: I42.0 splits on 2026-10-01 into I42.00, I42.01 (familial or genetic) and I42.09. Check your problem list before the cutover.
| Code | Official ICD-10-CM description | Programs | Risk adjustment |
|---|---|---|---|
| I40.0 | Infective myocarditis | rpmccmpcm | not risk adjusted |
| I40.1 | Isolated myocarditis | rpmccmpcm | not risk adjusted |
| I40.8 | Other acute myocarditis | rpmccmpcm | not risk adjusted |
| I40.9 | Acute myocarditis, unspecified | rpmccmpcm | not risk adjusted |
| I41 | Myocarditis in diseases classified elsewhere | rpmccmpcm | not risk adjusted |
| I42.0 | Dilated cardiomyopathydeleted 2026-10-01 | rpmccmpcm | HCC 227 · Cardiomyopathy/Myocarditis |
| I42.1 | Obstructive hypertrophic cardiomyopathy | rpmccmpcm | HCC 227 · Cardiomyopathy/Myocarditis |
| I42.2 | Other hypertrophic cardiomyopathy | rpmccmpcm | HCC 227 · Cardiomyopathy/Myocarditis |
| I42.3 | Endomyocardial (eosinophilic) disease | rpmccmpcm | HCC 227 · Cardiomyopathy/Myocarditis |
| I42.4 | Endocardial fibroelastosis | rpmccmpcm | HCC 227 · Cardiomyopathy/Myocarditis |
| I42.5 | Other restrictive cardiomyopathy | rpmccmpcm | HCC 227 · Cardiomyopathy/Myocarditis |
| I42.6 | Alcoholic cardiomyopathy | rpmccmpcm | HCC 227 · Cardiomyopathy/Myocarditis |
| I42.7 | Cardiomyopathy due to drug and external agent | rpmccmpcm | not risk adjusted |
| I42.8 | Other cardiomyopathiesdeleted 2026-10-01 | rpmccmpcm | HCC 227 · Cardiomyopathy/Myocarditis |
| I42.9 | Cardiomyopathy, unspecified | rpmccmpcm | HCC 227 · Cardiomyopathy/Myocarditis |
| I43 | Cardiomyopathy in diseases classified elsewhere | rpmccmpcm | HCC 227 · Cardiomyopathy/Myocarditis |
| I51.7 | Cardiomegaly | rpmccmpcm | not risk adjusted |
Atrial fibrillation and flutter
I489 codesrpmccmpcmRate and rhythm capture plus blood pressure, most often during rate-control or anticoagulation management.
Atrial fibrillation and flutter
I489 codesrpmccmpcmCMS chronic condition · CCW category: Atrial Fibrillation and Flutter · Devices: Single-lead ECG, Blood pressure cuff
I48.1 and I48.2 are no longer valid on their own. Code to I48.11, I48.19, I48.20 or I48.21.
Read the atrial fibrillation and flutter monitoring guide
| Code | Official ICD-10-CM description | Programs | Risk adjustment |
|---|---|---|---|
| I48.0 | Paroxysmal atrial fibrillation | rpmccmpcm | HCC 238 · Specified Heart Arrhythmias |
| I48.11 | Longstanding persistent atrial fibrillation | rpmccmpcm | HCC 238 · Specified Heart Arrhythmias |
| I48.19 | Other persistent atrial fibrillation | rpmccmpcm | HCC 238 · Specified Heart Arrhythmias |
| I48.20 | Chronic atrial fibrillation, unspecified | rpmccmpcm | HCC 238 · Specified Heart Arrhythmias |
| I48.21 | Permanent atrial fibrillation | rpmccmpcm | HCC 238 · Specified Heart Arrhythmias |
| I48.3 | Typical atrial flutter | rpmccmpcm | HCC 238 · Specified Heart Arrhythmias |
| I48.4 | Atypical atrial flutter | rpmccmpcm | HCC 238 · Specified Heart Arrhythmias |
| I48.91 | Unspecified atrial fibrillation | rpmccmpcm | HCC 238 · Specified Heart Arrhythmias |
| I48.92 | Unspecified atrial flutter | rpmccmpcm | HCC 238 · Specified Heart Arrhythmias |
Other cardiac dysrhythmias and conduction disorders
I44, I45, I47, I4939 codesrpmccmSymptomatic rhythm capture and heart rate trending.
Other cardiac dysrhythmias and conduction disorders
I44, I45, I47, I4939 codesrpmccmAdded by CCN Health · Devices: Single-lead ECG, Blood pressure cuff
| Code | Official ICD-10-CM description | Programs | Risk adjustment |
|---|---|---|---|
| I44.0 | Atrioventricular block, first degree | rpmccm | not risk adjusted |
| I44.1 | Atrioventricular block, second degree | rpmccm | not risk adjusted |
| I44.2 | Atrioventricular block, complete | rpmccm | HCC 238 · Specified Heart Arrhythmias |
| I44.30 | Unspecified atrioventricular blocklow specificity | rpmccm | not risk adjusted |
| I44.39 | Other atrioventricular block | rpmccm | not risk adjusted |
| I44.4 | Left anterior fascicular block | rpmccm | not risk adjusted |
| I44.5 | Left posterior fascicular block | rpmccm | not risk adjusted |
| I44.60 | Unspecified fascicular blocklow specificity | rpmccm | not risk adjusted |
| I44.69 | Other fascicular block | rpmccm | not risk adjusted |
| I44.7 | Left bundle-branch block, unspecifiedlow specificity | rpmccm | not risk adjusted |
| I45.0 | Right fascicular block | rpmccm | not risk adjusted |
| I45.10 | Unspecified right bundle-branch block | rpmccm | not risk adjusted |
| I45.19 | Other right bundle-branch block | rpmccm | not risk adjusted |
| I45.2 | Bifascicular block | rpmccm | not risk adjusted |
| I45.3 | Trifascicular block | rpmccm | not risk adjusted |
| I45.4 | Nonspecific intraventricular block | rpmccm | not risk adjusted |
| I45.5 | Other specified heart block | rpmccm | not risk adjusted |
| I45.6 | Pre-excitation syndrome | rpmccm | not risk adjusted |
| I45.81 | Long QT syndrome | rpmccm | not risk adjusted |
| I45.89 | Other specified conduction disorders | rpmccm | not risk adjusted |
| I45.9 | Conduction disorder, unspecified | rpmccm | not risk adjusted |
| I47.0 | Re-entry ventricular arrhythmia | rpmccm | HCC 238 · Specified Heart Arrhythmias |
| I47.10 | Supraventricular tachycardia, unspecifiedlow specificity | rpmccm | not risk adjusted |
| I47.11 | Inappropriate sinus tachycardia, so stated | rpmccm | not risk adjusted |
| I47.19 | Other supraventricular tachycardia | rpmccm | not risk adjusted |
| I47.20 | Ventricular tachycardia, unspecified | rpmccm | HCC 238 · Specified Heart Arrhythmias |
| I47.21 | Torsades de pointes | rpmccm | HCC 238 · Specified Heart Arrhythmias |
| I47.29 | Other ventricular tachycardia | rpmccm | HCC 238 · Specified Heart Arrhythmias |
| I47.9 | Paroxysmal tachycardia, unspecified | rpmccm | HCC 238 · Specified Heart Arrhythmias |
| I49.01 | Ventricular fibrillation | rpmccm | HCC 213 · Cardio-Respiratory Failure and Shock |
| I49.02 | Ventricular flutter | rpmccm | HCC 213 · Cardio-Respiratory Failure and Shock |
| I49.1 | Atrial premature depolarization | rpmccm | not risk adjusted |
| I49.2 | Junctional premature depolarization | rpmccm | HCC 238 · Specified Heart Arrhythmias |
| I49.3 | Ventricular premature depolarization | rpmccm | not risk adjusted |
| I49.40 | Unspecified premature depolarizationlow specificity | rpmccm | not risk adjusted |
| I49.49 | Other premature depolarization | rpmccm | not risk adjusted |
| I49.5 | Sick sinus syndrome | rpmccm | HCC 238 · Specified Heart Arrhythmias |
| I49.8 | Other specified cardiac arrhythmiasdeleted 2026-10-01 | rpmccm | not risk adjusted |
| I49.9 | Cardiac arrhythmia, unspecifiedlow specificity | rpmccm | not risk adjusted |
Ischemic heart disease
I20, I24, I2567 codesrpmccmpcmBlood pressure and heart rate against anti-anginal and secondary-prevention targets.
Ischemic heart disease
I20, I24, I2567 codesrpmccmpcmCMS chronic condition · CCW category: Ischemic Heart Disease · Devices: Blood pressure cuff, Single-lead ECG
| Code | Official ICD-10-CM description | Programs | Risk adjustment |
|---|---|---|---|
| I20.0 | Unstable angina | rpmccmpcm | HCC 229 · Unstable Angina and Other Acute Ischemic Heart Disease |
| I20.1 | Angina pectoris with documented spasm | rpmccmpcm | not risk adjusted |
| I20.2 | Refractory angina pectoris | rpmccmpcm | not risk adjusted |
| I20.81 | Angina pectoris with coronary microvascular dysfunction | rpmccmpcm | not risk adjusted |
| I20.89 | Other forms of angina pectoris | rpmccmpcm | not risk adjusted |
| I20.9 | Angina pectoris, unspecifiedlow specificity | rpmccmpcm | not risk adjusted |
| I24.0 | Acute coronary thrombosis not resulting in myocardial infarction | rpmccmpcm | HCC 229 · Unstable Angina and Other Acute Ischemic Heart Disease |
| I24.1 | Dressler's syndrome | rpmccmpcm | HCC 229 · Unstable Angina and Other Acute Ischemic Heart Disease |
| I24.81 | Acute coronary microvascular dysfunction | rpmccmpcm | HCC 229 · Unstable Angina and Other Acute Ischemic Heart Disease |
| I24.89 | Other forms of acute ischemic heart disease | rpmccmpcm | HCC 229 · Unstable Angina and Other Acute Ischemic Heart Disease |
| I24.9 | Acute ischemic heart disease, unspecified | rpmccmpcm | HCC 229 · Unstable Angina and Other Acute Ischemic Heart Disease |
| I25.10 | Atherosclerotic heart disease of native coronary artery without angina pectoris | rpmccmpcm | not risk adjusted |
| I25.110 | Atherosclerotic heart disease of native coronary artery with unstable angina pectoris | rpmccmpcm | HCC 229 · Unstable Angina and Other Acute Ischemic Heart Disease |
| I25.111 | Atherosclerotic heart disease of native coronary artery with angina pectoris with documented spasm | rpmccmpcm | not risk adjusted |
| I25.112 | Atherosclerotic heart disease of native coronary artery with refractory angina pectoris | rpmccmpcm | not risk adjusted |
| I25.118 | Atherosclerotic heart disease of native coronary artery with other forms of angina pectoris | rpmccmpcm | not risk adjusted |
| I25.119 | Atherosclerotic heart disease of native coronary artery with unspecified angina pectorislow specificity | rpmccmpcm | not risk adjusted |
| I25.2 | Old myocardial infarction | rpmccmpcm | not risk adjusted |
| I25.3 | Aneurysm of heart | rpmccmpcm | not risk adjusted |
| I25.41 | Coronary artery aneurysm | rpmccmpcm | not risk adjusted |
| I25.42 | Coronary artery dissection | rpmccmpcm | not risk adjusted |
| I25.5 | Ischemic cardiomyopathy | rpmccmpcm | not risk adjusted |
| I25.6 | Silent myocardial ischemia | rpmccmpcm | not risk adjusted |
| I25.700 | Atherosclerosis of coronary artery bypass graft(s), unspecified, with unstable angina pectoris | rpmccmpcm | HCC 229 · Unstable Angina and Other Acute Ischemic Heart Disease |
| I25.701 | Atherosclerosis of coronary artery bypass graft(s), unspecified, with angina pectoris with documented spasmlow specificity | rpmccmpcm | not risk adjusted |
| I25.702 | Atherosclerosis of coronary artery bypass graft(s), unspecified, with refractory angina pectorislow specificity | rpmccmpcm | not risk adjusted |
| I25.708 | Atherosclerosis of coronary artery bypass graft(s), unspecified, with other forms of angina pectorislow specificity | rpmccmpcm | not risk adjusted |
| I25.709 | Atherosclerosis of coronary artery bypass graft(s), unspecified, with unspecified angina pectorislow specificity | rpmccmpcm | not risk adjusted |
| I25.710 | Atherosclerosis of autologous vein coronary artery bypass graft(s) with unstable angina pectoris | rpmccmpcm | HCC 229 · Unstable Angina and Other Acute Ischemic Heart Disease |
| I25.711 | Atherosclerosis of autologous vein coronary artery bypass graft(s) with angina pectoris with documented spasm | rpmccmpcm | not risk adjusted |
| I25.712 | Atherosclerosis of autologous vein coronary artery bypass graft(s) with refractory angina pectoris | rpmccmpcm | not risk adjusted |
| I25.718 | Atherosclerosis of autologous vein coronary artery bypass graft(s) with other forms of angina pectoris | rpmccmpcm | not risk adjusted |
| I25.719 | Atherosclerosis of autologous vein coronary artery bypass graft(s) with unspecified angina pectorislow specificity | rpmccmpcm | not risk adjusted |
| I25.720 | Atherosclerosis of autologous artery coronary artery bypass graft(s) with unstable angina pectoris | rpmccmpcm | HCC 229 · Unstable Angina and Other Acute Ischemic Heart Disease |
| I25.721 | Atherosclerosis of autologous artery coronary artery bypass graft(s) with angina pectoris with documented spasm | rpmccmpcm | not risk adjusted |
| I25.722 | Atherosclerosis of autologous artery coronary artery bypass graft(s) with refractory angina pectoris | rpmccmpcm | not risk adjusted |
| I25.728 | Atherosclerosis of autologous artery coronary artery bypass graft(s) with other forms of angina pectoris | rpmccmpcm | not risk adjusted |
| I25.729 | Atherosclerosis of autologous artery coronary artery bypass graft(s) with unspecified angina pectorislow specificity | rpmccmpcm | not risk adjusted |
| I25.730 | Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with unstable angina pectoris | rpmccmpcm | HCC 229 · Unstable Angina and Other Acute Ischemic Heart Disease |
| I25.731 | Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with angina pectoris with documented spasm | rpmccmpcm | not risk adjusted |
| I25.732 | Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with refractory angina pectoris | rpmccmpcm | not risk adjusted |
| I25.738 | Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with other forms of angina pectoris | rpmccmpcm | not risk adjusted |
| I25.739 | Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with unspecified angina pectorislow specificity | rpmccmpcm | not risk adjusted |
| I25.750 | Atherosclerosis of native coronary artery of transplanted heart with unstable angina | rpmccmpcm | HCC 229 · Unstable Angina and Other Acute Ischemic Heart Disease |
| I25.751 | Atherosclerosis of native coronary artery of transplanted heart with angina pectoris with documented spasm | rpmccmpcm | not risk adjusted |
| I25.752 | Atherosclerosis of native coronary artery of transplanted heart with refractory angina pectoris | rpmccmpcm | not risk adjusted |
| I25.758 | Atherosclerosis of native coronary artery of transplanted heart with other forms of angina pectoris | rpmccmpcm | not risk adjusted |
| I25.759 | Atherosclerosis of native coronary artery of transplanted heart with unspecified angina pectorislow specificity | rpmccmpcm | not risk adjusted |
| I25.760 | Atherosclerosis of bypass graft of coronary artery of transplanted heart with unstable angina | rpmccmpcm | HCC 229 · Unstable Angina and Other Acute Ischemic Heart Disease |
| I25.761 | Atherosclerosis of bypass graft of coronary artery of transplanted heart with angina pectoris with documented spasm | rpmccmpcm | not risk adjusted |
| I25.762 | Atherosclerosis of bypass graft of coronary artery of transplanted heart with refractory angina pectoris | rpmccmpcm | not risk adjusted |
| I25.768 | Atherosclerosis of bypass graft of coronary artery of transplanted heart with other forms of angina pectoris | rpmccmpcm | not risk adjusted |
| I25.769 | Atherosclerosis of bypass graft of coronary artery of transplanted heart with unspecified angina pectorislow specificity | rpmccmpcm | not risk adjusted |
| I25.790 | Atherosclerosis of other coronary artery bypass graft(s) with unstable angina pectoris | rpmccmpcm | HCC 229 · Unstable Angina and Other Acute Ischemic Heart Disease |
| I25.791 | Atherosclerosis of other coronary artery bypass graft(s) with angina pectoris with documented spasm | rpmccmpcm | not risk adjusted |
| I25.792 | Atherosclerosis of other coronary artery bypass graft(s) with refractory angina pectoris | rpmccmpcm | not risk adjusted |
| I25.798 | Atherosclerosis of other coronary artery bypass graft(s) with other forms of angina pectoris | rpmccmpcm | not risk adjusted |
| I25.799 | Atherosclerosis of other coronary artery bypass graft(s) with unspecified angina pectorislow specificity | rpmccmpcm | not risk adjusted |
| I25.810 | Atherosclerosis of coronary artery bypass graft(s) without angina pectoris | rpmccmpcm | not risk adjusted |
| I25.811 | Atherosclerosis of native coronary artery of transplanted heart without angina pectoris | rpmccmpcm | not risk adjusted |
| I25.812 | Atherosclerosis of bypass graft of coronary artery of transplanted heart without angina pectoris | rpmccmpcm | not risk adjusted |
| I25.82 | Chronic total occlusion of coronary artery | rpmccmpcm | not risk adjusted |
| I25.83 | Coronary atherosclerosis due to lipid rich plaque | rpmccmpcm | not risk adjusted |
| I25.84 | Coronary atherosclerosis due to calcified coronary lesion | rpmccmpcm | not risk adjusted |
| I25.85 | Chronic coronary microvascular dysfunction | rpmccmpcm | not risk adjusted |
| I25.89 | Other forms of chronic ischemic heart disease | rpmccmpcm | not risk adjusted |
| I25.9 | Chronic ischemic heart disease, unspecifiedlow specificity | rpmccmpcm | not risk adjusted |
Myocardial infarction and its sequelae
I21, I22, I23, I25.228 codesrpmccmpcmPost-discharge blood pressure and heart rate surveillance during the highest-risk readmission window.
Myocardial infarction and its sequelae
I21, I22, I23, I25.228 codesrpmccmpcmCMS chronic condition · CCW category: Acute Myocardial Infarction · Devices: Blood pressure cuff, Single-lead ECG
I21 and I22 describe an acute event. For ongoing management most practices carry I25.2 (old myocardial infarction) once the acute episode has closed.
| Code | Official ICD-10-CM description | Programs | Risk adjustment |
|---|---|---|---|
| I21.01 | ST elevation (STEMI) myocardial infarction involving left main coronary artery | rpmccmpcm | HCC 228 · Acute Myocardial Infarction |
| I21.02 | ST elevation (STEMI) myocardial infarction involving left anterior descending coronary artery | rpmccmpcm | HCC 228 · Acute Myocardial Infarction |
| I21.09 | ST elevation (STEMI) myocardial infarction involving other coronary artery of anterior wall | rpmccmpcm | HCC 228 · Acute Myocardial Infarction |
| I21.11 | ST elevation (STEMI) myocardial infarction involving right coronary artery | rpmccmpcm | HCC 228 · Acute Myocardial Infarction |
| I21.19 | ST elevation (STEMI) myocardial infarction involving other coronary artery of inferior wall | rpmccmpcm | HCC 228 · Acute Myocardial Infarction |
| I21.21 | ST elevation (STEMI) myocardial infarction involving left circumflex coronary artery | rpmccmpcm | HCC 228 · Acute Myocardial Infarction |
| I21.29 | ST elevation (STEMI) myocardial infarction involving other sites | rpmccmpcm | HCC 228 · Acute Myocardial Infarction |
| I21.3 | ST elevation (STEMI) myocardial infarction of unspecified site | rpmccmpcm | HCC 228 · Acute Myocardial Infarction |
| I21.4 | Non-ST elevation (NSTEMI) myocardial infarction | rpmccmpcm | HCC 228 · Acute Myocardial Infarction |
| I21.9 | Acute myocardial infarction, unspecified | rpmccmpcm | HCC 228 · Acute Myocardial Infarction |
| I21.A1 | Myocardial infarction type 2 | rpmccmpcm | HCC 228 · Acute Myocardial Infarction |
| I21.A9 | Other myocardial infarction type | rpmccmpcm | HCC 228 · Acute Myocardial Infarction |
| I21.B | Myocardial infarction with coronary microvascular dysfunction | rpmccmpcm | HCC 228 · Acute Myocardial Infarction |
| I22.0 | Subsequent ST elevation (STEMI) myocardial infarction of anterior wall | rpmccmpcm | HCC 228 · Acute Myocardial Infarction |
| I22.1 | Subsequent ST elevation (STEMI) myocardial infarction of inferior wall | rpmccmpcm | HCC 228 · Acute Myocardial Infarction |
| I22.2 | Subsequent non-ST elevation (NSTEMI) myocardial infarction | rpmccmpcm | HCC 228 · Acute Myocardial Infarction |
| I22.8 | Subsequent ST elevation (STEMI) myocardial infarction of other sites | rpmccmpcm | HCC 228 · Acute Myocardial Infarction |
| I22.9 | Subsequent ST elevation (STEMI) myocardial infarction of unspecified site | rpmccmpcm | HCC 228 · Acute Myocardial Infarction |
| I23.0 | Hemopericardium as current complication following acute myocardial infarction | rpmccmpcm | HCC 229 · Unstable Angina and Other Acute Ischemic Heart Disease |
| I23.1 | Atrial septal defect as current complication following acute myocardial infarction | rpmccmpcm | HCC 229 · Unstable Angina and Other Acute Ischemic Heart Disease |
| I23.2 | Ventricular septal defect as current complication following acute myocardial infarction | rpmccmpcm | HCC 229 · Unstable Angina and Other Acute Ischemic Heart Disease |
| I23.3 | Rupture of cardiac wall without hemopericardium as current complication following acute myocardial infarction | rpmccmpcm | HCC 229 · Unstable Angina and Other Acute Ischemic Heart Disease |
| I23.4 | Rupture of chordae tendineae as current complication following acute myocardial infarction | rpmccmpcm | HCC 229 · Unstable Angina and Other Acute Ischemic Heart Disease |
| I23.5 | Rupture of papillary muscle as current complication following acute myocardial infarction | rpmccmpcm | HCC 229 · Unstable Angina and Other Acute Ischemic Heart Disease |
| I23.6 | Thrombosis of atrium, auricular appendage, and ventricle as current complications following acute myocardial infarction | rpmccmpcm | HCC 229 · Unstable Angina and Other Acute Ischemic Heart Disease |
| I23.7 | Postinfarction angina | rpmccmpcm | HCC 229 · Unstable Angina and Other Acute Ischemic Heart Disease |
| I23.8 | Other current complications following acute myocardial infarction | rpmccmpcm | HCC 229 · Unstable Angina and Other Acute Ischemic Heart Disease |
| I25.2 | Old myocardial infarction | rpmccmpcm | not risk adjusted |
Stroke, TIA and cerebrovascular sequelae
G45, G46, I63.9, I65, I66, I67, I69.3, I69.9140 codes in familyrpmccmpcmBlood pressure control is the dominant secondary-prevention lever. Activity and fall sensing supports the deficits captured by the I69 sequela codes.
Stroke, TIA and cerebrovascular sequelae
G45, G46, I63.9, I65, I66, I67, I69.3, I69.9140 codes in familyrpmccmpcmCMS chronic condition · CCW category: Stroke/Transient Ischemic Attack · Devices: Blood pressure cuff, Contactless activity and fall radar
I69 codes carry the deficit, so they are usually the ones that justify ongoing care management rather than the acute I63 code.
This family runs to 140 codes that differ mainly by anatomic site and laterality, which does not change whether the condition supports care management. The codes are not listed one by one here. Code to the site and side documented in the record, within G45, G46, I63.9, I65, I66, I67, I69.3, I69.9.
Peripheral and visceral vascular disease
I70, I71, I72, I73, I77, I79318 codes in familyrpmccmpcmBlood pressure and peripheral perfusion, often alongside diabetic foot surveillance.
Peripheral and visceral vascular disease
I70, I71, I72, I73, I77, I79318 codes in familyrpmccmpcmCMS other chronic or potentially disabling condition · CCW category: Peripheral Vascular Disease (PVD) · Devices: Blood pressure cuff, Pulse oximeter
This family runs to 318 codes that differ mainly by anatomic site and laterality, which does not change whether the condition supports care management. The codes are not listed one by one here. Code to the site and side documented in the record, within I70, I71, I72, I73, I77, I79.
Chronic venous disease and thromboembolism
I80, I82, I83, I87, I26297 codes in familyrpmccmAnticoagulation management with symptom and oxygenation checks.
Chronic venous disease and thromboembolism
I80, I82, I83, I87, I26297 codes in familyrpmccmAdded by CCN Health · Devices: Blood pressure cuff, Pulse oximeter
This family runs to 297 codes that differ mainly by anatomic site and laterality, which does not change whether the condition supports care management. The codes are not listed one by one here. Code to the site and side documented in the record, within I80, I82, I83, I87, I26.
Pulmonary heart disease and pulmonary hypertension
I2717 codesrpmccmpcmOxygen saturation and weight, since right heart failure presents as fluid gain.
Pulmonary heart disease and pulmonary hypertension
I2717 codesrpmccmpcmAdded by CCN Health · Devices: Pulse oximeter, Connected weight scale, Blood pressure cuff
| Code | Official ICD-10-CM description | Programs | Risk adjustment |
|---|---|---|---|
| I27.0 | Primary pulmonary hypertension | rpmccmpcm | HCC 226 · Heart Failure, Except End-Stage and Acute |
| I27.1 | Kyphoscoliotic heart disease | rpmccmpcm | HCC 226 · Heart Failure, Except End-Stage and Acute |
| I27.20 | Pulmonary hypertension, unspecified | rpmccmpcm | HCC 226 · Heart Failure, Except End-Stage and Acute |
| I27.21 | Secondary pulmonary arterial hypertension | rpmccmpcm | HCC 226 · Heart Failure, Except End-Stage and Acute |
| I27.22 | Pulmonary hypertension due to left heart disease | rpmccmpcm | HCC 226 · Heart Failure, Except End-Stage and Acute |
| I27.23 | Pulmonary hypertension due to lung diseases and hypoxia | rpmccmpcm | HCC 226 · Heart Failure, Except End-Stage and Acute |
| I27.24 | Chronic thromboembolic pulmonary hypertension | rpmccmpcm | HCC 226 · Heart Failure, Except End-Stage and Acute |
| I27.29 | Other secondary pulmonary hypertension | rpmccmpcm | HCC 226 · Heart Failure, Except End-Stage and Acute |
| I27.81 | Cor pulmonale (chronic) | rpmccmpcm | HCC 226 · Heart Failure, Except End-Stage and Acute |
| I27.82 | Chronic pulmonary embolism | rpmccmpcm | HCC 267 · Deep Vein Thrombosis and Pulmonary Embolism |
| I27.83 | Eisenmenger's syndrome | rpmccmpcm | HCC 226 · Heart Failure, Except End-Stage and Acute |
| I27.840 | Fontan-associated liver disease [FALD] | rpmccmpcm | not risk adjusted |
| I27.841 | Fontan-associated lymphatic dysfunction | rpmccmpcm | not risk adjusted |
| I27.848 | Other Fontan-associated condition | rpmccmpcm | not risk adjusted |
| I27.849 | Fontan related circulation, unspecifiedlow specificity | rpmccmpcm | not risk adjusted |
| I27.89 | Other specified pulmonary heart diseases | rpmccmpcm | HCC 226 · Heart Failure, Except End-Stage and Acute |
| I27.9 | Pulmonary heart disease, unspecified | rpmccmpcm | HCC 226 · Heart Failure, Except End-Stage and Acute |
Heart valve disorders
I05, I06, I07, I08, I34, I35, I36, I3742 codesrpmccmBlood pressure and weight surveillance between echocardiograms.
Heart valve disorders
I05, I06, I07, I08, I34, I35, I36, I3742 codesrpmccmAdded by CCN Health · Devices: Blood pressure cuff, Connected weight scale
| Code | Official ICD-10-CM description | Programs | Risk adjustment |
|---|---|---|---|
| I05.0 | Rheumatic mitral stenosis | rpmccm | not risk adjusted |
| I05.1 | Rheumatic mitral insufficiency | rpmccm | not risk adjusted |
| I05.2 | Rheumatic mitral stenosis with insufficiency | rpmccm | not risk adjusted |
| I05.8 | Other rheumatic mitral valve diseases | rpmccm | not risk adjusted |
| I05.9 | Rheumatic mitral valve disease, unspecified | rpmccm | not risk adjusted |
| I06.0 | Rheumatic aortic stenosis | rpmccm | not risk adjusted |
| I06.1 | Rheumatic aortic insufficiency | rpmccm | not risk adjusted |
| I06.2 | Rheumatic aortic stenosis with insufficiency | rpmccm | not risk adjusted |
| I06.8 | Other rheumatic aortic valve diseases | rpmccm | not risk adjusted |
| I06.9 | Rheumatic aortic valve disease, unspecified | rpmccm | not risk adjusted |
| I07.0 | Rheumatic tricuspid stenosis | rpmccm | not risk adjusted |
| I07.1 | Rheumatic tricuspid insufficiency | rpmccm | not risk adjusted |
| I07.2 | Rheumatic tricuspid stenosis and insufficiency | rpmccm | not risk adjusted |
| I07.8 | Other rheumatic tricuspid valve diseases | rpmccm | not risk adjusted |
| I07.9 | Rheumatic tricuspid valve disease, unspecified | rpmccm | not risk adjusted |
| I08.0 | Rheumatic disorders of both mitral and aortic valves | rpmccm | not risk adjusted |
| I08.1 | Rheumatic disorders of both mitral and tricuspid valves | rpmccm | not risk adjusted |
| I08.2 | Rheumatic disorders of both aortic and tricuspid valves | rpmccm | not risk adjusted |
| I08.3 | Combined rheumatic disorders of mitral, aortic and tricuspid valves | rpmccm | not risk adjusted |
| I08.8 | Other rheumatic multiple valve diseases | rpmccm | not risk adjusted |
| I08.9 | Rheumatic multiple valve disease, unspecified | rpmccm | not risk adjusted |
| I34.0 | Nonrheumatic mitral (valve) insufficiency | rpmccm | not risk adjusted |
| I34.1 | Nonrheumatic mitral (valve) prolapse | rpmccm | not risk adjusted |
| I34.2 | Nonrheumatic mitral (valve) stenosis | rpmccm | not risk adjusted |
| I34.81 | Nonrheumatic mitral (valve) annulus calcification | rpmccm | not risk adjusted |
| I34.89 | Other nonrheumatic mitral valve disorders | rpmccm | not risk adjusted |
| I34.9 | Nonrheumatic mitral valve disorder, unspecified | rpmccm | not risk adjusted |
| I35.0 | Nonrheumatic aortic (valve) stenosis | rpmccm | not risk adjusted |
| I35.1 | Nonrheumatic aortic (valve) insufficiency | rpmccm | not risk adjusted |
| I35.2 | Nonrheumatic aortic (valve) stenosis with insufficiency | rpmccm | not risk adjusted |
| I35.8 | Other nonrheumatic aortic valve disorders | rpmccm | not risk adjusted |
| I35.9 | Nonrheumatic aortic valve disorder, unspecified | rpmccm | not risk adjusted |
| I36.0 | Nonrheumatic tricuspid (valve) stenosis | rpmccm | not risk adjusted |
| I36.1 | Nonrheumatic tricuspid (valve) insufficiency | rpmccm | not risk adjusted |
| I36.2 | Nonrheumatic tricuspid (valve) stenosis with insufficiency | rpmccm | not risk adjusted |
| I36.8 | Other nonrheumatic tricuspid valve disorders | rpmccm | not risk adjusted |
| I36.9 | Nonrheumatic tricuspid valve disorder, unspecified | rpmccm | not risk adjusted |
| I37.0 | Nonrheumatic pulmonary valve stenosis | rpmccm | not risk adjusted |
| I37.1 | Nonrheumatic pulmonary valve insufficiency | rpmccm | not risk adjusted |
| I37.2 | Nonrheumatic pulmonary valve stenosis with insufficiency | rpmccm | not risk adjusted |
| I37.8 | Other nonrheumatic pulmonary valve disorders | rpmccm | not risk adjusted |
| I37.9 | Nonrheumatic pulmonary valve disorder, unspecified | rpmccm | not risk adjusted |
Endocrine and metabolic
Type 2 diabetes mellitus
E1187 codesrpmccmpcmBlood glucose by meter or CGM, commonly paired with blood pressure and weight because the comorbidities travel together.
Type 2 diabetes mellitus
E1187 codesrpmccmpcmCMS chronic condition · CCW category: Diabetes · Devices: Blood glucose meter, Continuous glucose monitor, Blood pressure cuff, Connected weight scale
Code to the complication. E11.9 (without complications) is accurate only when the record truly documents none, and it carries no HCC weight.
Read the type 2 diabetes mellitus monitoring guide
| Code | Official ICD-10-CM description | Programs | Risk adjustment |
|---|---|---|---|
| E11.00 | Type 2 diabetes mellitus with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHC) | rpmccmpcm | HCC 36 · Diabetes with Severe Acute Complications |
| E11.01 | Type 2 diabetes mellitus with hyperosmolarity with coma | rpmccmpcm | HCC 36 · Diabetes with Severe Acute Complications |
| E11.10 | Type 2 diabetes mellitus with ketoacidosis without coma | rpmccmpcm | HCC 36 · Diabetes with Severe Acute Complications |
| E11.11 | Type 2 diabetes mellitus with ketoacidosis with coma | rpmccmpcm | HCC 36 · Diabetes with Severe Acute Complications |
| E11.21 | Type 2 diabetes mellitus with diabetic nephropathy | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.22 | Type 2 diabetes mellitus with diabetic chronic kidney disease | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.29 | Type 2 diabetes mellitus with other diabetic kidney complication | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.311 | Type 2 diabetes mellitus with unspecified diabetic retinopathy with macular edema | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.319 | Type 2 diabetes mellitus with unspecified diabetic retinopathy without macular edema | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3211 | Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3212 | Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3213 | Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3219 | Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3291 | Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3292 | Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3293 | Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3299 | Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3311 | Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3312 | Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3313 | Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3319 | Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3391 | Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3392 | Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3393 | Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3399 | Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3411 | Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3412 | Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3413 | Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3419 | Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3491 | Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3492 | Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3493 | Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3499 | Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3511 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3512 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3513 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3519 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3521 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3522 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3523 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3529 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3531 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3532 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3533 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3539 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3541 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3542 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3543 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3549 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3551 | Type 2 diabetes mellitus with stable proliferative diabetic retinopathy, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3552 | Type 2 diabetes mellitus with stable proliferative diabetic retinopathy, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3553 | Type 2 diabetes mellitus with stable proliferative diabetic retinopathy, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3559 | Type 2 diabetes mellitus with stable proliferative diabetic retinopathy, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3591 | Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3592 | Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3593 | Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3599 | Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.36 | Type 2 diabetes mellitus with diabetic cataract | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.37X1 | Type 2 diabetes mellitus with diabetic macular edema, resolved following treatment, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.37X2 | Type 2 diabetes mellitus with diabetic macular edema, resolved following treatment, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.37X3 | Type 2 diabetes mellitus with diabetic macular edema, resolved following treatment, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.37X9 | Type 2 diabetes mellitus with diabetic macular edema, resolved following treatment, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.39 | Type 2 diabetes mellitus with other diabetic ophthalmic complication | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.40 | Type 2 diabetes mellitus with diabetic neuropathy, unspecified | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.41 | Type 2 diabetes mellitus with diabetic mononeuropathy | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.42 | Type 2 diabetes mellitus with diabetic polyneuropathy | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.43 | Type 2 diabetes mellitus with diabetic autonomic (poly)neuropathy | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.44 | Type 2 diabetes mellitus with diabetic amyotrophy | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.49 | Type 2 diabetes mellitus with other diabetic neurological complication | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.51 | Type 2 diabetes mellitus with diabetic peripheral angiopathy without gangrene | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.52 | Type 2 diabetes mellitus with diabetic peripheral angiopathy with gangrene | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.59 | Type 2 diabetes mellitus with other circulatory complications | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.610 | Type 2 diabetes mellitus with diabetic neuropathic arthropathy | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.618 | Type 2 diabetes mellitus with other diabetic arthropathy | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.620 | Type 2 diabetes mellitus with diabetic dermatitis | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.621 | Type 2 diabetes mellitus with foot ulcer | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.622 | Type 2 diabetes mellitus with other skin ulcer | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.628 | Type 2 diabetes mellitus with other skin complications | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.630 | Type 2 diabetes mellitus with periodontal disease | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.638 | Type 2 diabetes mellitus with other oral complications | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.641 | Type 2 diabetes mellitus with hypoglycemia with coma | rpmccmpcm | HCC 36 · Diabetes with Severe Acute Complications |
| E11.649 | Type 2 diabetes mellitus with hypoglycemia without coma | rpmccmpcm | HCC 38 · Diabetes with Glycemic, Unspecified, or No Complications |
| E11.65 | Type 2 diabetes mellitus with hyperglycemia | rpmccmpcm | HCC 38 · Diabetes with Glycemic, Unspecified, or No Complications |
| E11.69 | Type 2 diabetes mellitus with other specified complication | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.8 | Type 2 diabetes mellitus with unspecified complications | rpmccmpcm | HCC 38 · Diabetes with Glycemic, Unspecified, or No Complications |
| E11.9 | Type 2 diabetes mellitus without complications | rpmccmpcm | HCC 38 · Diabetes with Glycemic, Unspecified, or No Complications |
| E11.A | Type 2 diabetes mellitus without complications in remission | rpmccmpcm | not risk adjusted |
Type 1 diabetes mellitus
E1087 codesrpmccmpcmCGM trend and time-in-range review, with meter confirmation where CGM is not in use.
Type 1 diabetes mellitus
E1087 codesrpmccmpcmCMS chronic condition · CCW category: Diabetes · Devices: Continuous glucose monitor, Blood glucose meter
| Code | Official ICD-10-CM description | Programs | Risk adjustment |
|---|---|---|---|
| E10.10 | Type 1 diabetes mellitus with ketoacidosis without coma | rpmccmpcm | HCC 36 · Diabetes with Severe Acute Complications |
| E10.11 | Type 1 diabetes mellitus with ketoacidosis with coma | rpmccmpcm | HCC 36 · Diabetes with Severe Acute Complications |
| E10.21 | Type 1 diabetes mellitus with diabetic nephropathy | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.22 | Type 1 diabetes mellitus with diabetic chronic kidney disease | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.29 | Type 1 diabetes mellitus with other diabetic kidney complication | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.311 | Type 1 diabetes mellitus with unspecified diabetic retinopathy with macular edema | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.319 | Type 1 diabetes mellitus with unspecified diabetic retinopathy without macular edema | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3211 | Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3212 | Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3213 | Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3219 | Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3291 | Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3292 | Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3293 | Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3299 | Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3311 | Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3312 | Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3313 | Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3319 | Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3391 | Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3392 | Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3393 | Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3399 | Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3411 | Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3412 | Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3413 | Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3419 | Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3491 | Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3492 | Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3493 | Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3499 | Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3511 | Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3512 | Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3513 | Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3519 | Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3521 | Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3522 | Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3523 | Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3529 | Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3531 | Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3532 | Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3533 | Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3539 | Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3541 | Type 1 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3542 | Type 1 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3543 | Type 1 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3549 | Type 1 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3551 | Type 1 diabetes mellitus with stable proliferative diabetic retinopathy, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3552 | Type 1 diabetes mellitus with stable proliferative diabetic retinopathy, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3553 | Type 1 diabetes mellitus with stable proliferative diabetic retinopathy, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3559 | Type 1 diabetes mellitus with stable proliferative diabetic retinopathy, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3591 | Type 1 diabetes mellitus with proliferative diabetic retinopathy without macular edema, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3592 | Type 1 diabetes mellitus with proliferative diabetic retinopathy without macular edema, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3593 | Type 1 diabetes mellitus with proliferative diabetic retinopathy without macular edema, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3599 | Type 1 diabetes mellitus with proliferative diabetic retinopathy without macular edema, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.36 | Type 1 diabetes mellitus with diabetic cataract | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.37X1 | Type 1 diabetes mellitus with diabetic macular edema, resolved following treatment, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.37X2 | Type 1 diabetes mellitus with diabetic macular edema, resolved following treatment, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.37X3 | Type 1 diabetes mellitus with diabetic macular edema, resolved following treatment, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.37X9 | Type 1 diabetes mellitus with diabetic macular edema, resolved following treatment, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.39 | Type 1 diabetes mellitus with other diabetic ophthalmic complication | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.40 | Type 1 diabetes mellitus with diabetic neuropathy, unspecified | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.41 | Type 1 diabetes mellitus with diabetic mononeuropathy | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.42 | Type 1 diabetes mellitus with diabetic polyneuropathy | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.43 | Type 1 diabetes mellitus with diabetic autonomic (poly)neuropathy | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.44 | Type 1 diabetes mellitus with diabetic amyotrophy | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.49 | Type 1 diabetes mellitus with other diabetic neurological complication | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.51 | Type 1 diabetes mellitus with diabetic peripheral angiopathy without gangrene | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.52 | Type 1 diabetes mellitus with diabetic peripheral angiopathy with gangrene | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.59 | Type 1 diabetes mellitus with other circulatory complications | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.610 | Type 1 diabetes mellitus with diabetic neuropathic arthropathy | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.618 | Type 1 diabetes mellitus with other diabetic arthropathy | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.620 | Type 1 diabetes mellitus with diabetic dermatitis | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.621 | Type 1 diabetes mellitus with foot ulcer | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.622 | Type 1 diabetes mellitus with other skin ulcer | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.628 | Type 1 diabetes mellitus with other skin complications | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.630 | Type 1 diabetes mellitus with periodontal disease | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.638 | Type 1 diabetes mellitus with other oral complications | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.641 | Type 1 diabetes mellitus with hypoglycemia with coma | rpmccmpcm | HCC 36 · Diabetes with Severe Acute Complications |
| E10.649 | Type 1 diabetes mellitus with hypoglycemia without coma | rpmccmpcm | HCC 38 · Diabetes with Glycemic, Unspecified, or No Complications |
| E10.65 | Type 1 diabetes mellitus with hyperglycemia | rpmccmpcm | HCC 38 · Diabetes with Glycemic, Unspecified, or No Complications |
| E10.69 | Type 1 diabetes mellitus with other specified complication | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.8 | Type 1 diabetes mellitus with unspecified complications | rpmccmpcm | HCC 38 · Diabetes with Glycemic, Unspecified, or No Complications |
| E10.9 | Type 1 diabetes mellitus without complications | rpmccmpcm | HCC 38 · Diabetes with Glycemic, Unspecified, or No Complications |
| E10.A0 | Type 1 diabetes mellitus, presymptomatic, unspecifiedlow specificity | rpmccmpcm | not risk adjusted |
| E10.A1 | Type 1 diabetes mellitus, presymptomatic, Stage 1 | rpmccmpcm | not risk adjusted |
| E10.A2 | Type 1 diabetes mellitus, presymptomatic, Stage 2 | rpmccmpcm | not risk adjusted |
Diabetes due to underlying condition, drugs or chemicals
E08, E09, E13258 codesrpmccmpcmGlucose monitoring during and after the exposure or treatment that caused the hyperglycemia.
Diabetes due to underlying condition, drugs or chemicals
E08, E09, E13258 codesrpmccmpcmCMS chronic condition · CCW category: Diabetes · Devices: Blood glucose meter, Continuous glucose monitor
E08 and E09 require the underlying condition or the drug to be coded first. Steroid-induced hyperglycemia belongs in E09, not E11.
| Code | Official ICD-10-CM description | Programs | Risk adjustment |
|---|---|---|---|
| E08.00 | Diabetes mellitus due to underlying condition with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHC) | rpmccmpcm | HCC 36 · Diabetes with Severe Acute Complications |
| E08.01 | Diabetes mellitus due to underlying condition with hyperosmolarity with coma | rpmccmpcm | HCC 36 · Diabetes with Severe Acute Complications |
| E08.10 | Diabetes mellitus due to underlying condition with ketoacidosis without coma | rpmccmpcm | HCC 36 · Diabetes with Severe Acute Complications |
| E08.11 | Diabetes mellitus due to underlying condition with ketoacidosis with coma | rpmccmpcm | HCC 36 · Diabetes with Severe Acute Complications |
| E08.21 | Diabetes mellitus due to underlying condition with diabetic nephropathy | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.22 | Diabetes mellitus due to underlying condition with diabetic chronic kidney disease | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.29 | Diabetes mellitus due to underlying condition with other diabetic kidney complication | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.311 | Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy with macular edema | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.319 | Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy without macular edema | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3211 | Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3212 | Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3213 | Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3219 | Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3291 | Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3292 | Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3293 | Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3299 | Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3311 | Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3312 | Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3313 | Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3319 | Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3391 | Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy without macular edema, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3392 | Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy without macular edema, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3393 | Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy without macular edema, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3399 | Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy without macular edema, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3411 | Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy with macular edema, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3412 | Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy with macular edema, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3413 | Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy with macular edema, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3419 | Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy with macular edema, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3491 | Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy without macular edema, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3492 | Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy without macular edema, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3493 | Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy without macular edema, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3499 | Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy without macular edema, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3511 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with macular edema, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3512 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with macular edema, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3513 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with macular edema, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3519 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with macular edema, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3521 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment involving the macula, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3522 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment involving the macula, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3523 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment involving the macula, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3529 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment involving the macula, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3531 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3532 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3533 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3539 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3541 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3542 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3543 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3549 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3551 | Diabetes mellitus due to underlying condition with stable proliferative diabetic retinopathy, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3552 | Diabetes mellitus due to underlying condition with stable proliferative diabetic retinopathy, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3553 | Diabetes mellitus due to underlying condition with stable proliferative diabetic retinopathy, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3559 | Diabetes mellitus due to underlying condition with stable proliferative diabetic retinopathy, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3591 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy without macular edema, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3592 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy without macular edema, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3593 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy without macular edema, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3599 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy without macular edema, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.36 | Diabetes mellitus due to underlying condition with diabetic cataract | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.37X1 | Diabetes mellitus due to underlying condition with diabetic macular edema, resolved following treatment, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.37X2 | Diabetes mellitus due to underlying condition with diabetic macular edema, resolved following treatment, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.37X3 | Diabetes mellitus due to underlying condition with diabetic macular edema, resolved following treatment, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.37X9 | Diabetes mellitus due to underlying condition with diabetic macular edema, resolved following treatment, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.39 | Diabetes mellitus due to underlying condition with other diabetic ophthalmic complication | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.40 | Diabetes mellitus due to underlying condition with diabetic neuropathy, unspecified | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.41 | Diabetes mellitus due to underlying condition with diabetic mononeuropathy | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.42 | Diabetes mellitus due to underlying condition with diabetic polyneuropathy | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.43 | Diabetes mellitus due to underlying condition with diabetic autonomic (poly)neuropathy | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.44 | Diabetes mellitus due to underlying condition with diabetic amyotrophy | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.49 | Diabetes mellitus due to underlying condition with other diabetic neurological complication | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.51 | Diabetes mellitus due to underlying condition with diabetic peripheral angiopathy without gangrene | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.52 | Diabetes mellitus due to underlying condition with diabetic peripheral angiopathy with gangrene | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.59 | Diabetes mellitus due to underlying condition with other circulatory complications | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.610 | Diabetes mellitus due to underlying condition with diabetic neuropathic arthropathy | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.618 | Diabetes mellitus due to underlying condition with other diabetic arthropathy | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.620 | Diabetes mellitus due to underlying condition with diabetic dermatitis | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.621 | Diabetes mellitus due to underlying condition with foot ulcer | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.622 | Diabetes mellitus due to underlying condition with other skin ulcer | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.628 | Diabetes mellitus due to underlying condition with other skin complications | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.630 | Diabetes mellitus due to underlying condition with periodontal disease | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.638 | Diabetes mellitus due to underlying condition with other oral complications | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.641 | Diabetes mellitus due to underlying condition with hypoglycemia with coma | rpmccmpcm | HCC 36 · Diabetes with Severe Acute Complications |
| E08.649 | Diabetes mellitus due to underlying condition with hypoglycemia without coma | rpmccmpcm | HCC 38 · Diabetes with Glycemic, Unspecified, or No Complications |
| E08.65 | Diabetes mellitus due to underlying condition with hyperglycemia | rpmccmpcm | HCC 38 · Diabetes with Glycemic, Unspecified, or No Complications |
| E08.69 | Diabetes mellitus due to underlying condition with other specified complication | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.8 | Diabetes mellitus due to underlying condition with unspecified complications | rpmccmpcm | HCC 38 · Diabetes with Glycemic, Unspecified, or No Complications |
| E08.9 | Diabetes mellitus due to underlying condition without complications | rpmccmpcm | HCC 38 · Diabetes with Glycemic, Unspecified, or No Complications |
| E09.00 | Drug or chemical induced diabetes mellitus with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHC) | rpmccmpcm | not risk adjusted |
| E09.01 | Drug or chemical induced diabetes mellitus with hyperosmolarity with coma | rpmccmpcm | not risk adjusted |
| E09.10 | Drug or chemical induced diabetes mellitus with ketoacidosis without coma | rpmccmpcm | not risk adjusted |
| E09.11 | Drug or chemical induced diabetes mellitus with ketoacidosis with coma | rpmccmpcm | not risk adjusted |
| E09.21 | Drug or chemical induced diabetes mellitus with diabetic nephropathy | rpmccmpcm | not risk adjusted |
| E09.22 | Drug or chemical induced diabetes mellitus with diabetic chronic kidney disease | rpmccmpcm | not risk adjusted |
| E09.29 | Drug or chemical induced diabetes mellitus with other diabetic kidney complication | rpmccmpcm | not risk adjusted |
| E09.311 | Drug or chemical induced diabetes mellitus with unspecified diabetic retinopathy with macular edema | rpmccmpcm | not risk adjusted |
| E09.319 | Drug or chemical induced diabetes mellitus with unspecified diabetic retinopathy without macular edema | rpmccmpcm | not risk adjusted |
| E09.3211 | Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, right eye | rpmccmpcm | not risk adjusted |
| E09.3212 | Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, left eye | rpmccmpcm | not risk adjusted |
| E09.3213 | Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, bilateral | rpmccmpcm | not risk adjusted |
| E09.3219 | Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, unspecified eye | rpmccmpcm | not risk adjusted |
| E09.3291 | Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, right eye | rpmccmpcm | not risk adjusted |
| E09.3292 | Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, left eye | rpmccmpcm | not risk adjusted |
| E09.3293 | Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, bilateral | rpmccmpcm | not risk adjusted |
| E09.3299 | Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, unspecified eye | rpmccmpcm | not risk adjusted |
| E09.3311 | Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, right eye | rpmccmpcm | not risk adjusted |
| E09.3312 | Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, left eye | rpmccmpcm | not risk adjusted |
| E09.3313 | Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, bilateral | rpmccmpcm | not risk adjusted |
| E09.3319 | Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, unspecified eye | rpmccmpcm | not risk adjusted |
| E09.3391 | Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, right eye | rpmccmpcm | not risk adjusted |
| E09.3392 | Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, left eye | rpmccmpcm | not risk adjusted |
| E09.3393 | Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, bilateral | rpmccmpcm | not risk adjusted |
| E09.3399 | Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, unspecified eye | rpmccmpcm | not risk adjusted |
| E09.3411 | Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, right eye | rpmccmpcm | not risk adjusted |
| E09.3412 | Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, left eye | rpmccmpcm | not risk adjusted |
| E09.3413 | Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, bilateral | rpmccmpcm | not risk adjusted |
| E09.3419 | Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, unspecified eye | rpmccmpcm | not risk adjusted |
| E09.3491 | Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, right eye | rpmccmpcm | not risk adjusted |
| E09.3492 | Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, left eye | rpmccmpcm | not risk adjusted |
| E09.3493 | Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, bilateral | rpmccmpcm | not risk adjusted |
| E09.3499 | Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, unspecified eye | rpmccmpcm | not risk adjusted |
| E09.3511 | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with macular edema, right eye | rpmccmpcm | not risk adjusted |
| E09.3512 | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with macular edema, left eye | rpmccmpcm | not risk adjusted |
| E09.3513 | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with macular edema, bilateral | rpmccmpcm | not risk adjusted |
| E09.3519 | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with macular edema, unspecified eye | rpmccmpcm | not risk adjusted |
| E09.3521 | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, right eye | rpmccmpcm | not risk adjusted |
| E09.3522 | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, left eye | rpmccmpcm | not risk adjusted |
| E09.3523 | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, bilateral | rpmccmpcm | not risk adjusted |
| E09.3529 | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, unspecified eye | rpmccmpcm | not risk adjusted |
| E09.3531 | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, right eye | rpmccmpcm | not risk adjusted |
| E09.3532 | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, left eye | rpmccmpcm | not risk adjusted |
| E09.3533 | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, bilateral | rpmccmpcm | not risk adjusted |
| E09.3539 | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, unspecified eye | rpmccmpcm | not risk adjusted |
| E09.3541 | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, right eye | rpmccmpcm | not risk adjusted |
| E09.3542 | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, left eye | rpmccmpcm | not risk adjusted |
| E09.3543 | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, bilateral | rpmccmpcm | not risk adjusted |
| E09.3549 | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, unspecified eye | rpmccmpcm | not risk adjusted |
| E09.3551 | Drug or chemical induced diabetes mellitus with stable proliferative diabetic retinopathy, right eye | rpmccmpcm | not risk adjusted |
| E09.3552 | Drug or chemical induced diabetes mellitus with stable proliferative diabetic retinopathy, left eye | rpmccmpcm | not risk adjusted |
| E09.3553 | Drug or chemical induced diabetes mellitus with stable proliferative diabetic retinopathy, bilateral | rpmccmpcm | not risk adjusted |
| E09.3559 | Drug or chemical induced diabetes mellitus with stable proliferative diabetic retinopathy, unspecified eye | rpmccmpcm | not risk adjusted |
| E09.3591 | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy without macular edema, right eye | rpmccmpcm | not risk adjusted |
| E09.3592 | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy without macular edema, left eye | rpmccmpcm | not risk adjusted |
| E09.3593 | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy without macular edema, bilateral | rpmccmpcm | not risk adjusted |
| E09.3599 | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy without macular edema, unspecified eye | rpmccmpcm | not risk adjusted |
| E09.36 | Drug or chemical induced diabetes mellitus with diabetic cataract | rpmccmpcm | not risk adjusted |
| E09.37X1 | Drug or chemical induced diabetes mellitus with diabetic macular edema, resolved following treatment, right eye | rpmccmpcm | not risk adjusted |
| E09.37X2 | Drug or chemical induced diabetes mellitus with diabetic macular edema, resolved following treatment, left eye | rpmccmpcm | not risk adjusted |
| E09.37X3 | Drug or chemical induced diabetes mellitus with diabetic macular edema, resolved following treatment, bilateral | rpmccmpcm | not risk adjusted |
| E09.37X9 | Drug or chemical induced diabetes mellitus with diabetic macular edema, resolved following treatment, unspecified eye | rpmccmpcm | not risk adjusted |
| E09.39 | Drug or chemical induced diabetes mellitus with other diabetic ophthalmic complication | rpmccmpcm | not risk adjusted |
| E09.40 | Drug or chemical induced diabetes mellitus with neurological complications with diabetic neuropathy, unspecified | rpmccmpcm | not risk adjusted |
| E09.41 | Drug or chemical induced diabetes mellitus with neurological complications with diabetic mononeuropathy | rpmccmpcm | not risk adjusted |
| E09.42 | Drug or chemical induced diabetes mellitus with neurological complications with diabetic polyneuropathy | rpmccmpcm | not risk adjusted |
| E09.43 | Drug or chemical induced diabetes mellitus with neurological complications with diabetic autonomic (poly)neuropathy | rpmccmpcm | not risk adjusted |
| E09.44 | Drug or chemical induced diabetes mellitus with neurological complications with diabetic amyotrophy | rpmccmpcm | not risk adjusted |
| E09.49 | Drug or chemical induced diabetes mellitus with neurological complications with other diabetic neurological complication | rpmccmpcm | not risk adjusted |
| E09.51 | Drug or chemical induced diabetes mellitus with diabetic peripheral angiopathy without gangrene | rpmccmpcm | not risk adjusted |
| E09.52 | Drug or chemical induced diabetes mellitus with diabetic peripheral angiopathy with gangrene | rpmccmpcm | not risk adjusted |
| E09.59 | Drug or chemical induced diabetes mellitus with other circulatory complications | rpmccmpcm | not risk adjusted |
| E09.610 | Drug or chemical induced diabetes mellitus with diabetic neuropathic arthropathy | rpmccmpcm | not risk adjusted |
| E09.618 | Drug or chemical induced diabetes mellitus with other diabetic arthropathy | rpmccmpcm | not risk adjusted |
| E09.620 | Drug or chemical induced diabetes mellitus with diabetic dermatitis | rpmccmpcm | not risk adjusted |
| E09.621 | Drug or chemical induced diabetes mellitus with foot ulcer | rpmccmpcm | not risk adjusted |
| E09.622 | Drug or chemical induced diabetes mellitus with other skin ulcer | rpmccmpcm | not risk adjusted |
| E09.628 | Drug or chemical induced diabetes mellitus with other skin complications | rpmccmpcm | not risk adjusted |
| E09.630 | Drug or chemical induced diabetes mellitus with periodontal disease | rpmccmpcm | not risk adjusted |
| E09.638 | Drug or chemical induced diabetes mellitus with other oral complications | rpmccmpcm | not risk adjusted |
| E09.641 | Drug or chemical induced diabetes mellitus with hypoglycemia with coma | rpmccmpcm | not risk adjusted |
| E09.649 | Drug or chemical induced diabetes mellitus with hypoglycemia without coma | rpmccmpcm | not risk adjusted |
| E09.65 | Drug or chemical induced diabetes mellitus with hyperglycemia | rpmccmpcm | not risk adjusted |
| E09.69 | Drug or chemical induced diabetes mellitus with other specified complication | rpmccmpcm | not risk adjusted |
| E09.8 | Drug or chemical induced diabetes mellitus with unspecified complications | rpmccmpcm | not risk adjusted |
| E09.9 | Drug or chemical induced diabetes mellitus without complications | rpmccmpcm | not risk adjusted |
| E13.00 | Other specified diabetes mellitus with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHC) | rpmccmpcm | HCC 36 · Diabetes with Severe Acute Complications |
| E13.01 | Other specified diabetes mellitus with hyperosmolarity with coma | rpmccmpcm | HCC 36 · Diabetes with Severe Acute Complications |
| E13.10 | Other specified diabetes mellitus with ketoacidosis without coma | rpmccmpcm | HCC 36 · Diabetes with Severe Acute Complications |
| E13.11 | Other specified diabetes mellitus with ketoacidosis with coma | rpmccmpcm | HCC 36 · Diabetes with Severe Acute Complications |
| E13.21 | Other specified diabetes mellitus with diabetic nephropathy | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.22 | Other specified diabetes mellitus with diabetic chronic kidney disease | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.29 | Other specified diabetes mellitus with other diabetic kidney complication | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.311 | Other specified diabetes mellitus with unspecified diabetic retinopathy with macular edema | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.319 | Other specified diabetes mellitus with unspecified diabetic retinopathy without macular edema | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3211 | Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3212 | Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3213 | Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3219 | Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3291 | Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3292 | Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3293 | Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3299 | Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3311 | Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3312 | Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3313 | Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3319 | Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3391 | Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3392 | Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3393 | Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3399 | Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3411 | Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3412 | Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3413 | Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3419 | Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3491 | Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3492 | Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3493 | Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3499 | Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3511 | Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3512 | Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3513 | Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3519 | Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3521 | Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3522 | Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3523 | Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3529 | Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3531 | Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3532 | Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3533 | Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3539 | Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3541 | Other specified diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3542 | Other specified diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3543 | Other specified diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3549 | Other specified diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3551 | Other specified diabetes mellitus with stable proliferative diabetic retinopathy, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3552 | Other specified diabetes mellitus with stable proliferative diabetic retinopathy, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3553 | Other specified diabetes mellitus with stable proliferative diabetic retinopathy, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3559 | Other specified diabetes mellitus with stable proliferative diabetic retinopathy, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3591 | Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edema, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3592 | Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edema, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3593 | Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edema, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3599 | Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edema, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.36 | Other specified diabetes mellitus with diabetic cataract | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.37X1 | Other specified diabetes mellitus with diabetic macular edema, resolved following treatment, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.37X2 | Other specified diabetes mellitus with diabetic macular edema, resolved following treatment, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.37X3 | Other specified diabetes mellitus with diabetic macular edema, resolved following treatment, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.37X9 | Other specified diabetes mellitus with diabetic macular edema, resolved following treatment, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.39 | Other specified diabetes mellitus with other diabetic ophthalmic complication | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.40 | Other specified diabetes mellitus with diabetic neuropathy, unspecified | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.41 | Other specified diabetes mellitus with diabetic mononeuropathy | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.42 | Other specified diabetes mellitus with diabetic polyneuropathy | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.43 | Other specified diabetes mellitus with diabetic autonomic (poly)neuropathy | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.44 | Other specified diabetes mellitus with diabetic amyotrophy | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.49 | Other specified diabetes mellitus with other diabetic neurological complication | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.51 | Other specified diabetes mellitus with diabetic peripheral angiopathy without gangrene | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.52 | Other specified diabetes mellitus with diabetic peripheral angiopathy with gangrene | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.59 | Other specified diabetes mellitus with other circulatory complications | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.610 | Other specified diabetes mellitus with diabetic neuropathic arthropathy | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.618 | Other specified diabetes mellitus with other diabetic arthropathy | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.620 | Other specified diabetes mellitus with diabetic dermatitis | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.621 | Other specified diabetes mellitus with foot ulcer | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.622 | Other specified diabetes mellitus with other skin ulcer | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.628 | Other specified diabetes mellitus with other skin complications | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.630 | Other specified diabetes mellitus with periodontal disease | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.638 | Other specified diabetes mellitus with other oral complications | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.641 | Other specified diabetes mellitus with hypoglycemia with coma | rpmccmpcm | HCC 36 · Diabetes with Severe Acute Complications |
| E13.649 | Other specified diabetes mellitus with hypoglycemia without coma | rpmccmpcm | HCC 38 · Diabetes with Glycemic, Unspecified, or No Complications |
| E13.65 | Other specified diabetes mellitus with hyperglycemia | rpmccmpcm | HCC 38 · Diabetes with Glycemic, Unspecified, or No Complications |
| E13.69 | Other specified diabetes mellitus with other specified complication | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.8 | Other specified diabetes mellitus with unspecified complications | rpmccmpcm | HCC 38 · Diabetes with Glycemic, Unspecified, or No Complications |
| E13.9 | Other specified diabetes mellitus without complications | rpmccmpcm | HCC 38 · Diabetes with Glycemic, Unspecified, or No Complications |
Lipid metabolism disorders
E7818 codesccmManaged through laboratory follow-up and adherence rather than device data, so this supports CCM rather than RPM.
Lipid metabolism disorders
E7818 codesccmCMS chronic condition · CCW category: Hyperlipidemia
| Code | Official ICD-10-CM description | Programs | Risk adjustment |
|---|---|---|---|
| E78.00 | Pure hypercholesterolemia, unspecified | ccm | not risk adjusted |
| E78.010 | Homozygous familial hypercholesterolemia [HoFH] | ccm | not risk adjusted |
| E78.011 | Heterozygous familial hypercholesterolemia [HeFH] | ccm | not risk adjusted |
| E78.019 | Familial hypercholesterolemia, unspecified | ccm | not risk adjusted |
| E78.1 | Pure hyperglyceridemia | ccm | not risk adjusted |
| E78.2 | Mixed hyperlipidemia | ccm | not risk adjusted |
| E78.3 | Hyperchylomicronemia | ccm | not risk adjusted |
| E78.41 | Elevated Lipoprotein(a) | ccm | not risk adjusted |
| E78.49 | Other hyperlipidemia | ccm | not risk adjusted |
| E78.5 | Hyperlipidemia, unspecified | ccm | not risk adjusted |
| E78.6 | Lipoprotein deficiency | ccm | not risk adjusted |
| E78.70 | Disorder of bile acid and cholesterol metabolism, unspecified | ccm | not risk adjusted |
| E78.71 | Barth syndrome | ccm | not risk adjusted |
| E78.72 | Smith-Lemli-Opitz syndrome | ccm | not risk adjusted |
| E78.79 | Other disorders of bile acid and cholesterol metabolism | ccm | not risk adjusted |
| E78.81 | Lipoid dermatoarthritis | ccm | not risk adjusted |
| E78.89 | Other lipoprotein metabolism disorders | ccm | not risk adjusted |
| E78.9 | Disorder of lipoprotein metabolism, unspecified | ccm | not risk adjusted |
Obesity
E66, Z68.3, Z68.425 codesrpmccmWeight trend against a documented target, usually alongside blood pressure or glucose.
Obesity
E66, Z68.3, Z68.425 codesrpmccmCMS other chronic or potentially disabling condition · CCW category: Obesity · Devices: Connected weight scale, Blood pressure cuff
Z68 BMI codes are secondary codes. They never stand alone: code the obesity or the underlying condition first.
Effective 2026-10-01: Z68.1 gains finer detail at the low end on 2026-10-01 with Z68.18 (BMI 18.4 or less) and Z68.19 (BMI 18.5 to 19.9).
Read the obesity monitoring guide
| Code | Official ICD-10-CM description | Programs | Risk adjustment |
|---|---|---|---|
| E66.01 | Morbid (severe) obesity due to excess calories | rpmccm | HCC 48 · Morbid Obesity |
| E66.09 | Other obesity due to excess calories | rpmccm | not risk adjusted |
| E66.1 | Drug-induced obesity | rpmccm | not risk adjusted |
| E66.2 | Morbid (severe) obesity with alveolar hypoventilation | rpmccm | HCC 48 · Morbid Obesity |
| E66.3 | Overweight | rpmccm | not risk adjusted |
| E66.811 | Obesity, class 1 | rpmccm | not risk adjusted |
| E66.812 | Obesity, class 2 | rpmccm | not risk adjusted |
| E66.813 | Obesity, class 3 | rpmccm | HCC 48 · Morbid Obesity |
| E66.89 | Other obesity not elsewhere classified | rpmccm | not risk adjusted |
| E66.9 | Obesity, unspecifiedlow specificity | rpmccm | not risk adjusted |
| Z68.30 | Body mass index [BMI] 30.0-30.9, adult | rpmccm | not risk adjusted |
| Z68.31 | Body mass index [BMI] 31.0-31.9, adult | rpmccm | not risk adjusted |
| Z68.32 | Body mass index [BMI] 32.0-32.9, adult | rpmccm | not risk adjusted |
| Z68.33 | Body mass index [BMI] 33.0-33.9, adult | rpmccm | not risk adjusted |
| Z68.34 | Body mass index [BMI] 34.0-34.9, adult | rpmccm | not risk adjusted |
| Z68.35 | Body mass index [BMI] 35.0-35.9, adult | rpmccm | not risk adjusted |
| Z68.36 | Body mass index [BMI] 36.0-36.9, adult | rpmccm | not risk adjusted |
| Z68.37 | Body mass index [BMI] 37.0-37.9, adult | rpmccm | not risk adjusted |
| Z68.38 | Body mass index [BMI] 38.0-38.9, adult | rpmccm | not risk adjusted |
| Z68.39 | Body mass index [BMI] 39.0-39.9, adult | rpmccm | not risk adjusted |
| Z68.41 | Body mass index [BMI] 40.0-44.9, adult | rpmccm | HCC 48 · Morbid Obesity |
| Z68.42 | Body mass index [BMI] 45.0-49.9, adult | rpmccm | HCC 48 · Morbid Obesity |
| Z68.43 | Body mass index [BMI] 50.0-59.9, adult | rpmccm | HCC 48 · Morbid Obesity |
| Z68.44 | Body mass index [BMI] 60.0-69.9, adult | rpmccm | HCC 48 · Morbid Obesity |
| Z68.45 | Body mass index [BMI] 70 or greater, adult | rpmccm | HCC 48 · Morbid Obesity |
Thyroid disorders
E00, E01, E02, E03, E04, E05, E06, E07, E89.049 codesccmLaboratory-driven titration. Weight and heart rate can support monitoring during thyrotoxicosis.
Thyroid disorders
E00, E01, E02, E03, E04, E05, E06, E07, E89.049 codesccmCMS chronic condition · CCW category: Hypothyroidism · Devices: Connected weight scale
| Code | Official ICD-10-CM description | Programs | Risk adjustment |
|---|---|---|---|
| E00.0 | Congenital iodine-deficiency syndrome, neurological type | ccm | not risk adjusted |
| E00.1 | Congenital iodine-deficiency syndrome, myxedematous type | ccm | not risk adjusted |
| E00.2 | Congenital iodine-deficiency syndrome, mixed type | ccm | not risk adjusted |
| E00.9 | Congenital iodine-deficiency syndrome, unspecified | ccm | not risk adjusted |
| E01.0 | Iodine-deficiency related diffuse (endemic) goiter | ccm | not risk adjusted |
| E01.1 | Iodine-deficiency related multinodular (endemic) goiter | ccm | not risk adjusted |
| E01.2 | Iodine-deficiency related (endemic) goiter, unspecified | ccm | not risk adjusted |
| E01.8 | Other iodine-deficiency related thyroid disorders and allied conditions | ccm | not risk adjusted |
| E02 | Subclinical iodine-deficiency hypothyroidism | ccm | not risk adjusted |
| E03.0 | Congenital hypothyroidism with diffuse goiter | ccm | not risk adjusted |
| E03.1 | Congenital hypothyroidism without goiter | ccm | not risk adjusted |
| E03.2 | Hypothyroidism due to medicaments and other exogenous substances | ccm | not risk adjusted |
| E03.3 | Postinfectious hypothyroidism | ccm | not risk adjusted |
| E03.4 | Atrophy of thyroid (acquired) | ccm | not risk adjusted |
| E03.5 | Myxedema coma | ccm | HCC 202 · Coma, Brain Compression/Anoxic Damage |
| E03.8 | Other specified hypothyroidism | ccm | not risk adjusted |
| E03.9 | Hypothyroidism, unspecifiedlow specificity | ccm | not risk adjusted |
| E04.0 | Nontoxic diffuse goiter | ccm | not risk adjusted |
| E04.1 | Nontoxic single thyroid nodule | ccm | not risk adjusted |
| E04.2 | Nontoxic multinodular goiter | ccm | not risk adjusted |
| E04.8 | Other specified nontoxic goiter | ccm | not risk adjusted |
| E04.9 | Nontoxic goiter, unspecified | ccm | not risk adjusted |
| E05.00 | Thyrotoxicosis with diffuse goiter without thyrotoxic crisis or storm | ccm | not risk adjusted |
| E05.01 | Thyrotoxicosis with diffuse goiter with thyrotoxic crisis or storm | ccm | not risk adjusted |
| E05.10 | Thyrotoxicosis with toxic single thyroid nodule without thyrotoxic crisis or storm | ccm | not risk adjusted |
| E05.11 | Thyrotoxicosis with toxic single thyroid nodule with thyrotoxic crisis or storm | ccm | not risk adjusted |
| E05.20 | Thyrotoxicosis with toxic multinodular goiter without thyrotoxic crisis or storm | ccm | not risk adjusted |
| E05.21 | Thyrotoxicosis with toxic multinodular goiter with thyrotoxic crisis or storm | ccm | not risk adjusted |
| E05.30 | Thyrotoxicosis from ectopic thyroid tissue without thyrotoxic crisis or storm | ccm | not risk adjusted |
| E05.31 | Thyrotoxicosis from ectopic thyroid tissue with thyrotoxic crisis or storm | ccm | not risk adjusted |
| E05.40 | Thyrotoxicosis factitia without thyrotoxic crisis or storm | ccm | not risk adjusted |
| E05.41 | Thyrotoxicosis factitia with thyrotoxic crisis or storm | ccm | not risk adjusted |
| E05.80 | Other thyrotoxicosis without thyrotoxic crisis or storm | ccm | not risk adjusted |
| E05.81 | Other thyrotoxicosis with thyrotoxic crisis or storm | ccm | not risk adjusted |
| E05.90 | Thyrotoxicosis, unspecified without thyrotoxic crisis or storm | ccm | not risk adjusted |
| E05.91 | Thyrotoxicosis, unspecified with thyrotoxic crisis or storm | ccm | not risk adjusted |
| E06.0 | Acute thyroiditis | ccm | not risk adjusted |
| E06.1 | Subacute thyroiditis | ccm | not risk adjusted |
| E06.2 | Chronic thyroiditis with transient thyrotoxicosis | ccm | not risk adjusted |
| E06.3 | Autoimmune thyroiditis | ccm | not risk adjusted |
| E06.4 | Drug-induced thyroiditis | ccm | not risk adjusted |
| E06.5 | Other chronic thyroiditis | ccm | not risk adjusted |
| E06.9 | Thyroiditis, unspecified | ccm | not risk adjusted |
| E07.0 | Hypersecretion of calcitonin | ccm | not risk adjusted |
| E07.1 | Dyshormogenetic goiter | ccm | not risk adjusted |
| E07.81 | Sick-euthyroid syndrome | ccm | not risk adjusted |
| E07.89 | Other specified disorders of thyroid | ccm | not risk adjusted |
| E07.9 | Disorder of thyroid, unspecified | ccm | not risk adjusted |
| E89.0 | Postprocedural hypothyroidism | ccm | not risk adjusted |
Other endocrine, nutritional and metabolic disorders
E15, E16, E20, E21, E22, E23, E24, E26, E27, E83, E86, E87, E88132 codesccmpcmDepends on the disorder. Hypoglycemia and electrolyte disorders are the ones that most often justify device data.
Other endocrine, nutritional and metabolic disorders
E15, E16, E20, E21, E22, E23, E24, E26, E27, E83, E86, E87, E88132 codesccmpcmAdded by CCN Health · Devices: Blood glucose meter, Connected weight scale
E88.81 is no longer valid on its own. Metabolic syndrome is now E88.810.
Effective 2026-10-01: E89.830 and E89.838 arrive on 2026-10-01 for post-bariatric hypoglycemia.
| Code | Official ICD-10-CM description | Programs | Risk adjustment |
|---|---|---|---|
| E15 | Nondiabetic hypoglycemic coma | ccmpcm | not risk adjusted |
| E16.0 | Drug-induced hypoglycemia without coma | ccmpcm | not risk adjusted |
| E16.1 | Other hypoglycemia | ccmpcm | not risk adjusted |
| E16.2 | Hypoglycemia, unspecified | ccmpcm | not risk adjusted |
| E16.3 | Increased secretion of glucagon | ccmpcm | not risk adjusted |
| E16.4 | Increased secretion of gastrin | ccmpcm | not risk adjusted |
| E16.8 | Other specified disorders of pancreatic internal secretion | ccmpcm | not risk adjusted |
| E16.9 | Disorder of pancreatic internal secretion, unspecified | ccmpcm | not risk adjusted |
| E16.A1 | Hypoglycemia level 1 | ccmpcm | not risk adjusted |
| E16.A2 | Hypoglycemia level 2 | ccmpcm | not risk adjusted |
| E16.A3 | Hypoglycemia level 3 | ccmpcm | not risk adjusted |
| E20.0 | Idiopathic hypoparathyroidism | ccmpcm | not risk adjusted |
| E20.1 | Pseudohypoparathyroidism | ccmpcm | not risk adjusted |
| E20.810 | Autosomal dominant hypocalcemia | ccmpcm | not risk adjusted |
| E20.811 | Secondary hypoparathyroidism in diseases classified elsewhere | ccmpcm | not risk adjusted |
| E20.812 | Autoimmune hypoparathyroidism | ccmpcm | not risk adjusted |
| E20.818 | Other specified hypoparathyroidism due to impaired parathyroid hormone secretion | ccmpcm | not risk adjusted |
| E20.819 | Hypoparathyroidism due to impaired parathyroid hormone secretion, unspecified | ccmpcm | not risk adjusted |
| E20.89 | Other specified hypoparathyroidism | ccmpcm | not risk adjusted |
| E20.9 | Hypoparathyroidism, unspecified | ccmpcm | not risk adjusted |
| E21.0 | Primary hyperparathyroidism | ccmpcm | not risk adjusted |
| E21.1 | Secondary hyperparathyroidism, not elsewhere classified | ccmpcm | not risk adjusted |
| E21.2 | Other hyperparathyroidism | ccmpcm | not risk adjusted |
| E21.3 | Hyperparathyroidism, unspecified | ccmpcm | not risk adjusted |
| E21.4 | Other specified disorders of parathyroid gland | ccmpcm | not risk adjusted |
| E21.5 | Disorder of parathyroid gland, unspecified | ccmpcm | not risk adjusted |
| E22.0 | Acromegaly and pituitary gigantism | ccmpcm | HCC 51 · Addison's and Cushing's Diseases, Acromegaly, and Other Specified Endocrine Disorders |
| E22.1 | Hyperprolactinemia | ccmpcm | not risk adjusted |
| E22.2 | Syndrome of inappropriate secretion of antidiuretic hormone | ccmpcm | not risk adjusted |
| E22.8 | Other hyperfunction of pituitary gland | ccmpcm | not risk adjusted |
| E22.9 | Hyperfunction of pituitary gland, unspecifiedlow specificity | ccmpcm | not risk adjusted |
| E23.0 | Hypopituitarism | ccmpcm | not risk adjusted |
| E23.1 | Drug-induced hypopituitarism | ccmpcm | not risk adjusted |
| E23.2 | Diabetes insipidus | ccmpcm | not risk adjusted |
| E23.3 | Hypothalamic dysfunction, not elsewhere classified | ccmpcm | not risk adjusted |
| E23.6 | Other disorders of pituitary gland | ccmpcm | not risk adjusted |
| E23.7 | Disorder of pituitary gland, unspecified | ccmpcm | not risk adjusted |
| E24.0 | Pituitary-dependent Cushing's disease | ccmpcm | HCC 51 · Addison's and Cushing's Diseases, Acromegaly, and Other Specified Endocrine Disorders |
| E24.1 | Nelson's syndrome | ccmpcm | not risk adjusted |
| E24.2 | Drug-induced Cushing's syndrome | ccmpcm | not risk adjusted |
| E24.3 | Ectopic ACTH syndrome | ccmpcm | not risk adjusted |
| E24.4 | Alcohol-induced pseudo-Cushing's syndrome | ccmpcm | not risk adjusted |
| E24.8 | Other Cushing's syndrome | ccmpcm | not risk adjusted |
| E24.9 | Cushing's syndrome, unspecifiedlow specificity | ccmpcm | not risk adjusted |
| E26.01 | Conn's syndrome | ccmpcm | not risk adjusted |
| E26.02 | Glucocorticoid-remediable aldosteronism | ccmpcm | not risk adjusted |
| E26.09 | Other primary hyperaldosteronism | ccmpcm | not risk adjusted |
| E26.1 | Secondary hyperaldosteronism | ccmpcm | not risk adjusted |
| E26.81 | Bartter's syndrome | ccmpcm | not risk adjusted |
| E26.89 | Other hyperaldosteronism | ccmpcm | not risk adjusted |
| E26.9 | Hyperaldosteronism, unspecified | ccmpcm | not risk adjusted |
| E27.0 | Other adrenocortical overactivity | ccmpcm | not risk adjusted |
| E27.1 | Primary adrenocortical insufficiency | ccmpcm | HCC 51 · Addison's and Cushing's Diseases, Acromegaly, and Other Specified Endocrine Disorders |
| E27.2 | Addisonian crisis | ccmpcm | not risk adjusted |
| E27.3 | Drug-induced adrenocortical insufficiency | ccmpcm | not risk adjusted |
| E27.40 | Unspecified adrenocortical insufficiencylow specificity | ccmpcm | not risk adjusted |
| E27.49 | Other adrenocortical insufficiency | ccmpcm | not risk adjusted |
| E27.5 | Adrenomedullary hyperfunction | ccmpcm | not risk adjusted |
| E27.8 | Other specified disorders of adrenal gland | ccmpcm | not risk adjusted |
| E27.9 | Disorder of adrenal gland, unspecifiedlow specificity | ccmpcm | not risk adjusted |
| E83.00 | Disorder of copper metabolism, unspecified | ccmpcm | HCC 50 · Amyloidosis, Porphyria, and Other Specified Metabolic Disorders |
| E83.01 | Wilson's disease | ccmpcm | HCC 50 · Amyloidosis, Porphyria, and Other Specified Metabolic Disorders |
| E83.09 | Other disorders of copper metabolism | ccmpcm | HCC 50 · Amyloidosis, Porphyria, and Other Specified Metabolic Disorders |
| E83.10 | Disorder of iron metabolism, unspecifiedlow specificity | ccmpcm | not risk adjusted |
| E83.110 | Hereditary hemochromatosis | ccmpcm | not risk adjusted |
| E83.111 | Hemochromatosis due to repeated red blood cell transfusions | ccmpcm | not risk adjusted |
| E83.118 | Other hemochromatosis | ccmpcm | not risk adjusted |
| E83.119 | Hemochromatosis, unspecifiedlow specificity | ccmpcm | not risk adjusted |
| E83.19 | Other disorders of iron metabolism | ccmpcm | not risk adjusted |
| E83.2 | Disorders of zinc metabolism | ccmpcm | not risk adjusted |
| E83.30 | Disorder of phosphorus metabolism, unspecifiedlow specificity | ccmpcm | not risk adjusted |
| E83.31 | Familial hypophosphatemia | ccmpcm | HCC 50 · Amyloidosis, Porphyria, and Other Specified Metabolic Disorders |
| E83.32 | Hereditary vitamin D-dependent rickets (type 1) (type 2) | ccmpcm | not risk adjusted |
| E83.39 | Other disorders of phosphorus metabolism | ccmpcm | not risk adjusted |
| E83.40 | Disorders of magnesium metabolism, unspecifiedlow specificity | ccmpcm | not risk adjusted |
| E83.41 | Hypermagnesemia | ccmpcm | not risk adjusted |
| E83.42 | Hypomagnesemia | ccmpcm | not risk adjusted |
| E83.49 | Other disorders of magnesium metabolism | ccmpcm | not risk adjusted |
| E83.50 | Unspecified disorder of calcium metabolismlow specificity | ccmpcm | not risk adjusted |
| E83.51 | Hypocalcemia | ccmpcm | not risk adjusted |
| E83.52 | Hypercalcemia | ccmpcm | not risk adjusted |
| E83.59 | Other disorders of calcium metabolism | ccmpcm | not risk adjusted |
| E83.81 | Hungry bone syndrome | ccmpcm | not risk adjusted |
| E83.820 | Generalized arterial calcification of infancy with unspecified genetic causalitylow specificity | ccmpcm | not risk adjusted |
| E83.821 | ENPP1 deficiency causing generalized arterial calcification of infancy | ccmpcm | not risk adjusted |
| E83.822 | ENPP1 deficiency causing autosomal recessive hypophosphatemic rickets type 2 | ccmpcm | not risk adjusted |
| E83.823 | ABCC6 deficiency causing generalized arterial calcification of infancy | ccmpcm | not risk adjusted |
| E83.824 | ABCC6 deficiency causing pseudoxanthoma elasticum | ccmpcm | not risk adjusted |
| E83.825 | CD73 deficiency causing arterial calcification | ccmpcm | not risk adjusted |
| E83.89 | Other disorders of mineral metabolism | ccmpcm | not risk adjusted |
| E83.9 | Disorder of mineral metabolism, unspecifiedlow specificity | ccmpcm | not risk adjusted |
| E86.0 | Dehydration | ccmpcm | not risk adjusted |
| E86.1 | Hypovolemia | ccmpcm | not risk adjusted |
| E86.9 | Volume depletion, unspecified | ccmpcm | not risk adjusted |
| E87.0 | Hyperosmolality and hypernatremia | ccmpcm | not risk adjusted |
| E87.1 | Hypo-osmolality and hyponatremia | ccmpcm | not risk adjusted |
| E87.20 | Acidosis, unspecified | ccmpcm | not risk adjusted |
| E87.21 | Acute metabolic acidosis | ccmpcm | not risk adjusted |
| E87.22 | Chronic metabolic acidosis | ccmpcm | not risk adjusted |
| E87.29 | Other acidosis | ccmpcm | not risk adjusted |
| E87.3 | Alkalosis | ccmpcm | not risk adjusted |
| E87.4 | Mixed disorder of acid-base balance | ccmpcm | not risk adjusted |
| E87.5 | Hyperkalemia | ccmpcm | not risk adjusted |
| E87.6 | Hypokalemia | ccmpcm | not risk adjusted |
| E87.70 | Fluid overload, unspecified | ccmpcm | not risk adjusted |
| E87.71 | Transfusion associated circulatory overload | ccmpcm | not risk adjusted |
| E87.79 | Other fluid overload | ccmpcm | not risk adjusted |
| E87.8 | Other disorders of electrolyte and fluid balance, not elsewhere classified | ccmpcm | not risk adjusted |
| E88.01 | Alpha-1-antitrypsin deficiency | ccmpcm | HCC 50 · Amyloidosis, Porphyria, and Other Specified Metabolic Disorders |
| E88.02 | Plasminogen deficiency | ccmpcm | not risk adjusted |
| E88.09 | Other disorders of plasma-protein metabolism, not elsewhere classified | ccmpcm | not risk adjusted |
| E88.10 | Lipodystrophy, unspecifiedlow specificity | ccmpcm | not risk adjusted |
| E88.11 | Partial lipodystrophy | ccmpcm | not risk adjusted |
| E88.12 | Generalized lipodystrophy | ccmpcm | not risk adjusted |
| E88.13 | Localized lipodystrophy | ccmpcm | not risk adjusted |
| E88.14 | HIV-associated lipodystrophy | ccmpcm | not risk adjusted |
| E88.19 | Other lipodystrophy, not elsewhere classified | ccmpcm | not risk adjusted |
| E88.2 | Lipomatosis, not elsewhere classified | ccmpcm | not risk adjusted |
| E88.3 | Tumor lysis syndrome | ccmpcm | not risk adjusted |
| E88.40 | Mitochondrial metabolism disorder, unspecifiedlow specificity | ccmpcm | not risk adjusted |
| E88.41 | MELAS syndrome | ccmpcm | not risk adjusted |
| E88.42 | MERRF syndrome | ccmpcm | not risk adjusted |
| E88.43 | Disorders of mitochondrial tRNA synthetases | ccmpcm | not risk adjusted |
| E88.49 | Other mitochondrial metabolism disorders | ccmpcm | not risk adjusted |
| E88.810 | Metabolic syndrome | ccmpcm | not risk adjusted |
| E88.811 | Insulin resistance syndrome, Type A | ccmpcm | not risk adjusted |
| E88.818 | Other insulin resistance | ccmpcm | not risk adjusted |
| E88.819 | Insulin resistance, unspecifiedlow specificity | ccmpcm | not risk adjusted |
| E88.82 | Obesity due to disruption of MC4R pathway | ccmpcm | not risk adjusted |
| E88.89 | Other specified metabolic disorders | ccmpcm | HCC 50 · Amyloidosis, Porphyria, and Other Specified Metabolic Disorders |
| E88.9 | Metabolic disorder, unspecifiedlow specificity | ccmpcm | not risk adjusted |
| E88.A | Wasting disease (syndrome) due to underlying condition | ccmpcm | not risk adjusted |
Cystic fibrosis and metabolic developmental disorders
E84, E70, E71, E72, E74, E75, E76, E77, E79, E80183 codes in familyrpmccmpcmrtmLung function and oxygenation for cystic fibrosis, with weight as a nutritional marker.
Cystic fibrosis and metabolic developmental disorders
E84, E70, E71, E72, E74, E75, E76, E77, E79, E80183 codes in familyrpmccmpcmrtmCMS other chronic or potentially disabling condition · CCW category: Cystic Fibrosis and Other Metabolic Developmental Disorders · Devices: Spirometer or peak flow meter, Pulse oximeter, Connected weight scale
This family runs to 183 codes that differ mainly by anatomic site and laterality, which does not change whether the condition supports care management. The codes are not listed one by one here. Code to the site and side documented in the record, within E84, E70, E71, E72, E74, E75, E76, E77, E79, E80.
Respiratory
COPD, emphysema and bronchiectasis
J40, J41, J42, J43, J44, J4718 codesrpmccmpcmrtmOxygen saturation is the primary signal, with symptom scores and inhaler adherence supporting RTM.
COPD, emphysema and bronchiectasis
J40, J41, J42, J43, J44, J4718 codesrpmccmpcmrtmCMS chronic condition · CCW category: Chronic Obstructive Pulmonary Disease · Devices: Pulse oximeter, Spirometer or peak flow meter
Read the copd, emphysema and bronchiectasis monitoring guide
| Code | Official ICD-10-CM description | Programs | Risk adjustment |
|---|---|---|---|
| J40 | Bronchitis, not specified as acute or chronic | rpmccmpcmrtm | not risk adjusted |
| J41.0 | Simple chronic bronchitis | rpmccmpcmrtm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J41.1 | Mucopurulent chronic bronchitis | rpmccmpcmrtm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J41.8 | Mixed simple and mucopurulent chronic bronchitis | rpmccmpcmrtm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J42 | Unspecified chronic bronchitis | rpmccmpcmrtm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J43.0 | Unilateral pulmonary emphysema [MacLeod's syndrome] | rpmccmpcmrtm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J43.1 | Panlobular emphysema | rpmccmpcmrtm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J43.2 | Centrilobular emphysema | rpmccmpcmrtm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J43.8 | Other emphysema | rpmccmpcmrtm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J43.9 | Emphysema, unspecified | rpmccmpcmrtm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J44.0 | Chronic obstructive pulmonary disease with (acute) lower respiratory infection | rpmccmpcmrtm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J44.1 | Chronic obstructive pulmonary disease with (acute) exacerbation | rpmccmpcmrtm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J44.81 | Bronchiolitis obliterans and bronchiolitis obliterans syndrome | rpmccmpcmrtm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J44.89 | Other specified chronic obstructive pulmonary disease | rpmccmpcmrtm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J44.9 | Chronic obstructive pulmonary disease, unspecified | rpmccmpcmrtm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J47.0 | Bronchiectasis with acute lower respiratory infection | rpmccmpcmrtm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J47.1 | Bronchiectasis with (acute) exacerbation | rpmccmpcmrtm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J47.9 | Bronchiectasis, uncomplicated | rpmccmpcmrtm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
Asthma
J4518 codesrpmccmrtmPeak flow and symptom frequency. Inhaler adherence and technique are the classic RTM targets.
Asthma
J4518 codesrpmccmrtmCMS chronic condition · CCW category: Asthma · Devices: Spirometer or peak flow meter, Pulse oximeter, Patient-reported outcome app (RTM)
| Code | Official ICD-10-CM description | Programs | Risk adjustment |
|---|---|---|---|
| J45.20 | Mild intermittent asthma, uncomplicated | rpmccmrtm | not risk adjusted |
| J45.21 | Mild intermittent asthma with (acute) exacerbation | rpmccmrtm | not risk adjusted |
| J45.22 | Mild intermittent asthma with status asthmaticus | rpmccmrtm | not risk adjusted |
| J45.30 | Mild persistent asthma, uncomplicated | rpmccmrtm | not risk adjusted |
| J45.31 | Mild persistent asthma with (acute) exacerbation | rpmccmrtm | not risk adjusted |
| J45.32 | Mild persistent asthma with status asthmaticus | rpmccmrtm | not risk adjusted |
| J45.40 | Moderate persistent asthma, uncomplicated | rpmccmrtm | not risk adjusted |
| J45.41 | Moderate persistent asthma with (acute) exacerbation | rpmccmrtm | not risk adjusted |
| J45.42 | Moderate persistent asthma with status asthmaticus | rpmccmrtm | not risk adjusted |
| J45.50 | Severe persistent asthma, uncomplicated | rpmccmrtm | HCC 279 · Severe Persistent Asthma |
| J45.51 | Severe persistent asthma with (acute) exacerbation | rpmccmrtm | HCC 279 · Severe Persistent Asthma |
| J45.52 | Severe persistent asthma with status asthmaticus | rpmccmrtm | HCC 279 · Severe Persistent Asthma |
| J45.901 | Unspecified asthma with (acute) exacerbationlow specificity | rpmccmrtm | not risk adjusted |
| J45.902 | Unspecified asthma with status asthmaticuslow specificity | rpmccmrtm | not risk adjusted |
| J45.909 | Unspecified asthma, uncomplicatedlow specificity | rpmccmrtm | not risk adjusted |
| J45.990 | Exercise induced bronchospasm | rpmccmrtm | not risk adjusted |
| J45.991 | Cough variant asthma | rpmccmrtm | not risk adjusted |
| J45.998 | Other asthma | rpmccmrtm | not risk adjusted |
Respiratory failure and oxygen dependence
J96, J98.4, Z99.11, Z99.12, Z99.8116 codesrpmccmpcmContinuous or scheduled oxygen saturation with alerting thresholds.
Respiratory failure and oxygen dependence
J96, J98.4, Z99.11, Z99.12, Z99.8116 codesrpmccmpcmAdded by CCN Health · Devices: Pulse oximeter
Z99.81 (dependence on supplemental oxygen) is a secondary code that supports medical necessity. It never stands alone.
| Code | Official ICD-10-CM description | Programs | Risk adjustment |
|---|---|---|---|
| J96.00 | Acute respiratory failure, unspecified whether with hypoxia or hypercapnia | rpmccmpcm | HCC 213 · Cardio-Respiratory Failure and Shock |
| J96.01 | Acute respiratory failure with hypoxia | rpmccmpcm | HCC 213 · Cardio-Respiratory Failure and Shock |
| J96.02 | Acute respiratory failure with hypercapnia | rpmccmpcm | HCC 213 · Cardio-Respiratory Failure and Shock |
| J96.10 | Chronic respiratory failure, unspecified whether with hypoxia or hypercapnia | rpmccmpcm | HCC 213 · Cardio-Respiratory Failure and Shock |
| J96.11 | Chronic respiratory failure with hypoxia | rpmccmpcm | HCC 213 · Cardio-Respiratory Failure and Shock |
| J96.12 | Chronic respiratory failure with hypercapnia | rpmccmpcm | HCC 213 · Cardio-Respiratory Failure and Shock |
| J96.20 | Acute and chronic respiratory failure, unspecified whether with hypoxia or hypercapnia | rpmccmpcm | HCC 213 · Cardio-Respiratory Failure and Shock |
| J96.21 | Acute and chronic respiratory failure with hypoxia | rpmccmpcm | HCC 213 · Cardio-Respiratory Failure and Shock |
| J96.22 | Acute and chronic respiratory failure with hypercapnia | rpmccmpcm | HCC 213 · Cardio-Respiratory Failure and Shock |
| J96.90 | Respiratory failure, unspecified, unspecified whether with hypoxia or hypercapnia | rpmccmpcm | HCC 213 · Cardio-Respiratory Failure and Shock |
| J96.91 | Respiratory failure, unspecified with hypoxia | rpmccmpcm | HCC 213 · Cardio-Respiratory Failure and Shock |
| J96.92 | Respiratory failure, unspecified with hypercapnia | rpmccmpcm | HCC 213 · Cardio-Respiratory Failure and Shock |
| J98.4 | Other disorders of lung | rpmccmpcm | not risk adjusted |
| Z99.11 | Dependence on respirator [ventilator] status | rpmccmpcm | HCC 211 · Respirator Dependence/Tracheostomy Status/Complications |
| Z99.12 | Encounter for respirator [ventilator] dependence during power failure | rpmccmpcm | HCC 211 · Respirator Dependence/Tracheostomy Status/Complications |
| Z99.81 | Dependence on supplemental oxygen | rpmccmpcm | not risk adjusted |
Interstitial and occupational lung disease
J60, J61, J62, J63, J64, J65, J66, J67, J68, J69, J70, J80, J82, J8474 codesrpmccmpcmResting and ambulatory oxygen saturation, which often falls before symptoms change.
Interstitial and occupational lung disease
J60, J61, J62, J63, J64, J65, J66, J67, J68, J69, J70, J80, J82, J8474 codesrpmccmpcmAdded by CCN Health · Devices: Pulse oximeter, Spirometer or peak flow meter
| Code | Official ICD-10-CM description | Programs | Risk adjustment |
|---|---|---|---|
| J60 | Coalworker's pneumoconiosis | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J61 | Pneumoconiosis due to asbestos and other mineral fibers | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J62.0 | Pneumoconiosis due to talc dust | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J62.8 | Pneumoconiosis due to other dust containing silica | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J63.0 | Aluminosis (of lung) | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J63.1 | Bauxite fibrosis (of lung) | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J63.2 | Berylliosis | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J63.3 | Graphite fibrosis (of lung) | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J63.4 | Siderosis | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J63.5 | Stannosis | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J63.6 | Pneumoconiosis due to other specified inorganic dusts | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J64 | Unspecified pneumoconiosis | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J65 | Pneumoconiosis associated with tuberculosis | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J66.0 | Byssinosis | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J66.1 | Flax-dressers' disease | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J66.2 | Cannabinosis | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J66.8 | Airway disease due to other specific organic dusts | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J67.0 | Farmer's lung | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J67.1 | Bagassosis | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J67.2 | Bird fancier's lung | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J67.3 | Suberosis | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J67.4 | Maltworker's lung | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J67.5 | Mushroom-worker's lung | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J67.6 | Maple-bark-stripper's lung | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J67.7 | Air conditioner and humidifier lung | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J67.8 | Hypersensitivity pneumonitis due to other organic dusts | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J67.9 | Hypersensitivity pneumonitis due to unspecified organic dust | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J68.0 | Bronchitis and pneumonitis due to chemicals, gases, fumes and vapors | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J68.1 | Pulmonary edema due to chemicals, gases, fumes and vapors | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J68.2 | Upper respiratory inflammation due to chemicals, gases, fumes and vapors, not elsewhere classified | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J68.3 | Other acute and subacute respiratory conditions due to chemicals, gases, fumes and vapors | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J68.4 | Chronic respiratory conditions due to chemicals, gases, fumes and vapors | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J68.8 | Other respiratory conditions due to chemicals, gases, fumes and vapors | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J68.9 | Unspecified respiratory condition due to chemicals, gases, fumes and vapors | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J69.0 | Pneumonitis due to inhalation of food and vomit | rpmccmpcm | HCC 282 · Aspiration and Specified Bacterial Pneumonias |
| J69.1 | Pneumonitis due to inhalation of oils and essences | rpmccmpcm | HCC 282 · Aspiration and Specified Bacterial Pneumonias |
| J69.8 | Pneumonitis due to inhalation of other solids and liquids | rpmccmpcm | HCC 282 · Aspiration and Specified Bacterial Pneumonias |
| J70.0 | Acute pulmonary manifestations due to radiation | rpmccmpcm | not risk adjusted |
| J70.1 | Chronic and other pulmonary manifestations due to radiation | rpmccmpcm | not risk adjusted |
| J70.2 | Acute drug-induced interstitial lung disorders | rpmccmpcm | not risk adjusted |
| J70.3 | Chronic drug-induced interstitial lung disorders | rpmccmpcm | not risk adjusted |
| J70.4 | Drug-induced interstitial lung disorders, unspecified | rpmccmpcm | not risk adjusted |
| J70.5 | Respiratory conditions due to smoke inhalation | rpmccmpcm | not risk adjusted |
| J70.8 | Respiratory conditions due to other specified external agents | rpmccmpcm | not risk adjusted |
| J70.9 | Respiratory conditions due to unspecified external agent | rpmccmpcm | not risk adjusted |
| J80 | Acute respiratory distress syndrome | rpmccmpcm | HCC 213 · Cardio-Respiratory Failure and Shock |
| J82.81 | Chronic eosinophilic pneumonia | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J82.82 | Acute eosinophilic pneumonia | rpmccmpcm | not risk adjusted |
| J82.83 | Eosinophilic asthma | rpmccmpcm | not risk adjusted |
| J82.89 | Other pulmonary eosinophilia, not elsewhere classified | rpmccmpcm | not risk adjusted |
| J84.01 | Alveolar proteinosis | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J84.02 | Pulmonary alveolar microlithiasis | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J84.03 | Idiopathic pulmonary hemosiderosis | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J84.09 | Other alveolar and parieto-alveolar conditions | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J84.10 | Pulmonary fibrosis, unspecified | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J84.111 | Idiopathic interstitial pneumonia, not otherwise specified | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J84.112 | Idiopathic pulmonary fibrosis | rpmccmpcm | HCC 278 · Idiopathic Pulmonary Fibrosis and Lung Involvement in Systemic Sclerosis |
| J84.113 | Idiopathic non-specific interstitial pneumonitis | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J84.114 | Acute interstitial pneumonitis | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J84.115 | Respiratory bronchiolitis interstitial lung disease | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J84.116 | Cryptogenic organizing pneumonia | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J84.117 | Desquamative interstitial pneumonia | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J84.170 | Interstitial lung disease with progressive fibrotic phenotype in diseases classified elsewhere | rpmccmpcm | HCC 278 · Idiopathic Pulmonary Fibrosis and Lung Involvement in Systemic Sclerosis |
| J84.178 | Other interstitial pulmonary diseases with fibrosis in diseases classified elsewhere | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J84.2 | Lymphoid interstitial pneumonia | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J84.81 | Lymphangioleiomyomatosis | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J84.82 | Adult pulmonary Langerhans cell histiocytosis | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J84.83 | Surfactant mutations of the lung | rpmccmpcm | not risk adjusted |
| J84.841 | Neuroendocrine cell hyperplasia of infancy | rpmccmpcm | not risk adjusted |
| J84.842 | Pulmonary interstitial glycogenosis | rpmccmpcm | not risk adjusted |
| J84.843 | Alveolar capillary dysplasia with vein misalignment | rpmccmpcm | not risk adjusted |
| J84.848 | Other interstitial lung diseases of childhood | rpmccmpcm | not risk adjusted |
| J84.89 | Other specified interstitial pulmonary diseases | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J84.9 | Interstitial pulmonary disease, unspecified | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
Sleep apnea and sleep-wake disorders
G4743 codesrpmccmOvernight oxygen saturation and respiration, plus PAP adherence where the device reports it.
Sleep apnea and sleep-wake disorders
G4743 codesrpmccmAdded by CCN Health · Devices: Sleep and respiration monitor, Pulse oximeter
Not a CCW category, but sleep apnea is one of the most common comorbidities enrolled alongside hypertension, heart failure and obesity.
| Code | Official ICD-10-CM description | Programs | Risk adjustment |
|---|---|---|---|
| G47.00 | Insomnia, unspecified | rpmccm | not risk adjusted |
| G47.01 | Insomnia due to medical condition | rpmccm | not risk adjusted |
| G47.09 | Other insomnia | rpmccm | not risk adjusted |
| G47.10 | Hypersomnia, unspecified | rpmccm | not risk adjusted |
| G47.11 | Idiopathic hypersomnia with long sleep time | rpmccm | not risk adjusted |
| G47.12 | Idiopathic hypersomnia without long sleep time | rpmccm | not risk adjusted |
| G47.13 | Recurrent hypersomnia | rpmccm | not risk adjusted |
| G47.14 | Hypersomnia due to medical condition | rpmccm | not risk adjusted |
| G47.19 | Other hypersomnia | rpmccm | not risk adjusted |
| G47.20 | Circadian rhythm sleep disorder, unspecified type | rpmccm | not risk adjusted |
| G47.21 | Circadian rhythm sleep disorder, delayed sleep phase type | rpmccm | not risk adjusted |
| G47.22 | Circadian rhythm sleep disorder, advanced sleep phase type | rpmccm | not risk adjusted |
| G47.23 | Circadian rhythm sleep disorder, irregular sleep wake type | rpmccm | not risk adjusted |
| G47.24 | Circadian rhythm sleep disorder, free running type | rpmccm | not risk adjusted |
| G47.25 | Circadian rhythm sleep disorder, jet lag type | rpmccm | not risk adjusted |
| G47.26 | Circadian rhythm sleep disorder, shift work type | rpmccm | not risk adjusted |
| G47.27 | Circadian rhythm sleep disorder in conditions classified elsewhere | rpmccm | not risk adjusted |
| G47.29 | Other circadian rhythm sleep disorder | rpmccm | not risk adjusted |
| G47.30 | Sleep apnea, unspecified | rpmccm | not risk adjusted |
| G47.31 | Primary central sleep apnea | rpmccm | not risk adjusted |
| G47.32 | High altitude periodic breathing | rpmccm | not risk adjusted |
| G47.33 | Obstructive sleep apnea (adult) (pediatric) | rpmccm | not risk adjusted |
| G47.34 | Idiopathic sleep related nonobstructive alveolar hypoventilation | rpmccm | not risk adjusted |
| G47.35 | Congenital central alveolar hypoventilation syndrome | rpmccm | not risk adjusted |
| G47.36 | Sleep related hypoventilation in conditions classified elsewhere | rpmccm | not risk adjusted |
| G47.37 | Central sleep apnea in conditions classified elsewhere | rpmccm | not risk adjusted |
| G47.39 | Other sleep apnea | rpmccm | not risk adjusted |
| G47.411 | Narcolepsy with cataplexy | rpmccm | not risk adjusted |
| G47.419 | Narcolepsy without cataplexy | rpmccm | not risk adjusted |
| G47.421 | Narcolepsy in conditions classified elsewhere with cataplexy | rpmccm | not risk adjusted |
| G47.429 | Narcolepsy in conditions classified elsewhere without cataplexy | rpmccm | not risk adjusted |
| G47.50 | Parasomnia, unspecified | rpmccm | not risk adjusted |
| G47.51 | Confusional arousals | rpmccm | not risk adjusted |
| G47.52 | REM sleep behavior disorder | rpmccm | not risk adjusted |
| G47.53 | Recurrent isolated sleep paralysis | rpmccm | not risk adjusted |
| G47.54 | Parasomnia in conditions classified elsewhere | rpmccm | not risk adjusted |
| G47.59 | Other parasomnia | rpmccm | not risk adjusted |
| G47.61 | Periodic limb movement disorder | rpmccm | not risk adjusted |
| G47.62 | Sleep related leg cramps | rpmccm | not risk adjusted |
| G47.63 | Sleep related bruxism | rpmccm | not risk adjusted |
| G47.69 | Other sleep related movement disorders | rpmccm | not risk adjusted |
| G47.8 | Other sleep disorders | rpmccm | not risk adjusted |
| G47.9 | Sleep disorder, unspecified | rpmccm | not risk adjusted |
Kidney and urologic
Chronic kidney disease and ESRD
N18, N19, Z99.2, Z94.012 codesrpmccmpcmBlood pressure and weight for volume management. Weight change between dialysis sessions is the practical signal in late-stage disease.
Chronic kidney disease and ESRD
N18, N19, Z99.2, Z94.012 codesrpmccmpcmCMS chronic condition · CCW category: Chronic Kidney Disease · Devices: Blood pressure cuff, Connected weight scale
Stage the disease. N18.9 (unspecified) carries no HCC weight and invites review, while N18.30 through N18.6 do.
Read the chronic kidney disease and esrd monitoring guide
| Code | Official ICD-10-CM description | Programs | Risk adjustment |
|---|---|---|---|
| N18.1 | Chronic kidney disease, stage 1 | rpmccmpcm | not risk adjusted |
| N18.2 | Chronic kidney disease, stage 2 (mild) | rpmccmpcm | not risk adjusted |
| N18.30 | Chronic kidney disease, stage 3 unspecified | rpmccmpcm | HCC 329 · Chronic Kidney Disease, Moderate (Stage 3, Except 3B) |
| N18.31 | Chronic kidney disease, stage 3a | rpmccmpcm | HCC 329 · Chronic Kidney Disease, Moderate (Stage 3, Except 3B) |
| N18.32 | Chronic kidney disease, stage 3b | rpmccmpcm | HCC 328 · Chronic Kidney Disease, Moderate (Stage 3B) |
| N18.4 | Chronic kidney disease, stage 4 (severe) | rpmccmpcm | HCC 327 · Chronic Kidney Disease, Severe (Stage 4) |
| N18.5 | Chronic kidney disease, stage 5 | rpmccmpcm | HCC 326 · Chronic Kidney Disease, Stage 5 |
| N18.6 | End stage renal disease | rpmccmpcm | HCC 326 · Chronic Kidney Disease, Stage 5 |
| N18.9 | Chronic kidney disease, unspecifiedlow specificity | rpmccmpcm | not risk adjusted |
| N19 | Unspecified kidney failure | rpmccmpcm | not risk adjusted |
| Z94.0 | Kidney transplant status | rpmccmpcm | not risk adjusted |
| Z99.2 | Dependence on renal dialysis | rpmccmpcm | not risk adjusted |
Glomerular and tubulo-interstitial kidney disease
N00, N01, N02, N03, N04, N05, N06, N07, N08, N11, N13, N14, N15, N16, N25, N26148 codes in familyrpmccmpcmBlood pressure and weight, with proteinuria followed by laboratory.
Glomerular and tubulo-interstitial kidney disease
N00, N01, N02, N03, N04, N05, N06, N07, N08, N11, N13, N14, N15, N16, N25, N26148 codes in familyrpmccmpcmCMS chronic condition · CCW category: Chronic Kidney Disease · Devices: Blood pressure cuff, Connected weight scale
This family runs to 148 codes that differ mainly by anatomic site and laterality, which does not change whether the condition supports care management. The codes are not listed one by one here. Code to the site and side documented in the record, within N00, N01, N02, N03, N04, N05, N06, N07, N08, N11, N13, N14, N15, N16, N25, N26.
Benign prostatic hyperplasia
N404 codesccmSymptom-score follow-up rather than device data.
Benign prostatic hyperplasia
N404 codesccmCMS chronic condition · CCW category: Benign Prostatic Hyperplasia
| Code | Official ICD-10-CM description | Programs | Risk adjustment |
|---|---|---|---|
| N40.0 | Benign prostatic hyperplasia without lower urinary tract symptoms | ccm | not risk adjusted |
| N40.1 | Benign prostatic hyperplasia with lower urinary tract symptoms | ccm | not risk adjusted |
| N40.2 | Nodular prostate without lower urinary tract symptoms | ccm | not risk adjusted |
| N40.3 | Nodular prostate with lower urinary tract symptoms | ccm | not risk adjusted |
Behavioral health and substance use
Depressive disorders
F32, F33, F34.120 codesbhiccmPHQ-9 at defined intervals, with the score trend recorded in the care plan.
Depressive disorders
F32, F33, F34.120 codesbhiccmCMS other chronic or potentially disabling condition · CCW category: Depressive Disorders · Devices: Patient-reported outcome app (RTM)
Read the depressive disorders monitoring guide
| Code | Official ICD-10-CM description | Programs | Risk adjustment |
|---|---|---|---|
| F32.0 | Major depressive disorder, single episode, mild | bhiccm | not risk adjusted |
| F32.1 | Major depressive disorder, single episode, moderate | bhiccm | HCC 155 · Major Depression, Moderate or Severe, without Psychosis |
| F32.2 | Major depressive disorder, single episode, severe without psychotic features | bhiccm | HCC 155 · Major Depression, Moderate or Severe, without Psychosis |
| F32.3 | Major depressive disorder, single episode, severe with psychotic features | bhiccm | HCC 152 · Psychosis, Except Schizophrenia |
| F32.4 | Major depressive disorder, single episode, in partial remission | bhiccm | not risk adjusted |
| F32.5 | Major depressive disorder, single episode, in full remission | bhiccm | not risk adjusted |
| F32.81 | Premenstrual dysphoric disorder | bhiccm | not risk adjusted |
| F32.89 | Other specified depressive episodes | bhiccm | not risk adjusted |
| F32.9 | Major depressive disorder, single episode, unspecifiedlow specificity | bhiccm | not risk adjusted |
| F32.A | Depression, unspecifiedlow specificity | bhiccm | not risk adjusted |
| F33.0 | Major depressive disorder, recurrent, mild | bhiccm | not risk adjusted |
| F33.1 | Major depressive disorder, recurrent, moderate | bhiccm | HCC 155 · Major Depression, Moderate or Severe, without Psychosis |
| F33.2 | Major depressive disorder, recurrent severe without psychotic features | bhiccm | HCC 155 · Major Depression, Moderate or Severe, without Psychosis |
| F33.3 | Major depressive disorder, recurrent, severe with psychotic symptoms | bhiccm | HCC 152 · Psychosis, Except Schizophrenia |
| F33.40 | Major depressive disorder, recurrent, in remission, unspecifiedlow specificity | bhiccm | not risk adjusted |
| F33.41 | Major depressive disorder, recurrent, in partial remission | bhiccm | not risk adjusted |
| F33.42 | Major depressive disorder, recurrent, in full remission | bhiccm | not risk adjusted |
| F33.8 | Other recurrent depressive disorders | bhiccm | not risk adjusted |
| F33.9 | Major depressive disorder, recurrent, unspecifiedlow specificity | bhiccm | not risk adjusted |
| F34.1 | Dysthymic disorder | bhiccm | not risk adjusted |
Bipolar and related disorders
F30, F31, F34.038 codesbhiccmMood tracking and medication adherence, with laboratory monitoring where a mood stabilizer requires it.
Bipolar and related disorders
F30, F31, F34.038 codesbhiccmCMS other chronic or potentially disabling condition · CCW category: Bipolar Disorder · Devices: Patient-reported outcome app (RTM)
| Code | Official ICD-10-CM description | Programs | Risk adjustment |
|---|---|---|---|
| F30.10 | Manic episode without psychotic symptoms, unspecified | bhiccm | HCC 154 · Bipolar Disorders without Psychosis |
| F30.11 | Manic episode without psychotic symptoms, mild | bhiccm | HCC 154 · Bipolar Disorders without Psychosis |
| F30.12 | Manic episode without psychotic symptoms, moderate | bhiccm | HCC 154 · Bipolar Disorders without Psychosis |
| F30.13 | Manic episode, severe, without psychotic symptoms | bhiccm | HCC 154 · Bipolar Disorders without Psychosis |
| F30.2 | Manic episode, severe with psychotic symptoms | bhiccm | HCC 152 · Psychosis, Except Schizophrenia |
| F30.3 | Manic episode in partial remission | bhiccm | HCC 154 · Bipolar Disorders without Psychosis |
| F30.4 | Manic episode in full remission | bhiccm | not risk adjusted |
| F30.8 | Other manic episodes | bhiccm | HCC 154 · Bipolar Disorders without Psychosis |
| F30.9 | Manic episode, unspecified | bhiccm | HCC 154 · Bipolar Disorders without Psychosis |
| F31.0 | Bipolar disorder, current episode hypomanic | bhiccm | HCC 154 · Bipolar Disorders without Psychosis |
| F31.10 | Bipolar disorder, current episode manic without psychotic features, unspecified | bhiccm | HCC 154 · Bipolar Disorders without Psychosis |
| F31.11 | Bipolar disorder, current episode manic without psychotic features, mild | bhiccm | HCC 154 · Bipolar Disorders without Psychosis |
| F31.12 | Bipolar disorder, current episode manic without psychotic features, moderate | bhiccm | HCC 154 · Bipolar Disorders without Psychosis |
| F31.13 | Bipolar disorder, current episode manic without psychotic features, severe | bhiccm | HCC 154 · Bipolar Disorders without Psychosis |
| F31.2 | Bipolar disorder, current episode manic severe with psychotic features | bhiccm | HCC 152 · Psychosis, Except Schizophrenia |
| F31.30 | Bipolar disorder, current episode depressed, mild or moderate severity, unspecified | bhiccm | HCC 154 · Bipolar Disorders without Psychosis |
| F31.31 | Bipolar disorder, current episode depressed, mild | bhiccm | HCC 154 · Bipolar Disorders without Psychosis |
| F31.32 | Bipolar disorder, current episode depressed, moderate | bhiccm | HCC 154 · Bipolar Disorders without Psychosis |
| F31.4 | Bipolar disorder, current episode depressed, severe, without psychotic features | bhiccm | HCC 154 · Bipolar Disorders without Psychosis |
| F31.5 | Bipolar disorder, current episode depressed, severe, with psychotic features | bhiccm | HCC 152 · Psychosis, Except Schizophrenia |
| F31.60 | Bipolar disorder, current episode mixed, unspecified | bhiccm | HCC 154 · Bipolar Disorders without Psychosis |
| F31.61 | Bipolar disorder, current episode mixed, mild | bhiccm | HCC 154 · Bipolar Disorders without Psychosis |
| F31.62 | Bipolar disorder, current episode mixed, moderate | bhiccm | HCC 154 · Bipolar Disorders without Psychosis |
| F31.63 | Bipolar disorder, current episode mixed, severe, without psychotic features | bhiccm | HCC 154 · Bipolar Disorders without Psychosis |
| F31.64 | Bipolar disorder, current episode mixed, severe, with psychotic features | bhiccm | HCC 152 · Psychosis, Except Schizophrenia |
| F31.70 | Bipolar disorder, currently in remission, most recent episode unspecifiedlow specificity | bhiccm | not risk adjusted |
| F31.71 | Bipolar disorder, in partial remission, most recent episode hypomanic | bhiccm | HCC 154 · Bipolar Disorders without Psychosis |
| F31.72 | Bipolar disorder, in full remission, most recent episode hypomanic | bhiccm | not risk adjusted |
| F31.73 | Bipolar disorder, in partial remission, most recent episode manic | bhiccm | HCC 154 · Bipolar Disorders without Psychosis |
| F31.74 | Bipolar disorder, in full remission, most recent episode manic | bhiccm | not risk adjusted |
| F31.75 | Bipolar disorder, in partial remission, most recent episode depressed | bhiccm | HCC 154 · Bipolar Disorders without Psychosis |
| F31.76 | Bipolar disorder, in full remission, most recent episode depressed | bhiccm | not risk adjusted |
| F31.77 | Bipolar disorder, in partial remission, most recent episode mixed | bhiccm | HCC 154 · Bipolar Disorders without Psychosis |
| F31.78 | Bipolar disorder, in full remission, most recent episode mixed | bhiccm | not risk adjusted |
| F31.81 | Bipolar II disorder | bhiccm | HCC 154 · Bipolar Disorders without Psychosis |
| F31.89 | Other bipolar disorder | bhiccm | HCC 154 · Bipolar Disorders without Psychosis |
| F31.9 | Bipolar disorder, unspecified | bhiccm | HCC 154 · Bipolar Disorders without Psychosis |
| F34.0 | Cyclothymic disorder | bhiccm | not risk adjusted |
Anxiety and fear-related disorders
F40, F4128 codesbhiccmGAD-7 at defined intervals.
Anxiety and fear-related disorders
F40, F4128 codesbhiccmCMS other chronic or potentially disabling condition · CCW category: Anxiety Disorders · Devices: Patient-reported outcome app (RTM)
| Code | Official ICD-10-CM description | Programs | Risk adjustment |
|---|---|---|---|
| F40.00 | Agoraphobia, unspecified | bhiccm | not risk adjusted |
| F40.01 | Agoraphobia with panic disorder | bhiccm | not risk adjusted |
| F40.02 | Agoraphobia without panic disorder | bhiccm | not risk adjusted |
| F40.10 | Social phobia, unspecified | bhiccm | not risk adjusted |
| F40.11 | Social phobia, generalized | bhiccm | not risk adjusted |
| F40.210 | Arachnophobia | bhiccm | not risk adjusted |
| F40.218 | Other animal type phobia | bhiccm | not risk adjusted |
| F40.220 | Fear of thunderstorms | bhiccm | not risk adjusted |
| F40.228 | Other natural environment type phobia | bhiccm | not risk adjusted |
| F40.230 | Fear of blood | bhiccm | not risk adjusted |
| F40.231 | Fear of injections and transfusions | bhiccm | not risk adjusted |
| F40.232 | Fear of other medical care | bhiccm | not risk adjusted |
| F40.233 | Fear of injury | bhiccm | not risk adjusted |
| F40.240 | Claustrophobia | bhiccm | not risk adjusted |
| F40.241 | Acrophobia | bhiccm | not risk adjusted |
| F40.242 | Fear of bridges | bhiccm | not risk adjusted |
| F40.243 | Fear of flying | bhiccm | not risk adjusted |
| F40.248 | Other situational type phobia | bhiccm | not risk adjusted |
| F40.290 | Androphobia | bhiccm | not risk adjusted |
| F40.291 | Gynephobia | bhiccm | not risk adjusted |
| F40.298 | Other specified phobia | bhiccm | not risk adjusted |
| F40.8 | Other phobic anxiety disorders | bhiccm | not risk adjusted |
| F40.9 | Phobic anxiety disorder, unspecified | bhiccm | not risk adjusted |
| F41.0 | Panic disorder [episodic paroxysmal anxiety] | bhiccm | not risk adjusted |
| F41.1 | Generalized anxiety disorder | bhiccm | not risk adjusted |
| F41.3 | Other mixed anxiety disorders | bhiccm | not risk adjusted |
| F41.8 | Other specified anxiety disorders | bhiccm | not risk adjusted |
| F41.9 | Anxiety disorder, unspecified | bhiccm | not risk adjusted |
Trauma and stressor-related disorders
F4314 codesbhiccmPCL-5 or an equivalent validated instrument.
Trauma and stressor-related disorders
F4314 codesbhiccmCMS other chronic or potentially disabling condition · CCW category: Post-Traumatic Stress Disorder (PTSD) · Devices: Patient-reported outcome app (RTM)
| Code | Official ICD-10-CM description | Programs | Risk adjustment |
|---|---|---|---|
| F43.0 | Acute stress reaction | bhiccm | not risk adjusted |
| F43.10 | Post-traumatic stress disorder, unspecified | bhiccm | not risk adjusted |
| F43.11 | Post-traumatic stress disorder, acute | bhiccm | not risk adjusted |
| F43.12 | Post-traumatic stress disorder, chronic | bhiccm | not risk adjusted |
| F43.20 | Adjustment disorder, unspecified | bhiccm | not risk adjusted |
| F43.21 | Adjustment disorder with depressed mood | bhiccm | not risk adjusted |
| F43.22 | Adjustment disorder with anxiety | bhiccm | not risk adjusted |
| F43.23 | Adjustment disorder with mixed anxiety and depressed mood | bhiccm | not risk adjusted |
| F43.24 | Adjustment disorder with disturbance of conduct | bhiccm | not risk adjusted |
| F43.25 | Adjustment disorder with mixed disturbance of emotions and conduct | bhiccm | not risk adjusted |
| F43.29 | Adjustment disorder with other symptoms | bhiccm | not risk adjusted |
| F43.81 | Prolonged grief disorder | bhiccm | not risk adjusted |
| F43.89 | Other reactions to severe stress | bhiccm | not risk adjusted |
| F43.9 | Reaction to severe stress, unspecified | bhiccm | not risk adjusted |
Obsessive-compulsive, somatic and personality disorders
F42, F44, F45, F48, F60, F68, F6947 codes in familybhiStructured symptom follow-up in the primary care setting.
Obsessive-compulsive, somatic and personality disorders
F42, F44, F45, F48, F60, F68, F6947 codes in familybhiCMS other chronic or potentially disabling condition · CCW category: Personality Disorders · Devices: Patient-reported outcome app (RTM)
This family runs to 47 codes that differ mainly by anatomic site and laterality, which does not change whether the condition supports care management. The codes are not listed one by one here. Code to the site and side documented in the record, within F42, F44, F45, F48, F60, F68, F69.
Schizophrenia and other psychotic disorders
F20, F21, F22, F23, F24, F25, F28, F2918 codesbhiccmAdherence and metabolic surveillance, since antipsychotics drive weight and glucose change.
Schizophrenia and other psychotic disorders
F20, F21, F22, F23, F24, F25, F28, F2918 codesbhiccmCMS other chronic or potentially disabling condition · CCW category: Schizophrenia and Other Psychotic Disorders · Devices: Patient-reported outcome app (RTM)
| Code | Official ICD-10-CM description | Programs | Risk adjustment |
|---|---|---|---|
| F20.0 | Paranoid schizophrenia | bhiccm | HCC 151 · Schizophrenia |
| F20.1 | Disorganized schizophrenia | bhiccm | HCC 151 · Schizophrenia |
| F20.2 | Catatonic schizophrenia | bhiccm | HCC 151 · Schizophrenia |
| F20.3 | Undifferentiated schizophrenia | bhiccm | HCC 151 · Schizophrenia |
| F20.5 | Residual schizophrenia | bhiccm | HCC 151 · Schizophrenia |
| F20.81 | Schizophreniform disorder | bhiccm | HCC 151 · Schizophrenia |
| F20.89 | Other schizophrenia | bhiccm | HCC 151 · Schizophrenia |
| F20.9 | Schizophrenia, unspecified | bhiccm | HCC 151 · Schizophrenia |
| F21 | Schizotypal disorder | bhiccm | HCC 153 · Personality Disorders; Anorexia/Bulimia Nervosa |
| F22 | Delusional disorders | bhiccm | HCC 152 · Psychosis, Except Schizophrenia |
| F23 | Brief psychotic disorder | bhiccm | HCC 152 · Psychosis, Except Schizophrenia |
| F24 | Shared psychotic disorder | bhiccm | HCC 152 · Psychosis, Except Schizophrenia |
| F25.0 | Schizoaffective disorder, bipolar type | bhiccm | HCC 151 · Schizophrenia |
| F25.1 | Schizoaffective disorder, depressive type | bhiccm | HCC 151 · Schizophrenia |
| F25.8 | Other schizoaffective disorders | bhiccm | HCC 151 · Schizophrenia |
| F25.9 | Schizoaffective disorder, unspecified | bhiccm | HCC 151 · Schizophrenia |
| F28 | Other psychotic disorder not due to a substance or known physiological condition | bhiccm | HCC 152 · Psychosis, Except Schizophrenia |
| F29 | Unspecified psychosis not due to a substance or known physiological condition | bhiccm | HCC 152 · Psychosis, Except Schizophrenia |
Feeding and eating disorders
F5030 codesbhiccmWeight monitoring under an explicit protocol, with behavioral follow-up.
Feeding and eating disorders
F5030 codesbhiccmAdded by CCN Health · Devices: Connected weight scale
F50.2 is no longer valid. Bulimia nervosa is now F50.20 through F50.25.
| Code | Official ICD-10-CM description | Programs | Risk adjustment |
|---|---|---|---|
| F50.00 | Anorexia nervosa, unspecified | bhiccm | HCC 153 · Personality Disorders; Anorexia/Bulimia Nervosa |
| F50.010 | Anorexia nervosa, restricting type, mild | bhiccm | HCC 153 · Personality Disorders; Anorexia/Bulimia Nervosa |
| F50.011 | Anorexia nervosa, restricting type, moderate | bhiccm | HCC 153 · Personality Disorders; Anorexia/Bulimia Nervosa |
| F50.012 | Anorexia nervosa, restricting type, severe | bhiccm | HCC 153 · Personality Disorders; Anorexia/Bulimia Nervosa |
| F50.013 | Anorexia nervosa, restricting type, extreme | bhiccm | HCC 153 · Personality Disorders; Anorexia/Bulimia Nervosa |
| F50.014 | Anorexia nervosa, restricting type, in remission | bhiccm | HCC 153 · Personality Disorders; Anorexia/Bulimia Nervosa |
| F50.019 | Anorexia nervosa, restricting type, unspecified | bhiccm | HCC 153 · Personality Disorders; Anorexia/Bulimia Nervosa |
| F50.020 | Anorexia nervosa, binge eating/purging type, mild | bhiccm | HCC 153 · Personality Disorders; Anorexia/Bulimia Nervosa |
| F50.021 | Anorexia nervosa, binge eating/purging type, moderate | bhiccm | HCC 153 · Personality Disorders; Anorexia/Bulimia Nervosa |
| F50.022 | Anorexia nervosa, binge eating/purging type, severe | bhiccm | HCC 153 · Personality Disorders; Anorexia/Bulimia Nervosa |
| F50.023 | Anorexia nervosa, binge eating/purging type, extreme | bhiccm | HCC 153 · Personality Disorders; Anorexia/Bulimia Nervosa |
| F50.024 | Anorexia nervosa, binge eating/purging type, in remission | bhiccm | HCC 153 · Personality Disorders; Anorexia/Bulimia Nervosa |
| F50.029 | Anorexia nervosa, binge eating/purging type, unspecified | bhiccm | HCC 153 · Personality Disorders; Anorexia/Bulimia Nervosa |
| F50.20 | Bulimia nervosa, unspecified | bhiccm | HCC 153 · Personality Disorders; Anorexia/Bulimia Nervosa |
| F50.21 | Bulimia nervosa, mild | bhiccm | HCC 153 · Personality Disorders; Anorexia/Bulimia Nervosa |
| F50.22 | Bulimia nervosa, moderate | bhiccm | HCC 153 · Personality Disorders; Anorexia/Bulimia Nervosa |
| F50.23 | Bulimia nervosa, severe | bhiccm | HCC 153 · Personality Disorders; Anorexia/Bulimia Nervosa |
| F50.24 | Bulimia nervosa, extreme | bhiccm | HCC 153 · Personality Disorders; Anorexia/Bulimia Nervosa |
| F50.25 | Bulimia nervosa, in remission | bhiccm | HCC 153 · Personality Disorders; Anorexia/Bulimia Nervosa |
| F50.810 | Binge eating disorder, mild | bhiccm | not risk adjusted |
| F50.811 | Binge eating disorder, moderate | bhiccm | not risk adjusted |
| F50.812 | Binge eating disorder, severe | bhiccm | not risk adjusted |
| F50.813 | Binge eating disorder, extreme | bhiccm | not risk adjusted |
| F50.814 | Binge eating disorder, in remission | bhiccm | not risk adjusted |
| F50.819 | Binge eating disorder, unspecifiedlow specificity | bhiccm | not risk adjusted |
| F50.82 | Avoidant/restrictive food intake disorder | bhiccm | not risk adjusted |
| F50.83 | Pica in adults | bhiccm | not risk adjusted |
| F50.84 | Rumination disorder in adults | bhiccm | not risk adjusted |
| F50.89 | Other specified eating disorder | bhiccm | not risk adjusted |
| F50.9 | Eating disorder, unspecifiedlow specificity | bhiccm | not risk adjusted |
Alcohol-related disorders
F1058 codesbhiccmAUDIT-C and structured relapse-risk follow-up.
Alcohol-related disorders
F1058 codesbhiccmCMS other chronic or potentially disabling condition · CCW category: Alcohol Use Disorders · Devices: Patient-reported outcome app (RTM)
| Code | Official ICD-10-CM description | Programs | Risk adjustment |
|---|---|---|---|
| F10.10 | Alcohol abuse, uncomplicated | bhiccm | not risk adjusted |
| F10.11 | Alcohol abuse, in remission | bhiccm | not risk adjusted |
| F10.120 | Alcohol abuse with intoxication, uncomplicated | bhiccm | not risk adjusted |
| F10.121 | Alcohol abuse with intoxication delirium | bhiccm | not risk adjusted |
| F10.129 | Alcohol abuse with intoxication, unspecifiedlow specificity | bhiccm | not risk adjusted |
| F10.130 | Alcohol abuse with withdrawal, uncomplicated | bhiccm | HCC 139 · Alcohol Use Disorder, Moderate/Severe, or Alcohol Use with Specified Non-Psychotic Complications |
| F10.131 | Alcohol abuse with withdrawal delirium | bhiccm | HCC 136 · Alcohol Use with Psychotic Complications |
| F10.132 | Alcohol abuse with withdrawal with perceptual disturbance | bhiccm | HCC 136 · Alcohol Use with Psychotic Complications |
| F10.139 | Alcohol abuse with withdrawal, unspecified | bhiccm | HCC 139 · Alcohol Use Disorder, Moderate/Severe, or Alcohol Use with Specified Non-Psychotic Complications |
| F10.14 | Alcohol abuse with alcohol-induced mood disorder | bhiccm | HCC 139 · Alcohol Use Disorder, Moderate/Severe, or Alcohol Use with Specified Non-Psychotic Complications |
| F10.150 | Alcohol abuse with alcohol-induced psychotic disorder with delusions | bhiccm | HCC 136 · Alcohol Use with Psychotic Complications |
| F10.151 | Alcohol abuse with alcohol-induced psychotic disorder with hallucinations | bhiccm | HCC 136 · Alcohol Use with Psychotic Complications |
| F10.159 | Alcohol abuse with alcohol-induced psychotic disorder, unspecified | bhiccm | HCC 136 · Alcohol Use with Psychotic Complications |
| F10.180 | Alcohol abuse with alcohol-induced anxiety disorder | bhiccm | HCC 139 · Alcohol Use Disorder, Moderate/Severe, or Alcohol Use with Specified Non-Psychotic Complications |
| F10.181 | Alcohol abuse with alcohol-induced sexual dysfunction | bhiccm | HCC 139 · Alcohol Use Disorder, Moderate/Severe, or Alcohol Use with Specified Non-Psychotic Complications |
| F10.182 | Alcohol abuse with alcohol-induced sleep disorder | bhiccm | HCC 139 · Alcohol Use Disorder, Moderate/Severe, or Alcohol Use with Specified Non-Psychotic Complications |
| F10.188 | Alcohol abuse with other alcohol-induced disorder | bhiccm | HCC 139 · Alcohol Use Disorder, Moderate/Severe, or Alcohol Use with Specified Non-Psychotic Complications |
| F10.19 | Alcohol abuse with unspecified alcohol-induced disorderlow specificity | bhiccm | not risk adjusted |
| F10.20 | Alcohol dependence, uncomplicated | bhiccm | HCC 139 · Alcohol Use Disorder, Moderate/Severe, or Alcohol Use with Specified Non-Psychotic Complications |
| F10.21 | Alcohol dependence, in remission | bhiccm | HCC 139 · Alcohol Use Disorder, Moderate/Severe, or Alcohol Use with Specified Non-Psychotic Complications |
| F10.220 | Alcohol dependence with intoxication, uncomplicated | bhiccm | HCC 139 · Alcohol Use Disorder, Moderate/Severe, or Alcohol Use with Specified Non-Psychotic Complications |
| F10.221 | Alcohol dependence with intoxication delirium | bhiccm | HCC 139 · Alcohol Use Disorder, Moderate/Severe, or Alcohol Use with Specified Non-Psychotic Complications |
| F10.229 | Alcohol dependence with intoxication, unspecified | bhiccm | HCC 139 · Alcohol Use Disorder, Moderate/Severe, or Alcohol Use with Specified Non-Psychotic Complications |
| F10.230 | Alcohol dependence with withdrawal, uncomplicated | bhiccm | HCC 139 · Alcohol Use Disorder, Moderate/Severe, or Alcohol Use with Specified Non-Psychotic Complications |
| F10.231 | Alcohol dependence with withdrawal delirium | bhiccm | HCC 136 · Alcohol Use with Psychotic Complications |
| F10.232 | Alcohol dependence with withdrawal with perceptual disturbance | bhiccm | HCC 136 · Alcohol Use with Psychotic Complications |
| F10.239 | Alcohol dependence with withdrawal, unspecified | bhiccm | HCC 139 · Alcohol Use Disorder, Moderate/Severe, or Alcohol Use with Specified Non-Psychotic Complications |
| F10.24 | Alcohol dependence with alcohol-induced mood disorder | bhiccm | HCC 139 · Alcohol Use Disorder, Moderate/Severe, or Alcohol Use with Specified Non-Psychotic Complications |
| F10.250 | Alcohol dependence with alcohol-induced psychotic disorder with delusions | bhiccm | HCC 136 · Alcohol Use with Psychotic Complications |
| F10.251 | Alcohol dependence with alcohol-induced psychotic disorder with hallucinations | bhiccm | HCC 136 · Alcohol Use with Psychotic Complications |
| F10.259 | Alcohol dependence with alcohol-induced psychotic disorder, unspecified | bhiccm | HCC 136 · Alcohol Use with Psychotic Complications |
| F10.26 | Alcohol dependence with alcohol-induced persisting amnestic disorder | bhiccm | HCC 136 · Alcohol Use with Psychotic Complications |
| F10.27 | Alcohol dependence with alcohol-induced persisting dementia | bhiccm | HCC 136 · Alcohol Use with Psychotic Complications |
| F10.280 | Alcohol dependence with alcohol-induced anxiety disorder | bhiccm | HCC 139 · Alcohol Use Disorder, Moderate/Severe, or Alcohol Use with Specified Non-Psychotic Complications |
| F10.281 | Alcohol dependence with alcohol-induced sexual dysfunction | bhiccm | HCC 139 · Alcohol Use Disorder, Moderate/Severe, or Alcohol Use with Specified Non-Psychotic Complications |
| F10.282 | Alcohol dependence with alcohol-induced sleep disorder | bhiccm | HCC 139 · Alcohol Use Disorder, Moderate/Severe, or Alcohol Use with Specified Non-Psychotic Complications |
| F10.288 | Alcohol dependence with other alcohol-induced disorder | bhiccm | HCC 139 · Alcohol Use Disorder, Moderate/Severe, or Alcohol Use with Specified Non-Psychotic Complications |
| F10.29 | Alcohol dependence with unspecified alcohol-induced disorder | bhiccm | HCC 139 · Alcohol Use Disorder, Moderate/Severe, or Alcohol Use with Specified Non-Psychotic Complications |
| F10.90 | Alcohol use, unspecified, uncomplicatedlow specificity | bhiccm | not risk adjusted |
| F10.91 | Alcohol use, unspecified, in remissionlow specificity | bhiccm | not risk adjusted |
| F10.920 | Alcohol use, unspecified with intoxication, uncomplicatedlow specificity | bhiccm | not risk adjusted |
| F10.921 | Alcohol use, unspecified with intoxication deliriumlow specificity | bhiccm | not risk adjusted |
| F10.929 | Alcohol use, unspecified with intoxication, unspecifiedlow specificity | bhiccm | not risk adjusted |
| F10.930 | Alcohol use, unspecified with withdrawal, uncomplicated | bhiccm | HCC 139 · Alcohol Use Disorder, Moderate/Severe, or Alcohol Use with Specified Non-Psychotic Complications |
| F10.931 | Alcohol use, unspecified with withdrawal delirium | bhiccm | HCC 136 · Alcohol Use with Psychotic Complications |
| F10.932 | Alcohol use, unspecified with withdrawal with perceptual disturbance | bhiccm | HCC 136 · Alcohol Use with Psychotic Complications |
| F10.939 | Alcohol use, unspecified with withdrawal, unspecified | bhiccm | HCC 139 · Alcohol Use Disorder, Moderate/Severe, or Alcohol Use with Specified Non-Psychotic Complications |
| F10.94 | Alcohol use, unspecified with alcohol-induced mood disorder | bhiccm | HCC 139 · Alcohol Use Disorder, Moderate/Severe, or Alcohol Use with Specified Non-Psychotic Complications |
| F10.950 | Alcohol use, unspecified with alcohol-induced psychotic disorder with delusions | bhiccm | HCC 136 · Alcohol Use with Psychotic Complications |
| F10.951 | Alcohol use, unspecified with alcohol-induced psychotic disorder with hallucinations | bhiccm | HCC 136 · Alcohol Use with Psychotic Complications |
| F10.959 | Alcohol use, unspecified with alcohol-induced psychotic disorder, unspecified | bhiccm | HCC 136 · Alcohol Use with Psychotic Complications |
| F10.96 | Alcohol use, unspecified with alcohol-induced persisting amnestic disorder | bhiccm | HCC 136 · Alcohol Use with Psychotic Complications |
| F10.97 | Alcohol use, unspecified with alcohol-induced persisting dementia | bhiccm | HCC 136 · Alcohol Use with Psychotic Complications |
| F10.980 | Alcohol use, unspecified with alcohol-induced anxiety disorder | bhiccm | HCC 139 · Alcohol Use Disorder, Moderate/Severe, or Alcohol Use with Specified Non-Psychotic Complications |
| F10.981 | Alcohol use, unspecified with alcohol-induced sexual dysfunction | bhiccm | HCC 139 · Alcohol Use Disorder, Moderate/Severe, or Alcohol Use with Specified Non-Psychotic Complications |
| F10.982 | Alcohol use, unspecified with alcohol-induced sleep disorder | bhiccm | HCC 139 · Alcohol Use Disorder, Moderate/Severe, or Alcohol Use with Specified Non-Psychotic Complications |
| F10.988 | Alcohol use, unspecified with other alcohol-induced disorder | bhiccm | HCC 139 · Alcohol Use Disorder, Moderate/Severe, or Alcohol Use with Specified Non-Psychotic Complications |
| F10.99 | Alcohol use, unspecified with unspecified alcohol-induced disorderlow specificity | bhiccm | not risk adjusted |
Opioid-related disorders
F1145 codesbhiccmMedication-assisted therapy adherence and structured follow-up.
Opioid-related disorders
F1145 codesbhiccmCMS other chronic or potentially disabling condition · CCW category: Opioid Use Disorder (OUD) · Devices: Patient-reported outcome app (RTM)
| Code | Official ICD-10-CM description | Programs | Risk adjustment |
|---|---|---|---|
| F11.10 | Opioid abuse, uncomplicated | bhiccm | HCC 138 · Drug Use Disorder, Mild, Uncomplicated, Except Cannabis |
| F11.11 | Opioid abuse, in remission | bhiccm | HCC 138 · Drug Use Disorder, Mild, Uncomplicated, Except Cannabis |
| F11.120 | Opioid abuse with intoxication, uncomplicated | bhiccm | HCC 137 · Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications |
| F11.121 | Opioid abuse with intoxication delirium | bhiccm | HCC 137 · Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications |
| F11.122 | Opioid abuse with intoxication with perceptual disturbance | bhiccm | HCC 137 · Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications |
| F11.129 | Opioid abuse with intoxication, unspecified | bhiccm | HCC 137 · Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications |
| F11.13 | Opioid abuse with withdrawal | bhiccm | HCC 137 · Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications |
| F11.14 | Opioid abuse with opioid-induced mood disorder | bhiccm | HCC 137 · Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications |
| F11.150 | Opioid abuse with opioid-induced psychotic disorder with delusions | bhiccm | HCC 135 · Drug Use with Psychotic Complications |
| F11.151 | Opioid abuse with opioid-induced psychotic disorder with hallucinations | bhiccm | HCC 135 · Drug Use with Psychotic Complications |
| F11.159 | Opioid abuse with opioid-induced psychotic disorder, unspecified | bhiccm | HCC 135 · Drug Use with Psychotic Complications |
| F11.181 | Opioid abuse with opioid-induced sexual dysfunction | bhiccm | HCC 137 · Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications |
| F11.182 | Opioid abuse with opioid-induced sleep disorder | bhiccm | HCC 137 · Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications |
| F11.188 | Opioid abuse with other opioid-induced disorder | bhiccm | HCC 137 · Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications |
| F11.19 | Opioid abuse with unspecified opioid-induced disorder | bhiccm | HCC 137 · Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications |
| F11.20 | Opioid dependence, uncomplicated | bhiccm | HCC 137 · Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications |
| F11.21 | Opioid dependence, in remission | bhiccm | HCC 137 · Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications |
| F11.220 | Opioid dependence with intoxication, uncomplicated | bhiccm | HCC 137 · Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications |
| F11.221 | Opioid dependence with intoxication delirium | bhiccm | HCC 137 · Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications |
| F11.222 | Opioid dependence with intoxication with perceptual disturbance | bhiccm | HCC 137 · Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications |
| F11.229 | Opioid dependence with intoxication, unspecified | bhiccm | HCC 137 · Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications |
| F11.23 | Opioid dependence with withdrawal | bhiccm | HCC 137 · Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications |
| F11.24 | Opioid dependence with opioid-induced mood disorder | bhiccm | HCC 137 · Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications |
| F11.250 | Opioid dependence with opioid-induced psychotic disorder with delusions | bhiccm | HCC 135 · Drug Use with Psychotic Complications |
| F11.251 | Opioid dependence with opioid-induced psychotic disorder with hallucinations | bhiccm | HCC 135 · Drug Use with Psychotic Complications |
| F11.259 | Opioid dependence with opioid-induced psychotic disorder, unspecified | bhiccm | HCC 135 · Drug Use with Psychotic Complications |
| F11.281 | Opioid dependence with opioid-induced sexual dysfunction | bhiccm | HCC 137 · Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications |
| F11.282 | Opioid dependence with opioid-induced sleep disorder | bhiccm | HCC 137 · Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications |
| F11.288 | Opioid dependence with other opioid-induced disorder | bhiccm | HCC 137 · Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications |
| F11.29 | Opioid dependence with unspecified opioid-induced disorder | bhiccm | HCC 137 · Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications |
| F11.90 | Opioid use, unspecified, uncomplicatedlow specificity | bhiccm | not risk adjusted |
| F11.91 | Opioid use, unspecified, in remissionlow specificity | bhiccm | not risk adjusted |
| F11.920 | Opioid use, unspecified with intoxication, uncomplicated | bhiccm | HCC 137 · Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications |
| F11.921 | Opioid use, unspecified with intoxication delirium | bhiccm | HCC 137 · Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications |
| F11.922 | Opioid use, unspecified with intoxication with perceptual disturbance | bhiccm | HCC 137 · Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications |
| F11.929 | Opioid use, unspecified with intoxication, unspecified | bhiccm | HCC 137 · Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications |
| F11.93 | Opioid use, unspecified with withdrawal | bhiccm | HCC 137 · Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications |
| F11.94 | Opioid use, unspecified with opioid-induced mood disorder | bhiccm | HCC 137 · Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications |
| F11.950 | Opioid use, unspecified with opioid-induced psychotic disorder with delusions | bhiccm | HCC 135 · Drug Use with Psychotic Complications |
| F11.951 | Opioid use, unspecified with opioid-induced psychotic disorder with hallucinations | bhiccm | HCC 135 · Drug Use with Psychotic Complications |
| F11.959 | Opioid use, unspecified with opioid-induced psychotic disorder, unspecified | bhiccm | HCC 135 · Drug Use with Psychotic Complications |
| F11.981 | Opioid use, unspecified with opioid-induced sexual dysfunction | bhiccm | HCC 137 · Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications |
| F11.982 | Opioid use, unspecified with opioid-induced sleep disorder | bhiccm | HCC 137 · Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications |
| F11.988 | Opioid use, unspecified with other opioid-induced disorder | bhiccm | HCC 137 · Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications |
| F11.99 | Opioid use, unspecified with unspecified opioid-induced disorder | bhiccm | HCC 137 · Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications |
Other substance-related disorders
F12, F13, F14, F15, F16, F18, F19335 codes in familybhiccmStructured follow-up and relapse-risk assessment.
Other substance-related disorders
F12, F13, F14, F15, F16, F18, F19335 codes in familybhiccmCMS other chronic or potentially disabling condition · CCW category: Drug Use Disorders · Devices: Patient-reported outcome app (RTM)
This family runs to 335 codes that differ mainly by anatomic site and laterality, which does not change whether the condition supports care management. The codes are not listed one by one here. Code to the site and side documented in the record, within F12, F13, F14, F15, F16, F18, F19.
Tobacco-related disorders
F17, Z87.89121 codesbhiccmCessation counselling and relapse follow-up.
Tobacco-related disorders
F17, Z87.89121 codesbhiccmCMS other chronic or potentially disabling condition · CCW category: Tobacco Use Disorders
| Code | Official ICD-10-CM description | Programs | Risk adjustment |
|---|---|---|---|
| F17.200 | Nicotine dependence, unspecified, uncomplicated | bhiccm | not risk adjusted |
| F17.201 | Nicotine dependence, unspecified, in remission | bhiccm | not risk adjusted |
| F17.203 | Nicotine dependence unspecified, with withdrawal | bhiccm | not risk adjusted |
| F17.208 | Nicotine dependence, unspecified, with other nicotine-induced disorders | bhiccm | not risk adjusted |
| F17.209 | Nicotine dependence, unspecified, with unspecified nicotine-induced disorders | bhiccm | not risk adjusted |
| F17.210 | Nicotine dependence, cigarettes, uncomplicated | bhiccm | not risk adjusted |
| F17.211 | Nicotine dependence, cigarettes, in remission | bhiccm | not risk adjusted |
| F17.213 | Nicotine dependence, cigarettes, with withdrawal | bhiccm | not risk adjusted |
| F17.218 | Nicotine dependence, cigarettes, with other nicotine-induced disorders | bhiccm | not risk adjusted |
| F17.219 | Nicotine dependence, cigarettes, with unspecified nicotine-induced disorders | bhiccm | not risk adjusted |
| F17.220 | Nicotine dependence, chewing tobacco, uncomplicated | bhiccm | not risk adjusted |
| F17.221 | Nicotine dependence, chewing tobacco, in remission | bhiccm | not risk adjusted |
| F17.223 | Nicotine dependence, chewing tobacco, with withdrawal | bhiccm | not risk adjusted |
| F17.228 | Nicotine dependence, chewing tobacco, with other nicotine-induced disorders | bhiccm | not risk adjusted |
| F17.229 | Nicotine dependence, chewing tobacco, with unspecified nicotine-induced disorders | bhiccm | not risk adjusted |
| F17.290 | Nicotine dependence, other tobacco product, uncomplicated | bhiccm | not risk adjusted |
| F17.291 | Nicotine dependence, other tobacco product, in remission | bhiccm | not risk adjusted |
| F17.293 | Nicotine dependence, other tobacco product, with withdrawal | bhiccm | not risk adjusted |
| F17.298 | Nicotine dependence, other tobacco product, with other nicotine-induced disorders | bhiccm | not risk adjusted |
| F17.299 | Nicotine dependence, other tobacco product, with unspecified nicotine-induced disorders | bhiccm | not risk adjusted |
| Z87.891 | Personal history of nicotine dependence | bhiccm | not risk adjusted |
ADHD, conduct and neurodevelopmental disorders
F90, F91, F80, F81, F82, F88, F8927 codes in familybhiStructured rating scales and medication follow-up.
ADHD, conduct and neurodevelopmental disorders
F90, F91, F80, F81, F82, F88, F8927 codes in familybhiCMS other chronic or potentially disabling condition · CCW category: ADHD, Conduct Disorders, and Hyperkinetic Syndrome · Devices: Patient-reported outcome app (RTM)
This family runs to 27 codes that differ mainly by anatomic site and laterality, which does not change whether the condition supports care management. The codes are not listed one by one here. Code to the site and side documented in the record, within F90, F91, F80, F81, F82, F88, F89.
Autism spectrum and intellectual disabilities
F84, F70, F71, F72, F73, F78, F7913 codes in familybhiccmCare coordination and caregiver support rather than device data.
Autism spectrum and intellectual disabilities
F84, F70, F71, F72, F73, F78, F7913 codes in familybhiccmCMS other chronic or potentially disabling condition · CCW category: Autism Spectrum Disorders
This family runs to 13 codes that differ mainly by anatomic site and laterality, which does not change whether the condition supports care management. The codes are not listed one by one here. Code to the site and side documented in the record, within F84, F70, F71, F72, F73, F78, F79.
Neurologic and cognitive
Alzheimer's disease
G304 codesccmpcmActivity, night-time movement and fall detection, with caregiver-reported change.
Alzheimer's disease
G304 codesccmpcmCMS chronic condition · CCW category: Alzheimer's Disease · Devices: Contactless activity and fall radar
| Code | Official ICD-10-CM description | Programs | Risk adjustment |
|---|---|---|---|
| G30.0 | Alzheimer's disease with early onset | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| G30.1 | Alzheimer's disease with late onset | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| G30.8 | Other Alzheimer's disease | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| G30.9 | Alzheimer's disease, unspecified | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
Non-Alzheimer's dementia
F01, F02, F03, G31, G13.2, G13.888 codesccmpcmActivity and fall detection with caregiver-reported change.
Non-Alzheimer's dementia
F01, F02, F03, G31, G13.2, G13.888 codesccmpcmCMS chronic condition · CCW category: Non-Alzheimer's Dementia · Devices: Contactless activity and fall radar
F01, F02 and F03 now require severity and a behavioural qualifier. F03.91 is no longer valid on its own.
| Code | Official ICD-10-CM description | Programs | Risk adjustment |
|---|---|---|---|
| F01.50 | Vascular dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| F01.511 | Vascular dementia, unspecified severity, with agitation | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| F01.518 | Vascular dementia, unspecified severity, with other behavioral disturbance | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| F01.52 | Vascular dementia, unspecified severity, with psychotic disturbance | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| F01.53 | Vascular dementia, unspecified severity, with mood disturbance | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| F01.54 | Vascular dementia, unspecified severity, with anxiety | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| F01.A0 | Vascular dementia, mild, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| F01.A11 | Vascular dementia, mild, with agitation | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| F01.A18 | Vascular dementia, mild, with other behavioral disturbance | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| F01.A2 | Vascular dementia, mild, with psychotic disturbance | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| F01.A3 | Vascular dementia, mild, with mood disturbance | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| F01.A4 | Vascular dementia, mild, with anxiety | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| F01.B0 | Vascular dementia, moderate, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety | ccmpcm | HCC 126 · Dementia, Moderate |
| F01.B11 | Vascular dementia, moderate, with agitation | ccmpcm | HCC 126 · Dementia, Moderate |
| F01.B18 | Vascular dementia, moderate, with other behavioral disturbance | ccmpcm | HCC 126 · Dementia, Moderate |
| F01.B2 | Vascular dementia, moderate, with psychotic disturbance | ccmpcm | HCC 126 · Dementia, Moderate |
| F01.B3 | Vascular dementia, moderate, with mood disturbance | ccmpcm | HCC 126 · Dementia, Moderate |
| F01.B4 | Vascular dementia, moderate, with anxiety | ccmpcm | HCC 126 · Dementia, Moderate |
| F01.C0 | Vascular dementia, severe, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety | ccmpcm | HCC 125 · Dementia, Severe |
| F01.C11 | Vascular dementia, severe, with agitation | ccmpcm | HCC 125 · Dementia, Severe |
| F01.C18 | Vascular dementia, severe, with other behavioral disturbance | ccmpcm | HCC 125 · Dementia, Severe |
| F01.C2 | Vascular dementia, severe, with psychotic disturbance | ccmpcm | HCC 125 · Dementia, Severe |
| F01.C3 | Vascular dementia, severe, with mood disturbance | ccmpcm | HCC 125 · Dementia, Severe |
| F01.C4 | Vascular dementia, severe, with anxiety | ccmpcm | HCC 125 · Dementia, Severe |
| F02.80 | Dementia in other diseases classified elsewhere, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| F02.811 | Dementia in other diseases classified elsewhere, unspecified severity, with agitation | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| F02.818 | Dementia in other diseases classified elsewhere, unspecified severity, with other behavioral disturbance | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| F02.82 | Dementia in other diseases classified elsewhere, unspecified severity, with psychotic disturbance | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| F02.83 | Dementia in other diseases classified elsewhere, unspecified severity, with mood disturbance | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| F02.84 | Dementia in other diseases classified elsewhere, unspecified severity, with anxiety | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| F02.A0 | Dementia in other diseases classified elsewhere, mild, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| F02.A11 | Dementia in other diseases classified elsewhere, mild, with agitation | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| F02.A18 | Dementia in other diseases classified elsewhere, mild, with other behavioral disturbance | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| F02.A2 | Dementia in other diseases classified elsewhere, mild, with psychotic disturbance | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| F02.A3 | Dementia in other diseases classified elsewhere, mild, with mood disturbance | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| F02.A4 | Dementia in other diseases classified elsewhere, mild, with anxiety | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| F02.B0 | Dementia in other diseases classified elsewhere, moderate, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety | ccmpcm | HCC 126 · Dementia, Moderate |
| F02.B11 | Dementia in other diseases classified elsewhere, moderate, with agitation | ccmpcm | HCC 126 · Dementia, Moderate |
| F02.B18 | Dementia in other diseases classified elsewhere, moderate, with other behavioral disturbance | ccmpcm | HCC 126 · Dementia, Moderate |
| F02.B2 | Dementia in other diseases classified elsewhere, moderate, with psychotic disturbance | ccmpcm | HCC 126 · Dementia, Moderate |
| F02.B3 | Dementia in other diseases classified elsewhere, moderate, with mood disturbance | ccmpcm | HCC 126 · Dementia, Moderate |
| F02.B4 | Dementia in other diseases classified elsewhere, moderate, with anxiety | ccmpcm | HCC 126 · Dementia, Moderate |
| F02.C0 | Dementia in other diseases classified elsewhere, severe, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety | ccmpcm | HCC 125 · Dementia, Severe |
| F02.C11 | Dementia in other diseases classified elsewhere, severe, with agitation | ccmpcm | HCC 125 · Dementia, Severe |
| F02.C18 | Dementia in other diseases classified elsewhere, severe, with other behavioral disturbance | ccmpcm | HCC 125 · Dementia, Severe |
| F02.C2 | Dementia in other diseases classified elsewhere, severe, with psychotic disturbance | ccmpcm | HCC 125 · Dementia, Severe |
| F02.C3 | Dementia in other diseases classified elsewhere, severe, with mood disturbance | ccmpcm | HCC 125 · Dementia, Severe |
| F02.C4 | Dementia in other diseases classified elsewhere, severe, with anxiety | ccmpcm | HCC 125 · Dementia, Severe |
| F03.90 | Unspecified dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| F03.911 | Unspecified dementia, unspecified severity, with agitation | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| F03.918 | Unspecified dementia, unspecified severity, with other behavioral disturbance | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| F03.92 | Unspecified dementia, unspecified severity, with psychotic disturbance | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| F03.93 | Unspecified dementia, unspecified severity, with mood disturbance | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| F03.94 | Unspecified dementia, unspecified severity, with anxiety | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| F03.A0 | Unspecified dementia, mild, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| F03.A11 | Unspecified dementia, mild, with agitation | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| F03.A18 | Unspecified dementia, mild, with other behavioral disturbance | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| F03.A2 | Unspecified dementia, mild, with psychotic disturbance | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| F03.A3 | Unspecified dementia, mild, with mood disturbance | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| F03.A4 | Unspecified dementia, mild, with anxiety | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| F03.B0 | Unspecified dementia, moderate, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety | ccmpcm | HCC 126 · Dementia, Moderate |
| F03.B11 | Unspecified dementia, moderate, with agitation | ccmpcm | HCC 126 · Dementia, Moderate |
| F03.B18 | Unspecified dementia, moderate, with other behavioral disturbance | ccmpcm | HCC 126 · Dementia, Moderate |
| F03.B2 | Unspecified dementia, moderate, with psychotic disturbance | ccmpcm | HCC 126 · Dementia, Moderate |
| F03.B3 | Unspecified dementia, moderate, with mood disturbance | ccmpcm | HCC 126 · Dementia, Moderate |
| F03.B4 | Unspecified dementia, moderate, with anxiety | ccmpcm | HCC 126 · Dementia, Moderate |
| F03.C0 | Unspecified dementia, severe, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety | ccmpcm | HCC 125 · Dementia, Severe |
| F03.C11 | Unspecified dementia, severe, with agitation | ccmpcm | HCC 125 · Dementia, Severe |
| F03.C18 | Unspecified dementia, severe, with other behavioral disturbance | ccmpcm | HCC 125 · Dementia, Severe |
| F03.C2 | Unspecified dementia, severe, with psychotic disturbance | ccmpcm | HCC 125 · Dementia, Severe |
| F03.C3 | Unspecified dementia, severe, with mood disturbance | ccmpcm | HCC 125 · Dementia, Severe |
| F03.C4 | Unspecified dementia, severe, with anxiety | ccmpcm | HCC 125 · Dementia, Severe |
| G13.2 | Systemic atrophy primarily affecting the central nervous system in myxedema | ccmpcm | not risk adjusted |
| G13.8 | Systemic atrophy primarily affecting central nervous system in other diseases classified elsewhere | ccmpcm | not risk adjusted |
| G31.01 | Pick's disease | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| G31.09 | Other frontotemporal neurocognitive disorder | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| G31.1 | Senile degeneration of brain, not elsewhere classified | ccmpcm | not risk adjusted |
| G31.2 | Degeneration of nervous system due to alcohol | ccmpcm | not risk adjusted |
| G31.80 | Leukodystrophy, unspecified | ccmpcm | HCC 200 · Friedreich and Other Hereditary Ataxias; Huntington Disease |
| G31.81 | Alpers disease | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| G31.82 | Leigh's disease | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| G31.83 | Neurocognitive disorder with Lewy bodies | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| G31.84 | Mild cognitive impairment of uncertain or unknown etiology | ccmpcm | not risk adjusted |
| G31.85 | Corticobasal degeneration | ccmpcm | not risk adjusted |
| G31.86 | Alexander disease | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| G31.87 | Primary progressive apraxia of speech | ccmpcm | not risk adjusted |
| G31.89 | Other specified degenerative diseases of nervous system | ccmpcm | not risk adjusted |
| G31.9 | Degenerative disease of nervous system, unspecifiedlow specificity | ccmpcm | not risk adjusted |
Parkinson's disease and secondary parkinsonism
G20, G21, G23, G24, G2545 codesccmpcmrtmGait, activity and fall detection, with therapy adherence tracked under RTM.
Parkinson's disease and secondary parkinsonism
G20, G21, G23, G24, G2545 codesccmpcmrtmCMS chronic condition · CCW category: Parkinson's Disease and Secondary Parkinsonism · Devices: Contactless activity and fall radar, Patient-reported outcome app (RTM)
G20 alone is no longer valid. Code to G20.A1, G20.A2, G20.B1, G20.B2 or G20.C.
| Code | Official ICD-10-CM description | Programs | Risk adjustment |
|---|---|---|---|
| G20.A1 | Parkinson's disease without dyskinesia, without mention of fluctuations | ccmpcmrtm | HCC 199 · Parkinson and Other Degenerative Disease of Basal Ganglia |
| G20.A2 | Parkinson's disease without dyskinesia, with fluctuations | ccmpcmrtm | HCC 199 · Parkinson and Other Degenerative Disease of Basal Ganglia |
| G20.B1 | Parkinson's disease with dyskinesia, without mention of fluctuations | ccmpcmrtm | HCC 199 · Parkinson and Other Degenerative Disease of Basal Ganglia |
| G20.B2 | Parkinson's disease with dyskinesia, with fluctuations | ccmpcmrtm | HCC 199 · Parkinson and Other Degenerative Disease of Basal Ganglia |
| G20.C | Parkinsonism, unspecified | ccmpcmrtm | HCC 199 · Parkinson and Other Degenerative Disease of Basal Ganglia |
| G21.0 | Malignant neuroleptic syndrome | ccmpcmrtm | not risk adjusted |
| G21.11 | Neuroleptic induced parkinsonism | ccmpcmrtm | not risk adjusted |
| G21.19 | Other drug induced secondary parkinsonism | ccmpcmrtm | not risk adjusted |
| G21.2 | Secondary parkinsonism due to other external agents | ccmpcmrtm | not risk adjusted |
| G21.3 | Postencephalitic parkinsonism | ccmpcmrtm | HCC 199 · Parkinson and Other Degenerative Disease of Basal Ganglia |
| G21.4 | Vascular parkinsonism | ccmpcmrtm | HCC 199 · Parkinson and Other Degenerative Disease of Basal Ganglia |
| G21.8 | Other secondary parkinsonism | ccmpcmrtm | HCC 199 · Parkinson and Other Degenerative Disease of Basal Ganglia |
| G21.9 | Secondary parkinsonism, unspecified | ccmpcmrtm | HCC 199 · Parkinson and Other Degenerative Disease of Basal Ganglia |
| G23.0 | Hallervorden-Spatz disease | ccmpcmrtm | HCC 199 · Parkinson and Other Degenerative Disease of Basal Ganglia |
| G23.1 | Progressive supranuclear ophthalmoplegia [Steele-Richardson-Olszewski] | ccmpcmrtm | HCC 199 · Parkinson and Other Degenerative Disease of Basal Ganglia |
| G23.2 | Striatonigral degeneration | ccmpcmrtm | HCC 199 · Parkinson and Other Degenerative Disease of Basal Ganglia |
| G23.3 | Hypomyelination with atrophy of the basal ganglia and cerebellum | ccmpcmrtm | HCC 199 · Parkinson and Other Degenerative Disease of Basal Ganglia |
| G23.8 | Other specified degenerative diseases of basal ganglia | ccmpcmrtm | HCC 199 · Parkinson and Other Degenerative Disease of Basal Ganglia |
| G23.9 | Degenerative disease of basal ganglia, unspecified | ccmpcmrtm | HCC 199 · Parkinson and Other Degenerative Disease of Basal Ganglia |
| G24.01 | Drug induced subacute dyskinesia | ccmpcmrtm | not risk adjusted |
| G24.02 | Drug induced acute dystonia | ccmpcmrtm | not risk adjusted |
| G24.09 | Other drug induced dystonia | ccmpcmrtm | not risk adjusted |
| G24.1 | Genetic torsion dystonia | ccmpcmrtm | not risk adjusted |
| G24.2 | Idiopathic nonfamilial dystonia | ccmpcmrtm | not risk adjusted |
| G24.3 | Spasmodic torticollis | ccmpcmrtm | not risk adjusted |
| G24.4 | Idiopathic orofacial dystonia | ccmpcmrtm | not risk adjusted |
| G24.5 | Blepharospasm | ccmpcmrtm | not risk adjusted |
| G24.8 | Other dystonia | ccmpcmrtm | not risk adjusted |
| G24.9 | Dystonia, unspecified | ccmpcmrtm | not risk adjusted |
| G25.0 | Essential tremor | ccmpcmrtm | not risk adjusted |
| G25.1 | Drug-induced tremor | ccmpcmrtm | not risk adjusted |
| G25.2 | Other specified forms of tremor | ccmpcmrtm | not risk adjusted |
| G25.3 | Myoclonus | ccmpcmrtm | not risk adjusted |
| G25.4 | Drug-induced chorea | ccmpcmrtm | not risk adjusted |
| G25.5 | Other chorea | ccmpcmrtm | not risk adjusted |
| G25.61 | Drug induced tics | ccmpcmrtm | not risk adjusted |
| G25.69 | Other tics of organic origin | ccmpcmrtm | not risk adjusted |
| G25.70 | Drug induced movement disorder, unspecified | ccmpcmrtm | not risk adjusted |
| G25.71 | Drug induced akathisia | ccmpcmrtm | not risk adjusted |
| G25.79 | Other drug induced movement disorders | ccmpcmrtm | not risk adjusted |
| G25.81 | Restless legs syndrome | ccmpcmrtm | not risk adjusted |
| G25.82 | Stiff-man syndrome | ccmpcmrtm | not risk adjusted |
| G25.83 | Benign shuddering attacks | ccmpcmrtm | not risk adjusted |
| G25.89 | Other specified extrapyramidal and movement disorders | ccmpcmrtm | not risk adjusted |
| G25.9 | Extrapyramidal and movement disorder, unspecified | ccmpcmrtm | not risk adjusted |
Multiple sclerosis and demyelinating disease
G35, G36, G3721 codesccmpcmrtmFunction and fatigue tracking, with therapy adherence under RTM.
Multiple sclerosis and demyelinating disease
G35, G36, G3721 codesccmpcmrtmCMS other chronic or potentially disabling condition · CCW category: Multiple Sclerosis and Transverse Myelitis · Devices: Patient-reported outcome app (RTM), Contactless activity and fall radar
G35 alone is no longer valid as of FY2026. Code to G35.A through G35.D.
| Code | Official ICD-10-CM description | Programs | Risk adjustment |
|---|---|---|---|
| G35.A | Relapsing-remitting multiple sclerosis | ccmpcmrtm | HCC 198 · Multiple Sclerosis |
| G35.B0 | Primary progressive multiple sclerosis, unspecified | ccmpcmrtm | HCC 198 · Multiple Sclerosis |
| G35.B1 | Active primary progressive multiple sclerosis | ccmpcmrtm | HCC 198 · Multiple Sclerosis |
| G35.B2 | Non-active primary progressive multiple sclerosis | ccmpcmrtm | HCC 198 · Multiple Sclerosis |
| G35.C0 | Secondary progressive multiple sclerosis, unspecified | ccmpcmrtm | HCC 198 · Multiple Sclerosis |
| G35.C1 | Active secondary progressive multiple sclerosis | ccmpcmrtm | HCC 198 · Multiple Sclerosis |
| G35.C2 | Non-active secondary progressive multiple sclerosis | ccmpcmrtm | HCC 198 · Multiple Sclerosis |
| G35.D | Multiple sclerosis, unspecified | ccmpcmrtm | HCC 198 · Multiple Sclerosis |
| G36.0 | Neuromyelitis optica [Devic] | ccmpcmrtm | HCC 198 · Multiple Sclerosis |
| G36.1 | Acute and subacute hemorrhagic leukoencephalitis [Hurst] | ccmpcmrtm | HCC 198 · Multiple Sclerosis |
| G36.8 | Other specified acute disseminated demyelination | ccmpcmrtm | HCC 198 · Multiple Sclerosis |
| G36.9 | Acute disseminated demyelination, unspecified | ccmpcmrtm | HCC 198 · Multiple Sclerosis |
| G37.0 | Diffuse sclerosis of central nervous system | ccmpcmrtm | HCC 198 · Multiple Sclerosis |
| G37.1 | Central demyelination of corpus callosum | ccmpcmrtm | HCC 198 · Multiple Sclerosis |
| G37.2 | Central pontine myelinolysis | ccmpcmrtm | HCC 198 · Multiple Sclerosis |
| G37.3 | Acute transverse myelitis in demyelinating disease of central nervous system | ccmpcmrtm | HCC 182 · Spinal Cord Disorders/Injuries |
| G37.4 | Subacute necrotizing myelitis of central nervous system | ccmpcmrtm | HCC 182 · Spinal Cord Disorders/Injuries |
| G37.5 | Concentric sclerosis [Balo] of central nervous system | ccmpcmrtm | HCC 198 · Multiple Sclerosis |
| G37.81 | Myelin oligodendrocyte glycoprotein antibody disease | ccmpcmrtm | HCC 198 · Multiple Sclerosis |
| G37.89 | Other specified demyelinating diseases of central nervous system | ccmpcmrtm | HCC 198 · Multiple Sclerosis |
| G37.9 | Demyelinating disease of central nervous system, unspecified | ccmpcmrtm | HCC 198 · Multiple Sclerosis |
Epilepsy and recurrent seizures
G4058 codesccmpcmSeizure diary and medication adherence.
Epilepsy and recurrent seizures
G4058 codesccmpcmCMS other chronic or potentially disabling condition · CCW category: Epilepsy · Devices: Patient-reported outcome app (RTM)
| Code | Official ICD-10-CM description | Programs | Risk adjustment |
|---|---|---|---|
| G40.001 | Localization-related (focal) (partial) idiopathic epilepsy and epileptic syndromes with seizures of localized onset, not intractable, with status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.009 | Localization-related (focal) (partial) idiopathic epilepsy and epileptic syndromes with seizures of localized onset, not intractable, without status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.011 | Localization-related (focal) (partial) idiopathic epilepsy and epileptic syndromes with seizures of localized onset, intractable, with status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.019 | Localization-related (focal) (partial) idiopathic epilepsy and epileptic syndromes with seizures of localized onset, intractable, without status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.101 | Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures, not intractable, with status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.109 | Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures, not intractable, without status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.111 | Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures, intractable, with status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.119 | Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures, intractable, without status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.201 | Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, not intractable, with status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.209 | Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, not intractable, without status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.211 | Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, intractable, with status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.219 | Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, intractable, without status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.301 | Generalized idiopathic epilepsy and epileptic syndromes, not intractable, with status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.309 | Generalized idiopathic epilepsy and epileptic syndromes, not intractable, without status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.311 | Generalized idiopathic epilepsy and epileptic syndromes, intractable, with status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.319 | Generalized idiopathic epilepsy and epileptic syndromes, intractable, without status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.401 | Other generalized epilepsy and epileptic syndromes, not intractable, with status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.409 | Other generalized epilepsy and epileptic syndromes, not intractable, without status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.411 | Other generalized epilepsy and epileptic syndromes, intractable, with status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.419 | Other generalized epilepsy and epileptic syndromes, intractable, without status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.42 | Cyclin-Dependent Kinase-Like 5 Deficiency Disorder | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.501 | Epileptic seizures related to external causes, not intractable, with status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.509 | Epileptic seizures related to external causes, not intractable, without status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.801 | Other epilepsy, not intractable, with status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.802 | Other epilepsy, not intractable, without status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.803 | Other epilepsy, intractable, with status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.804 | Other epilepsy, intractable, without status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.811 | Lennox-Gastaut syndrome, not intractable, with status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.812 | Lennox-Gastaut syndrome, not intractable, without status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.813 | Lennox-Gastaut syndrome, intractable, with status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.814 | Lennox-Gastaut syndrome, intractable, without status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.821 | Epileptic spasms, not intractable, with status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.822 | Epileptic spasms, not intractable, without status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.823 | Epileptic spasms, intractable, with status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.824 | Epileptic spasms, intractable, without status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.833 | Dravet syndrome, intractable, with status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.834 | Dravet syndrome, intractable, without status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.841 | KCNQ2-related epilepsy, not intractable, with status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.842 | KCNQ2-related epilepsy, not intractable, without status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.843 | KCNQ2-related epilepsy, intractable, with status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.844 | KCNQ2-related epilepsy, intractable, without status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.89 | Other seizures | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.901 | Epilepsy, unspecified, not intractable, with status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.909 | Epilepsy, unspecified, not intractable, without status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.911 | Epilepsy, unspecified, intractable, with status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.919 | Epilepsy, unspecified, intractable, without status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.A01 | Absence epileptic syndrome, not intractable, with status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.A09 | Absence epileptic syndrome, not intractable, without status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.A11 | Absence epileptic syndrome, intractable, with status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.A19 | Absence epileptic syndrome, intractable, without status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.B01 | Juvenile myoclonic epilepsy, not intractable, with status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.B09 | Juvenile myoclonic epilepsy, not intractable, without status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.B11 | Juvenile myoclonic epilepsy, intractable, with status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.B19 | Juvenile myoclonic epilepsy, intractable, without status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.C01 | Lafora progressive myoclonus epilepsy, not intractable, with status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.C09 | Lafora progressive myoclonus epilepsy, not intractable, without status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.C11 | Lafora progressive myoclonus epilepsy, intractable, with status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.C19 | Lafora progressive myoclonus epilepsy, intractable, without status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
Migraine and other chronic headache
G43, G4488 codesccmrtmHeadache diary, trigger tracking and abortive-medication frequency.
Migraine and other chronic headache
G43, G4488 codesccmrtmCMS other chronic or potentially disabling condition · CCW category: Migraine and Other Chronic Headache · Devices: Patient-reported outcome app (RTM)
| Code | Official ICD-10-CM description | Programs | Risk adjustment |
|---|---|---|---|
| G43.001 | Migraine without aura, not intractable, with status migrainosus | ccmrtm | not risk adjusted |
| G43.009 | Migraine without aura, not intractable, without status migrainosus | ccmrtm | not risk adjusted |
| G43.011 | Migraine without aura, intractable, with status migrainosus | ccmrtm | not risk adjusted |
| G43.019 | Migraine without aura, intractable, without status migrainosus | ccmrtm | not risk adjusted |
| G43.101 | Migraine with aura, not intractable, with status migrainosus | ccmrtm | not risk adjusted |
| G43.109 | Migraine with aura, not intractable, without status migrainosus | ccmrtm | not risk adjusted |
| G43.111 | Migraine with aura, intractable, with status migrainosus | ccmrtm | not risk adjusted |
| G43.119 | Migraine with aura, intractable, without status migrainosus | ccmrtm | not risk adjusted |
| G43.401 | Hemiplegic migraine, not intractable, with status migrainosus | ccmrtm | not risk adjusted |
| G43.409 | Hemiplegic migraine, not intractable, without status migrainosus | ccmrtm | not risk adjusted |
| G43.411 | Hemiplegic migraine, intractable, with status migrainosus | ccmrtm | not risk adjusted |
| G43.419 | Hemiplegic migraine, intractable, without status migrainosus | ccmrtm | not risk adjusted |
| G43.501 | Persistent migraine aura without cerebral infarction, not intractable, with status migrainosus | ccmrtm | not risk adjusted |
| G43.509 | Persistent migraine aura without cerebral infarction, not intractable, without status migrainosus | ccmrtm | not risk adjusted |
| G43.511 | Persistent migraine aura without cerebral infarction, intractable, with status migrainosus | ccmrtm | not risk adjusted |
| G43.519 | Persistent migraine aura without cerebral infarction, intractable, without status migrainosus | ccmrtm | not risk adjusted |
| G43.601 | Persistent migraine aura with cerebral infarction, not intractable, with status migrainosus | ccmrtm | not risk adjusted |
| G43.609 | Persistent migraine aura with cerebral infarction, not intractable, without status migrainosus | ccmrtm | not risk adjusted |
| G43.611 | Persistent migraine aura with cerebral infarction, intractable, with status migrainosus | ccmrtm | not risk adjusted |
| G43.619 | Persistent migraine aura with cerebral infarction, intractable, without status migrainosus | ccmrtm | not risk adjusted |
| G43.701 | Chronic migraine without aura, not intractable, with status migrainosus | ccmrtm | not risk adjusted |
| G43.709 | Chronic migraine without aura, not intractable, without status migrainosus | ccmrtm | not risk adjusted |
| G43.711 | Chronic migraine without aura, intractable, with status migrainosus | ccmrtm | not risk adjusted |
| G43.719 | Chronic migraine without aura, intractable, without status migrainosus | ccmrtm | not risk adjusted |
| G43.801 | Other migraine, not intractable, with status migrainosus | ccmrtm | not risk adjusted |
| G43.809 | Other migraine, not intractable, without status migrainosus | ccmrtm | not risk adjusted |
| G43.811 | Other migraine, intractable, with status migrainosus | ccmrtm | not risk adjusted |
| G43.819 | Other migraine, intractable, without status migrainosus | ccmrtm | not risk adjusted |
| G43.821 | Menstrual migraine, not intractable, with status migrainosus | ccmrtm | not risk adjusted |
| G43.829 | Menstrual migraine, not intractable, without status migrainosus | ccmrtm | not risk adjusted |
| G43.831 | Menstrual migraine, intractable, with status migrainosus | ccmrtm | not risk adjusted |
| G43.839 | Menstrual migraine, intractable, without status migrainosus | ccmrtm | not risk adjusted |
| G43.901 | Migraine, unspecified, not intractable, with status migrainosus | ccmrtm | not risk adjusted |
| G43.909 | Migraine, unspecified, not intractable, without status migrainosus | ccmrtm | not risk adjusted |
| G43.911 | Migraine, unspecified, intractable, with status migrainosus | ccmrtm | not risk adjusted |
| G43.919 | Migraine, unspecified, intractable, without status migrainosus | ccmrtm | not risk adjusted |
| G43.A0 | Cyclical vomiting, in migraine, not intractable | ccmrtm | not risk adjusted |
| G43.A1 | Cyclical vomiting, in migraine, intractable | ccmrtm | not risk adjusted |
| G43.B0 | Ophthalmoplegic migraine, not intractable | ccmrtm | not risk adjusted |
| G43.B1 | Ophthalmoplegic migraine, intractable | ccmrtm | not risk adjusted |
| G43.C0 | Periodic headache syndromes in child or adult, not intractable | ccmrtm | not risk adjusted |
| G43.C1 | Periodic headache syndromes in child or adult, intractable | ccmrtm | not risk adjusted |
| G43.D0 | Abdominal migraine, not intractable | ccmrtm | not risk adjusted |
| G43.D1 | Abdominal migraine, intractable | ccmrtm | not risk adjusted |
| G43.E01 | Chronic migraine with aura, not intractable, with status migrainosus | ccmrtm | not risk adjusted |
| G43.E09 | Chronic migraine with aura, not intractable, without status migrainosus | ccmrtm | not risk adjusted |
| G43.E11 | Chronic migraine with aura, intractable, with status migrainosus | ccmrtm | not risk adjusted |
| G43.E19 | Chronic migraine with aura, intractable, without status migrainosus | ccmrtm | not risk adjusted |
| G44.001 | Cluster headache syndrome, unspecified, intractable | ccmrtm | not risk adjusted |
| G44.009 | Cluster headache syndrome, unspecified, not intractable | ccmrtm | not risk adjusted |
| G44.011 | Episodic cluster headache, intractable | ccmrtm | not risk adjusted |
| G44.019 | Episodic cluster headache, not intractable | ccmrtm | not risk adjusted |
| G44.021 | Chronic cluster headache, intractable | ccmrtm | not risk adjusted |
| G44.029 | Chronic cluster headache, not intractable | ccmrtm | not risk adjusted |
| G44.031 | Episodic paroxysmal hemicrania, intractable | ccmrtm | not risk adjusted |
| G44.039 | Episodic paroxysmal hemicrania, not intractable | ccmrtm | not risk adjusted |
| G44.041 | Chronic paroxysmal hemicrania, intractable | ccmrtm | not risk adjusted |
| G44.049 | Chronic paroxysmal hemicrania, not intractable | ccmrtm | not risk adjusted |
| G44.051 | Short lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT), intractable | ccmrtm | not risk adjusted |
| G44.059 | Short lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT), not intractable | ccmrtm | not risk adjusted |
| G44.091 | Other trigeminal autonomic cephalgias (TAC), intractable | ccmrtm | not risk adjusted |
| G44.099 | Other trigeminal autonomic cephalgias (TAC), not intractable | ccmrtm | not risk adjusted |
| G44.1 | Vascular headache, not elsewhere classified | ccmrtm | not risk adjusted |
| G44.201 | Tension-type headache, unspecified, intractable | ccmrtm | not risk adjusted |
| G44.209 | Tension-type headache, unspecified, not intractable | ccmrtm | not risk adjusted |
| G44.211 | Episodic tension-type headache, intractable | ccmrtm | not risk adjusted |
| G44.219 | Episodic tension-type headache, not intractable | ccmrtm | not risk adjusted |
| G44.221 | Chronic tension-type headache, intractable | ccmrtm | not risk adjusted |
| G44.229 | Chronic tension-type headache, not intractable | ccmrtm | not risk adjusted |
| G44.301 | Post-traumatic headache, unspecified, intractable | ccmrtm | not risk adjusted |
| G44.309 | Post-traumatic headache, unspecified, not intractable | ccmrtm | not risk adjusted |
| G44.311 | Acute post-traumatic headache, intractable | ccmrtm | not risk adjusted |
| G44.319 | Acute post-traumatic headache, not intractable | ccmrtm | not risk adjusted |
| G44.321 | Chronic post-traumatic headache, intractable | ccmrtm | not risk adjusted |
| G44.329 | Chronic post-traumatic headache, not intractable | ccmrtm | not risk adjusted |
| G44.40 | Drug-induced headache, not elsewhere classified, not intractable | ccmrtm | not risk adjusted |
| G44.41 | Drug-induced headache, not elsewhere classified, intractable | ccmrtm | not risk adjusted |
| G44.51 | Hemicrania continua | ccmrtm | not risk adjusted |
| G44.52 | New daily persistent headache (NDPH) | ccmrtm | not risk adjusted |
| G44.53 | Primary thunderclap headache | ccmrtm | not risk adjusted |
| G44.59 | Other complicated headache syndrome | ccmrtm | not risk adjusted |
| G44.81 | Hypnic headache | ccmrtm | not risk adjusted |
| G44.82 | Headache associated with sexual activity | ccmrtm | not risk adjusted |
| G44.83 | Primary cough headache | ccmrtm | not risk adjusted |
| G44.84 | Primary exertional headache | ccmrtm | not risk adjusted |
| G44.85 | Primary stabbing headache | ccmrtm | not risk adjusted |
| G44.86 | Cervicogenic headache | ccmrtm | not risk adjusted |
| G44.89 | Other headache syndrome | ccmrtm | not risk adjusted |
Polyneuropathy and nerve disorders
G54, G56, G57, G58, G59, G60, G61, G62, G63, G64, G65107 codes in familyccmpcmrtmPain and function scores, most often alongside diabetes management.
Polyneuropathy and nerve disorders
G54, G56, G57, G58, G59, G60, G61, G62, G63, G64, G65107 codes in familyccmpcmrtmAdded by CCN Health · Devices: Patient-reported outcome app (RTM)
This family runs to 107 codes that differ mainly by anatomic site and laterality, which does not change whether the condition supports care management. The codes are not listed one by one here. Code to the site and side documented in the record, within G54, G56, G57, G58, G59, G60, G61, G62, G63, G64, G65.
Paralysis, cerebral palsy and spinal cord injury
G80, G81, G82, G83, G9562 codes in familyccmpcmrtmFunction, mobility and pressure-injury surveillance.
Paralysis, cerebral palsy and spinal cord injury
G80, G81, G82, G83, G9562 codes in familyccmpcmrtmCMS other chronic or potentially disabling condition · CCW category: Cerebral Palsy · Devices: Contactless activity and fall radar, Patient-reported outcome app (RTM)
This family runs to 62 codes that differ mainly by anatomic site and laterality, which does not change whether the condition supports care management. The codes are not listed one by one here. Code to the site and side documented in the record, within G80, G81, G82, G83, G95.
Traumatic brain injury sequelae
F06, F07, G93.1, G93.424 codes in familyccmbhipcmCognitive and behavioural follow-up with structured instruments.
Traumatic brain injury sequelae
F06, F07, G93.1, G93.424 codes in familyccmbhipcmCMS other chronic or potentially disabling condition · CCW category: Traumatic Brain Injury and Nonpsychotic Mental Disorders due to Brain Damage · Devices: Patient-reported outcome app (RTM)
This family runs to 24 codes that differ mainly by anatomic site and laterality, which does not change whether the condition supports care management. The codes are not listed one by one here. Code to the site and side documented in the record, within F06, F07, G93.1, G93.4.
Muscular dystrophy and myopathies
G71, G72, G7340 codes in familyccmpcmrtmFunction tracking, with respiratory surveillance where the diaphragm is involved.
Muscular dystrophy and myopathies
G71, G72, G7340 codes in familyccmpcmrtmCMS other chronic or potentially disabling condition · CCW category: Muscular Dystrophy · Devices: Patient-reported outcome app (RTM), Pulse oximeter
This family runs to 40 codes that differ mainly by anatomic site and laterality, which does not change whether the condition supports care management. The codes are not listed one by one here. Code to the site and side documented in the record, within G71, G72, G73.
Musculoskeletal and pain
Osteoarthritis
M15, M16, M17, M18, M1998 codesrtmccmPain scores, range of motion and home-exercise adherence. This is the core RTM use case.
Osteoarthritis
M15, M16, M17, M18, M1998 codesrtmccmCMS chronic condition · CCW category: Rheumatoid Arthritis/Osteoarthritis · Devices: Patient-reported outcome app (RTM)
| Code | Official ICD-10-CM description | Programs | Risk adjustment |
|---|---|---|---|
| M15.0 | Primary generalized (osteo)arthritis | rtmccm | not risk adjusted |
| M15.1 | Heberden's nodes (with arthropathy) | rtmccm | not risk adjusted |
| M15.2 | Bouchard's nodes (with arthropathy) | rtmccm | not risk adjusted |
| M15.3 | Secondary multiple arthritis | rtmccm | not risk adjusted |
| M15.4 | Erosive (osteo)arthritis | rtmccm | not risk adjusted |
| M15.8 | Other polyosteoarthritis | rtmccm | not risk adjusted |
| M15.9 | Polyosteoarthritis, unspecified | rtmccm | not risk adjusted |
| M16.0 | Bilateral primary osteoarthritis of hip | rtmccm | not risk adjusted |
| M16.10 | Unilateral primary osteoarthritis, unspecified hip | rtmccm | not risk adjusted |
| M16.11 | Unilateral primary osteoarthritis, right hip | rtmccm | not risk adjusted |
| M16.12 | Unilateral primary osteoarthritis, left hip | rtmccm | not risk adjusted |
| M16.2 | Bilateral osteoarthritis resulting from hip dysplasia | rtmccm | not risk adjusted |
| M16.30 | Unilateral osteoarthritis resulting from hip dysplasia, unspecified hip | rtmccm | not risk adjusted |
| M16.31 | Unilateral osteoarthritis resulting from hip dysplasia, right hip | rtmccm | not risk adjusted |
| M16.32 | Unilateral osteoarthritis resulting from hip dysplasia, left hip | rtmccm | not risk adjusted |
| M16.4 | Bilateral post-traumatic osteoarthritis of hip | rtmccm | not risk adjusted |
| M16.50 | Unilateral post-traumatic osteoarthritis, unspecified hip | rtmccm | not risk adjusted |
| M16.51 | Unilateral post-traumatic osteoarthritis, right hip | rtmccm | not risk adjusted |
| M16.52 | Unilateral post-traumatic osteoarthritis, left hip | rtmccm | not risk adjusted |
| M16.6 | Other bilateral secondary osteoarthritis of hip | rtmccm | not risk adjusted |
| M16.7 | Other unilateral secondary osteoarthritis of hip | rtmccm | not risk adjusted |
| M16.9 | Osteoarthritis of hip, unspecified | rtmccm | not risk adjusted |
| M17.0 | Bilateral primary osteoarthritis of knee | rtmccm | not risk adjusted |
| M17.10 | Unilateral primary osteoarthritis, unspecified knee | rtmccm | not risk adjusted |
| M17.11 | Unilateral primary osteoarthritis, right knee | rtmccm | not risk adjusted |
| M17.12 | Unilateral primary osteoarthritis, left knee | rtmccm | not risk adjusted |
| M17.2 | Bilateral post-traumatic osteoarthritis of knee | rtmccm | not risk adjusted |
| M17.30 | Unilateral post-traumatic osteoarthritis, unspecified knee | rtmccm | not risk adjusted |
| M17.31 | Unilateral post-traumatic osteoarthritis, right knee | rtmccm | not risk adjusted |
| M17.32 | Unilateral post-traumatic osteoarthritis, left knee | rtmccm | not risk adjusted |
| M17.4 | Other bilateral secondary osteoarthritis of knee | rtmccm | not risk adjusted |
| M17.5 | Other unilateral secondary osteoarthritis of knee | rtmccm | not risk adjusted |
| M17.9 | Osteoarthritis of knee, unspecified | rtmccm | not risk adjusted |
| M18.0 | Bilateral primary osteoarthritis of first carpometacarpal joints | rtmccm | not risk adjusted |
| M18.10 | Unilateral primary osteoarthritis of first carpometacarpal joint, unspecified hand | rtmccm | not risk adjusted |
| M18.11 | Unilateral primary osteoarthritis of first carpometacarpal joint, right hand | rtmccm | not risk adjusted |
| M18.12 | Unilateral primary osteoarthritis of first carpometacarpal joint, left hand | rtmccm | not risk adjusted |
| M18.2 | Bilateral post-traumatic osteoarthritis of first carpometacarpal joints | rtmccm | not risk adjusted |
| M18.30 | Unilateral post-traumatic osteoarthritis of first carpometacarpal joint, unspecified hand | rtmccm | not risk adjusted |
| M18.31 | Unilateral post-traumatic osteoarthritis of first carpometacarpal joint, right hand | rtmccm | not risk adjusted |
| M18.32 | Unilateral post-traumatic osteoarthritis of first carpometacarpal joint, left hand | rtmccm | not risk adjusted |
| M18.4 | Other bilateral secondary osteoarthritis of first carpometacarpal joints | rtmccm | not risk adjusted |
| M18.50 | Other unilateral secondary osteoarthritis of first carpometacarpal joint, unspecified hand | rtmccm | not risk adjusted |
| M18.51 | Other unilateral secondary osteoarthritis of first carpometacarpal joint, right hand | rtmccm | not risk adjusted |
| M18.52 | Other unilateral secondary osteoarthritis of first carpometacarpal joint, left hand | rtmccm | not risk adjusted |
| M18.9 | Osteoarthritis of first carpometacarpal joint, unspecified | rtmccm | not risk adjusted |
| M19.011 | Primary osteoarthritis, right shoulder | rtmccm | not risk adjusted |
| M19.012 | Primary osteoarthritis, left shoulder | rtmccm | not risk adjusted |
| M19.019 | Primary osteoarthritis, unspecified shoulder | rtmccm | not risk adjusted |
| M19.021 | Primary osteoarthritis, right elbow | rtmccm | not risk adjusted |
| M19.022 | Primary osteoarthritis, left elbow | rtmccm | not risk adjusted |
| M19.029 | Primary osteoarthritis, unspecified elbow | rtmccm | not risk adjusted |
| M19.031 | Primary osteoarthritis, right wrist | rtmccm | not risk adjusted |
| M19.032 | Primary osteoarthritis, left wrist | rtmccm | not risk adjusted |
| M19.039 | Primary osteoarthritis, unspecified wrist | rtmccm | not risk adjusted |
| M19.041 | Primary osteoarthritis, right hand | rtmccm | not risk adjusted |
| M19.042 | Primary osteoarthritis, left hand | rtmccm | not risk adjusted |
| M19.049 | Primary osteoarthritis, unspecified hand | rtmccm | not risk adjusted |
| M19.071 | Primary osteoarthritis, right ankle and foot | rtmccm | not risk adjusted |
| M19.072 | Primary osteoarthritis, left ankle and foot | rtmccm | not risk adjusted |
| M19.079 | Primary osteoarthritis, unspecified ankle and foot | rtmccm | not risk adjusted |
| M19.09 | Primary osteoarthritis, other specified site | rtmccm | not risk adjusted |
| M19.111 | Post-traumatic osteoarthritis, right shoulder | rtmccm | not risk adjusted |
| M19.112 | Post-traumatic osteoarthritis, left shoulder | rtmccm | not risk adjusted |
| M19.119 | Post-traumatic osteoarthritis, unspecified shoulder | rtmccm | not risk adjusted |
| M19.121 | Post-traumatic osteoarthritis, right elbow | rtmccm | not risk adjusted |
| M19.122 | Post-traumatic osteoarthritis, left elbow | rtmccm | not risk adjusted |
| M19.129 | Post-traumatic osteoarthritis, unspecified elbow | rtmccm | not risk adjusted |
| M19.131 | Post-traumatic osteoarthritis, right wrist | rtmccm | not risk adjusted |
| M19.132 | Post-traumatic osteoarthritis, left wrist | rtmccm | not risk adjusted |
| M19.139 | Post-traumatic osteoarthritis, unspecified wrist | rtmccm | not risk adjusted |
| M19.141 | Post-traumatic osteoarthritis, right hand | rtmccm | not risk adjusted |
| M19.142 | Post-traumatic osteoarthritis, left hand | rtmccm | not risk adjusted |
| M19.149 | Post-traumatic osteoarthritis, unspecified hand | rtmccm | not risk adjusted |
| M19.171 | Post-traumatic osteoarthritis, right ankle and foot | rtmccm | not risk adjusted |
| M19.172 | Post-traumatic osteoarthritis, left ankle and foot | rtmccm | not risk adjusted |
| M19.179 | Post-traumatic osteoarthritis, unspecified ankle and foot | rtmccm | not risk adjusted |
| M19.19 | Post-traumatic osteoarthritis, other specified site | rtmccm | not risk adjusted |
| M19.211 | Secondary osteoarthritis, right shoulder | rtmccm | not risk adjusted |
| M19.212 | Secondary osteoarthritis, left shoulder | rtmccm | not risk adjusted |
| M19.219 | Secondary osteoarthritis, unspecified shoulder | rtmccm | not risk adjusted |
| M19.221 | Secondary osteoarthritis, right elbow | rtmccm | not risk adjusted |
| M19.222 | Secondary osteoarthritis, left elbow | rtmccm | not risk adjusted |
| M19.229 | Secondary osteoarthritis, unspecified elbow | rtmccm | not risk adjusted |
| M19.231 | Secondary osteoarthritis, right wrist | rtmccm | not risk adjusted |
| M19.232 | Secondary osteoarthritis, left wrist | rtmccm | not risk adjusted |
| M19.239 | Secondary osteoarthritis, unspecified wrist | rtmccm | not risk adjusted |
| M19.241 | Secondary osteoarthritis, right hand | rtmccm | not risk adjusted |
| M19.242 | Secondary osteoarthritis, left hand | rtmccm | not risk adjusted |
| M19.249 | Secondary osteoarthritis, unspecified hand | rtmccm | not risk adjusted |
| M19.271 | Secondary osteoarthritis, right ankle and foot | rtmccm | not risk adjusted |
| M19.272 | Secondary osteoarthritis, left ankle and foot | rtmccm | not risk adjusted |
| M19.279 | Secondary osteoarthritis, unspecified ankle and foot | rtmccm | not risk adjusted |
| M19.29 | Secondary osteoarthritis, other specified site | rtmccm | not risk adjusted |
| M19.90 | Unspecified osteoarthritis, unspecified site | rtmccm | not risk adjusted |
| M19.91 | Primary osteoarthritis, unspecified site | rtmccm | not risk adjusted |
| M19.92 | Post-traumatic osteoarthritis, unspecified site | rtmccm | not risk adjusted |
| M19.93 | Secondary osteoarthritis, unspecified site | rtmccm | not risk adjusted |
Rheumatoid and inflammatory arthritis
M05, M06, M08, M12, M13, M45, M46743 codes in familyrtmccmpcmDisease-activity scores, function and therapy adherence.
Rheumatoid and inflammatory arthritis
M05, M06, M08, M12, M13, M45, M46743 codes in familyrtmccmpcmCMS chronic condition · CCW category: Rheumatoid Arthritis/Osteoarthritis · Devices: Patient-reported outcome app (RTM)
This family runs to 743 codes that differ mainly by anatomic site and laterality, which does not change whether the condition supports care management. The codes are not listed one by one here. Code to the site and side documented in the record, within M05, M06, M08, M12, M13, M45, M46.
Low back pain and dorsalgia
M54, M51.1, M51.3, M47.81, M43.166 codesrtmccmPain, function and home-exercise adherence, the standard RTM programme.
Low back pain and dorsalgia
M54, M51.1, M51.3, M47.81, M43.166 codesrtmccmAdded by CCN Health · Devices: Patient-reported outcome app (RTM)
M54.5 was deleted on 2021-10-01. Code to M54.50, M54.51 (vertebrogenic) or M54.59.
| Code | Official ICD-10-CM description | Programs | Risk adjustment |
|---|---|---|---|
| M43.10 | Spondylolisthesis, site unspecified | rtmccm | not risk adjusted |
| M43.11 | Spondylolisthesis, occipito-atlanto-axial region | rtmccm | not risk adjusted |
| M43.12 | Spondylolisthesis, cervical region | rtmccm | not risk adjusted |
| M43.13 | Spondylolisthesis, cervicothoracic region | rtmccm | not risk adjusted |
| M43.14 | Spondylolisthesis, thoracic region | rtmccm | not risk adjusted |
| M43.15 | Spondylolisthesis, thoracolumbar region | rtmccm | not risk adjusted |
| M43.16 | Spondylolisthesis, lumbar region | rtmccm | not risk adjusted |
| M43.17 | Spondylolisthesis, lumbosacral region | rtmccm | not risk adjusted |
| M43.18 | Spondylolisthesis, sacral and sacrococcygeal region | rtmccm | not risk adjusted |
| M43.19 | Spondylolisthesis, multiple sites in spine | rtmccm | not risk adjusted |
| M47.811 | Spondylosis without myelopathy or radiculopathy, occipito-atlanto-axial region | rtmccm | not risk adjusted |
| M47.812 | Spondylosis without myelopathy or radiculopathy, cervical region | rtmccm | not risk adjusted |
| M47.813 | Spondylosis without myelopathy or radiculopathy, cervicothoracic region | rtmccm | not risk adjusted |
| M47.814 | Spondylosis without myelopathy or radiculopathy, thoracic region | rtmccm | not risk adjusted |
| M47.815 | Spondylosis without myelopathy or radiculopathy, thoracolumbar region | rtmccm | not risk adjusted |
| M47.816 | Spondylosis without myelopathy or radiculopathy, lumbar region | rtmccm | not risk adjusted |
| M47.817 | Spondylosis without myelopathy or radiculopathy, lumbosacral region | rtmccm | not risk adjusted |
| M47.818 | Spondylosis without myelopathy or radiculopathy, sacral and sacrococcygeal region | rtmccm | not risk adjusted |
| M47.819 | Spondylosis without myelopathy or radiculopathy, site unspecified | rtmccm | not risk adjusted |
| M51.14 | Intervertebral disc disorders with radiculopathy, thoracic region | rtmccm | not risk adjusted |
| M51.15 | Intervertebral disc disorders with radiculopathy, thoracolumbar region | rtmccm | not risk adjusted |
| M51.16 | Intervertebral disc disorders with radiculopathy, lumbar region | rtmccm | not risk adjusted |
| M51.17 | Intervertebral disc disorders with radiculopathy, lumbosacral region | rtmccm | not risk adjusted |
| M51.34 | Other intervertebral disc degeneration, thoracic region | rtmccm | not risk adjusted |
| M51.35 | Other intervertebral disc degeneration, thoracolumbar region | rtmccm | not risk adjusted |
| M51.360 | Other intervertebral disc degeneration, lumbar region with discogenic back pain only | rtmccm | not risk adjusted |
| M51.361 | Other intervertebral disc degeneration, lumbar region with lower extremity pain only | rtmccm | not risk adjusted |
| M51.362 | Other intervertebral disc degeneration, lumbar region with discogenic back pain and lower extremity pain | rtmccm | not risk adjusted |
| M51.369 | Other intervertebral disc degeneration, lumbar region without mention of lumbar back pain or lower extremity pain | rtmccm | not risk adjusted |
| M51.370 | Other intervertebral disc degeneration, lumbosacral region with discogenic back pain only | rtmccm | not risk adjusted |
| M51.371 | Other intervertebral disc degeneration, lumbosacral region with lower extremity pain only | rtmccm | not risk adjusted |
| M51.372 | Other intervertebral disc degeneration, lumbosacral region with discogenic back pain and lower extremity pain | rtmccm | not risk adjusted |
| M51.379 | Other intervertebral disc degeneration, lumbosacral region without mention of lumbar back pain or lower extremity pain | rtmccm | not risk adjusted |
| M54.00 | Panniculitis affecting regions of neck and back, site unspecified | rtmccm | not risk adjusted |
| M54.01 | Panniculitis affecting regions of neck and back, occipito-atlanto-axial region | rtmccm | not risk adjusted |
| M54.02 | Panniculitis affecting regions of neck and back, cervical region | rtmccm | not risk adjusted |
| M54.03 | Panniculitis affecting regions of neck and back, cervicothoracic region | rtmccm | not risk adjusted |
| M54.04 | Panniculitis affecting regions of neck and back, thoracic region | rtmccm | not risk adjusted |
| M54.05 | Panniculitis affecting regions of neck and back, thoracolumbar region | rtmccm | not risk adjusted |
| M54.06 | Panniculitis affecting regions of neck and back, lumbar region | rtmccm | not risk adjusted |
| M54.07 | Panniculitis affecting regions of neck and back, lumbosacral region | rtmccm | not risk adjusted |
| M54.08 | Panniculitis affecting regions of neck and back, sacral and sacrococcygeal region | rtmccm | not risk adjusted |
| M54.09 | Panniculitis affecting regions, neck and back, multiple sites in spine | rtmccm | not risk adjusted |
| M54.10 | Radiculopathy, site unspecified | rtmccm | not risk adjusted |
| M54.11 | Radiculopathy, occipito-atlanto-axial region | rtmccm | not risk adjusted |
| M54.12 | Radiculopathy, cervical region | rtmccm | not risk adjusted |
| M54.13 | Radiculopathy, cervicothoracic region | rtmccm | not risk adjusted |
| M54.14 | Radiculopathy, thoracic region | rtmccm | not risk adjusted |
| M54.15 | Radiculopathy, thoracolumbar region | rtmccm | not risk adjusted |
| M54.16 | Radiculopathy, lumbar region | rtmccm | not risk adjusted |
| M54.17 | Radiculopathy, lumbosacral region | rtmccm | not risk adjusted |
| M54.18 | Radiculopathy, sacral and sacrococcygeal region | rtmccm | not risk adjusted |
| M54.2 | Cervicalgia | rtmccm | not risk adjusted |
| M54.30 | Sciatica, unspecified side | rtmccm | not risk adjusted |
| M54.31 | Sciatica, right side | rtmccm | not risk adjusted |
| M54.32 | Sciatica, left side | rtmccm | not risk adjusted |
| M54.40 | Lumbago with sciatica, unspecified side | rtmccm | not risk adjusted |
| M54.41 | Lumbago with sciatica, right side | rtmccm | not risk adjusted |
| M54.42 | Lumbago with sciatica, left side | rtmccm | not risk adjusted |
| M54.50 | Low back pain, unspecified | rtmccm | not risk adjusted |
| M54.51 | Vertebrogenic low back pain | rtmccm | not risk adjusted |
| M54.59 | Other low back pain | rtmccm | not risk adjusted |
| M54.6 | Pain in thoracic spine | rtmccm | not risk adjusted |
| M54.81 | Occipital neuralgia | rtmccm | not risk adjusted |
| M54.89 | Other dorsalgia | rtmccm | not risk adjusted |
| M54.9 | Dorsalgia, unspecified | rtmccm | not risk adjusted |
Chronic pain and fibromyalgia
M79.7, G89.2, G89.4, R52, G93.310 codesrtmccmbhiPain scores, sleep and function, with behavioural support where indicated.
Chronic pain and fibromyalgia
M79.7, G89.2, G89.4, R52, G93.310 codesrtmccmbhiCMS other chronic or potentially disabling condition · CCW category: Fibromyalgia, Chronic Pain and Fatigue · Devices: Patient-reported outcome app (RTM)
G89.4 (chronic pain syndrome) and G89.29 (other chronic pain) are secondary codes. Code the underlying condition alongside.
| Code | Official ICD-10-CM description | Programs | Risk adjustment |
|---|---|---|---|
| G89.21 | Chronic pain due to trauma | rtmccmbhi | not risk adjusted |
| G89.22 | Chronic post-thoracotomy pain | rtmccmbhi | not risk adjusted |
| G89.28 | Other chronic postprocedural pain | rtmccmbhi | not risk adjusted |
| G89.29 | Other chronic pain | rtmccmbhi | not risk adjusted |
| G89.4 | Chronic pain syndrome | rtmccmbhi | not risk adjusted |
| G93.31 | Postviral fatigue syndrome | rtmccmbhi | not risk adjusted |
| G93.32 | Myalgic encephalomyelitis/chronic fatigue syndrome | rtmccmbhi | not risk adjusted |
| G93.39 | Other post infection and related fatigue syndromes | rtmccmbhi | not risk adjusted |
| M79.7 | Fibromyalgia | rtmccmbhi | not risk adjusted |
| R52 | Pain, unspecified | rtmccmbhi | not risk adjusted |
Osteoporosis
M80, M81, M85496 codes in familyccmrtmFall risk and activity, with therapy adherence for balance and strength programmes.
Osteoporosis
M80, M81, M85496 codes in familyccmrtmCMS chronic condition · CCW category: Osteoporosis With or Without Pathological Fracture · Devices: Contactless activity and fall radar, Patient-reported outcome app (RTM)
This family runs to 496 codes that differ mainly by anatomic site and laterality, which does not change whether the condition supports care management. The codes are not listed one by one here. Code to the site and side documented in the record, within M80, M81, M85.
Gout and crystal arthropathies
M1A, M10, M11460 codes in familyccmrtmFlare frequency and urate-lowering therapy adherence.
Gout and crystal arthropathies
M1A, M10, M11460 codes in familyccmrtmAdded by CCN Health · Devices: Patient-reported outcome app (RTM)
This family runs to 460 codes that differ mainly by anatomic site and laterality, which does not change whether the condition supports care management. The codes are not listed one by one here. Code to the site and side documented in the record, within M1A, M10, M11.
Systemic lupus and connective tissue disease
M30, M31, M32, M33, M34, M35, M3684 codes in familyccmpcmBlood pressure and symptom tracking, particularly where renal involvement is present.
Systemic lupus and connective tissue disease
M30, M31, M32, M33, M34, M35, M3684 codes in familyccmpcmAdded by CCN Health · Devices: Blood pressure cuff, Patient-reported outcome app (RTM)
This family runs to 84 codes that differ mainly by anatomic site and laterality, which does not change whether the condition supports care management. The codes are not listed one by one here. Code to the site and side documented in the record, within M30, M31, M32, M33, M34, M35, M36.
Mobility impairment and acquired deformity
M20, M21, M24, M25, R26, Z74.0, Z99.3596 codes in familyrtmccmGait, activity level and fall events.
Mobility impairment and acquired deformity
M20, M21, M24, M25, R26, Z74.0, Z99.3596 codes in familyrtmccmCMS other chronic or potentially disabling condition · CCW category: Mobility Impairments · Devices: Contactless activity and fall radar, Patient-reported outcome app (RTM)
This family runs to 596 codes that differ mainly by anatomic site and laterality, which does not change whether the condition supports care management. The codes are not listed one by one here. Code to the site and side documented in the record, within M20, M21, M24, M25, R26, Z74.0, Z99.3.
Other chronic and potentially disabling
Anemia
D50, D51, D52, D53, D55, D56, D58, D59, D60, D61, D62, D63, D6484 codesccmLaboratory-driven. Anemia most often appears as the second CCM condition alongside CKD or heart failure.
Anemia
D50, D51, D52, D53, D55, D56, D58, D59, D60, D61, D62, D63, D6484 codesccmCMS chronic condition · CCW category: Anemia
| Code | Official ICD-10-CM description | Programs | Risk adjustment |
|---|---|---|---|
| D50.0 | Iron deficiency anemia secondary to blood loss (chronic) | ccm | not risk adjusted |
| D50.1 | Sideropenic dysphagia | ccm | not risk adjusted |
| D50.8 | Other iron deficiency anemias | ccm | not risk adjusted |
| D50.9 | Iron deficiency anemia, unspecified | ccm | not risk adjusted |
| D51.0 | Vitamin B12 deficiency anemia due to intrinsic factor deficiency | ccm | not risk adjusted |
| D51.1 | Vitamin B12 deficiency anemia due to selective vitamin B12 malabsorption with proteinuria | ccm | not risk adjusted |
| D51.2 | Transcobalamin II deficiency | ccm | not risk adjusted |
| D51.3 | Other dietary vitamin B12 deficiency anemia | ccm | not risk adjusted |
| D51.8 | Other vitamin B12 deficiency anemias | ccm | not risk adjusted |
| D51.9 | Vitamin B12 deficiency anemia, unspecified | ccm | not risk adjusted |
| D52.0 | Dietary folate deficiency anemia | ccm | not risk adjusted |
| D52.1 | Drug-induced folate deficiency anemia | ccm | not risk adjusted |
| D52.8 | Other folate deficiency anemias | ccm | not risk adjusted |
| D52.9 | Folate deficiency anemia, unspecified | ccm | not risk adjusted |
| D53.0 | Protein deficiency anemia | ccm | not risk adjusted |
| D53.1 | Other megaloblastic anemias, not elsewhere classified | ccm | not risk adjusted |
| D53.2 | Scorbutic anemia | ccm | not risk adjusted |
| D53.8 | Other specified nutritional anemias | ccm | not risk adjusted |
| D53.9 | Nutritional anemia, unspecified | ccm | not risk adjusted |
| D55.0 | Anemia due to glucose-6-phosphate dehydrogenase [G6PD] deficiency | ccm | not risk adjusted |
| D55.1 | Anemia due to other disorders of glutathione metabolism | ccm | not risk adjusted |
| D55.21 | Anemia due to pyruvate kinase deficiency | ccm | not risk adjusted |
| D55.29 | Anemia due to other disorders of glycolytic enzymes | ccm | not risk adjusted |
| D55.3 | Anemia due to disorders of nucleotide metabolism | ccm | not risk adjusted |
| D55.8 | Other anemias due to enzyme disorders | ccm | not risk adjusted |
| D55.9 | Anemia due to enzyme disorder, unspecified | ccm | not risk adjusted |
| D56.0 | Alpha thalassemia | ccm | not risk adjusted |
| D56.1 | Beta thalassemia | ccm | HCC 108 · Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major |
| D56.2 | Delta-beta thalassemia | ccm | HCC 108 · Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major |
| D56.3 | Thalassemia minor | ccm | not risk adjusted |
| D56.4 | Hereditary persistence of fetal hemoglobin [HPFH] | ccm | not risk adjusted |
| D56.5 | Hemoglobin E-beta thalassemia | ccm | HCC 108 · Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major |
| D56.8 | Other thalassemias | ccm | not risk adjusted |
| D56.9 | Thalassemia, unspecifiedlow specificity | ccm | not risk adjusted |
| D58.0 | Hereditary spherocytosis | ccm | not risk adjusted |
| D58.1 | Hereditary elliptocytosis | ccm | not risk adjusted |
| D58.2 | Other hemoglobinopathies | ccm | not risk adjusted |
| D58.8 | Other specified hereditary hemolytic anemias | ccm | not risk adjusted |
| D58.9 | Hereditary hemolytic anemia, unspecified | ccm | not risk adjusted |
| D59.0 | Drug-induced autoimmune hemolytic anemia | ccm | not risk adjusted |
| D59.10 | Autoimmune hemolytic anemia, unspecified | ccm | HCC 109 · Acquired Hemolytic, Aplastic, and Sideroblastic Anemias |
| D59.11 | Warm autoimmune hemolytic anemia | ccm | HCC 109 · Acquired Hemolytic, Aplastic, and Sideroblastic Anemias |
| D59.12 | Cold autoimmune hemolytic anemia | ccm | HCC 109 · Acquired Hemolytic, Aplastic, and Sideroblastic Anemias |
| D59.13 | Mixed type autoimmune hemolytic anemia | ccm | HCC 109 · Acquired Hemolytic, Aplastic, and Sideroblastic Anemias |
| D59.19 | Other autoimmune hemolytic anemia | ccm | HCC 109 · Acquired Hemolytic, Aplastic, and Sideroblastic Anemias |
| D59.2 | Drug-induced nonautoimmune hemolytic anemia | ccm | not risk adjusted |
| D59.30 | Hemolytic-uremic syndrome, unspecified | ccm | HCC 109 · Acquired Hemolytic, Aplastic, and Sideroblastic Anemias |
| D59.31 | Infection-associated hemolytic-uremic syndrome | ccm | HCC 109 · Acquired Hemolytic, Aplastic, and Sideroblastic Anemias |
| D59.32 | Hereditary hemolytic-uremic syndrome | ccm | HCC 109 · Acquired Hemolytic, Aplastic, and Sideroblastic Anemias |
| D59.39 | Other hemolytic-uremic syndrome | ccm | HCC 109 · Acquired Hemolytic, Aplastic, and Sideroblastic Anemias |
| D59.4 | Other nonautoimmune hemolytic anemias | ccm | HCC 109 · Acquired Hemolytic, Aplastic, and Sideroblastic Anemias |
| D59.5 | Paroxysmal nocturnal hemoglobinuria [Marchiafava-Micheli] | ccm | HCC 109 · Acquired Hemolytic, Aplastic, and Sideroblastic Anemias |
| D59.6 | Hemoglobinuria due to hemolysis from other external causes | ccm | HCC 109 · Acquired Hemolytic, Aplastic, and Sideroblastic Anemias |
| D59.8 | Other acquired hemolytic anemias | ccm | HCC 109 · Acquired Hemolytic, Aplastic, and Sideroblastic Anemias |
| D59.9 | Acquired hemolytic anemia, unspecified | ccm | HCC 109 · Acquired Hemolytic, Aplastic, and Sideroblastic Anemias |
| D60.0 | Chronic acquired pure red cell aplasia | ccm | HCC 109 · Acquired Hemolytic, Aplastic, and Sideroblastic Anemias |
| D60.1 | Transient acquired pure red cell aplasia | ccm | not risk adjusted |
| D60.8 | Other acquired pure red cell aplasias | ccm | HCC 109 · Acquired Hemolytic, Aplastic, and Sideroblastic Anemias |
| D60.9 | Acquired pure red cell aplasia, unspecified | ccm | HCC 109 · Acquired Hemolytic, Aplastic, and Sideroblastic Anemias |
| D61.01 | Constitutional (pure) red blood cell aplasia | ccm | HCC 109 · Acquired Hemolytic, Aplastic, and Sideroblastic Anemias |
| D61.02 | Shwachman-Diamond syndrome | ccm | HCC 109 · Acquired Hemolytic, Aplastic, and Sideroblastic Anemias |
| D61.03 | Fanconi anemia | ccm | HCC 109 · Acquired Hemolytic, Aplastic, and Sideroblastic Anemias |
| D61.09 | Other constitutional aplastic anemia | ccm | HCC 109 · Acquired Hemolytic, Aplastic, and Sideroblastic Anemias |
| D61.1 | Drug-induced aplastic anemia | ccm | not risk adjusted |
| D61.2 | Aplastic anemia due to other external agents | ccm | HCC 109 · Acquired Hemolytic, Aplastic, and Sideroblastic Anemias |
| D61.3 | Idiopathic aplastic anemia | ccm | HCC 109 · Acquired Hemolytic, Aplastic, and Sideroblastic Anemias |
| D61.810 | Antineoplastic chemotherapy induced pancytopenia | ccm | not risk adjusted |
| D61.811 | Other drug-induced pancytopenia | ccm | not risk adjusted |
| D61.818 | Other pancytopenia | ccm | HCC 109 · Acquired Hemolytic, Aplastic, and Sideroblastic Anemias |
| D61.82 | Myelophthisis | ccm | HCC 109 · Acquired Hemolytic, Aplastic, and Sideroblastic Anemias |
| D61.89 | Other specified aplastic anemias and other bone marrow failure syndromes | ccm | HCC 109 · Acquired Hemolytic, Aplastic, and Sideroblastic Anemias |
| D61.9 | Aplastic anemia, unspecifiedlow specificity | ccm | not risk adjusted |
| D62 | Acute posthemorrhagic anemia | ccm | not risk adjusted |
| D63.0 | Anemia in neoplastic disease | ccm | not risk adjusted |
| D63.1 | Anemia in chronic kidney disease | ccm | not risk adjusted |
| D63.8 | Anemia in other chronic diseases classified elsewhere | ccm | not risk adjusted |
| D64.0 | Hereditary sideroblastic anemia | ccm | HCC 109 · Acquired Hemolytic, Aplastic, and Sideroblastic Anemias |
| D64.1 | Secondary sideroblastic anemia due to disease | ccm | HCC 109 · Acquired Hemolytic, Aplastic, and Sideroblastic Anemias |
| D64.2 | Secondary sideroblastic anemia due to drugs and toxins | ccm | not risk adjusted |
| D64.3 | Other sideroblastic anemias | ccm | HCC 109 · Acquired Hemolytic, Aplastic, and Sideroblastic Anemias |
| D64.4 | Congenital dyserythropoietic anemia | ccm | HCC 109 · Acquired Hemolytic, Aplastic, and Sideroblastic Anemias |
| D64.81 | Anemia due to antineoplastic chemotherapy | ccm | not risk adjusted |
| D64.89 | Other specified anemias | ccm | not risk adjusted |
| D64.9 | Anemia, unspecifiedlow specificity | ccm | not risk adjusted |
Sickle cell disease
D5743 codesrpmccmpcmOxygen saturation and pain-crisis reporting.
Sickle cell disease
D5743 codesrpmccmpcmCMS other chronic or potentially disabling condition · CCW category: Sickle Cell Disease · Devices: Pulse oximeter, Patient-reported outcome app (RTM)
| Code | Official ICD-10-CM description | Programs | Risk adjustment |
|---|---|---|---|
| D57.00 | Hb-SS disease with crisis, unspecified | rpmccmpcm | HCC 107 · Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero |
| D57.01 | Hb-SS disease with acute chest syndrome | rpmccmpcm | HCC 107 · Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero |
| D57.02 | Hb-SS disease with splenic sequestration | rpmccmpcm | HCC 107 · Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero |
| D57.03 | Hb-SS disease with cerebral vascular involvement | rpmccmpcm | HCC 107 · Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero |
| D57.04 | Hb-SS disease with dactylitis | rpmccmpcm | HCC 107 · Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero |
| D57.09 | Hb-SS disease with crisis with other specified complication | rpmccmpcm | HCC 107 · Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero |
| D57.1 | Sickle-cell disease without crisis | rpmccmpcm | HCC 107 · Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero |
| D57.20 | Sickle-cell/Hb-C disease without crisis | rpmccmpcm | HCC 108 · Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major |
| D57.211 | Sickle-cell/Hb-C disease with acute chest syndrome | rpmccmpcm | HCC 108 · Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major |
| D57.212 | Sickle-cell/Hb-C disease with splenic sequestration | rpmccmpcm | HCC 108 · Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major |
| D57.213 | Sickle-cell/Hb-C disease with cerebral vascular involvement | rpmccmpcm | HCC 108 · Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major |
| D57.214 | Sickle-cell/Hb-C disease with dactylitis | rpmccmpcm | HCC 108 · Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major |
| D57.218 | Sickle-cell/Hb-C disease with crisis with other specified complication | rpmccmpcm | HCC 108 · Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major |
| D57.219 | Sickle-cell/Hb-C disease with crisis, unspecified | rpmccmpcm | HCC 108 · Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major |
| D57.3 | Sickle-cell trait | rpmccmpcm | not risk adjusted |
| D57.40 | Sickle-cell thalassemia without crisis | rpmccmpcm | HCC 108 · Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major |
| D57.411 | Sickle-cell thalassemia, unspecified, with acute chest syndrome | rpmccmpcm | HCC 108 · Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major |
| D57.412 | Sickle-cell thalassemia, unspecified, with splenic sequestration | rpmccmpcm | HCC 108 · Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major |
| D57.413 | Sickle-cell thalassemia, unspecified, with cerebral vascular involvement | rpmccmpcm | HCC 108 · Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major |
| D57.414 | Sickle-cell thalassemia, unspecified, with dactylitis | rpmccmpcm | HCC 108 · Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major |
| D57.418 | Sickle-cell thalassemia, unspecified, with crisis with other specified complication | rpmccmpcm | HCC 108 · Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major |
| D57.419 | Sickle-cell thalassemia, unspecified, with crisis | rpmccmpcm | HCC 108 · Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major |
| D57.42 | Sickle-cell thalassemia beta zero without crisis | rpmccmpcm | HCC 107 · Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero |
| D57.431 | Sickle-cell thalassemia beta zero with acute chest syndrome | rpmccmpcm | HCC 107 · Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero |
| D57.432 | Sickle-cell thalassemia beta zero with splenic sequestration | rpmccmpcm | HCC 107 · Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero |
| D57.433 | Sickle-cell thalassemia beta zero with cerebral vascular involvement | rpmccmpcm | HCC 107 · Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero |
| D57.434 | Sickle-cell thalassemia beta zero with dactylitis | rpmccmpcm | HCC 107 · Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero |
| D57.438 | Sickle-cell thalassemia beta zero with crisis with other specified complication | rpmccmpcm | HCC 107 · Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero |
| D57.439 | Sickle-cell thalassemia beta zero with crisis, unspecified | rpmccmpcm | HCC 107 · Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero |
| D57.44 | Sickle-cell thalassemia beta plus without crisis | rpmccmpcm | HCC 108 · Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major |
| D57.451 | Sickle-cell thalassemia beta plus with acute chest syndrome | rpmccmpcm | HCC 108 · Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major |
| D57.452 | Sickle-cell thalassemia beta plus with splenic sequestration | rpmccmpcm | HCC 108 · Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major |
| D57.453 | Sickle-cell thalassemia beta plus with cerebral vascular involvement | rpmccmpcm | HCC 108 · Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major |
| D57.454 | Sickle-cell thalassemia beta plus with dactylitis | rpmccmpcm | HCC 108 · Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major |
| D57.458 | Sickle-cell thalassemia beta plus with crisis with other specified complication | rpmccmpcm | HCC 108 · Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major |
| D57.459 | Sickle-cell thalassemia beta plus with crisis, unspecified | rpmccmpcm | HCC 108 · Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major |
| D57.80 | Other sickle-cell disorders without crisis | rpmccmpcm | HCC 108 · Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major |
| D57.811 | Other sickle-cell disorders with acute chest syndrome | rpmccmpcm | HCC 108 · Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major |
| D57.812 | Other sickle-cell disorders with splenic sequestration | rpmccmpcm | HCC 108 · Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major |
| D57.813 | Other sickle-cell disorders with cerebral vascular involvement | rpmccmpcm | HCC 108 · Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major |
| D57.814 | Other sickle-cell disorders with dactylitis | rpmccmpcm | HCC 108 · Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major |
| D57.818 | Other sickle-cell disorders with crisis with other specified complication | rpmccmpcm | HCC 108 · Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major |
| D57.819 | Other sickle-cell disorders with crisis, unspecified | rpmccmpcm | HCC 108 · Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major |
HIV and AIDS
B20, Z212 codesccmpcmAdherence and laboratory follow-up.
HIV and AIDS
B20, Z212 codesccmpcmCMS other chronic or potentially disabling condition · CCW category: Human Immunodeficiency Virus and/or Acquired Immunodeficiency Syndrome (HIV/AIDS)
| Code | Official ICD-10-CM description | Programs | Risk adjustment |
|---|---|---|---|
| B20 | Human immunodeficiency virus [HIV] disease | ccmpcm | HCC 1 · HIV/AIDS |
| Z21 | Asymptomatic human immunodeficiency virus [HIV] infection status | ccmpcm | HCC 1 · HIV/AIDS |
Viral hepatitis
B15, B16, B17, B18, B1923 codesccmpcmTreatment adherence and laboratory follow-up.
Viral hepatitis
B15, B16, B17, B18, B1923 codesccmpcmCMS other chronic or potentially disabling condition · CCW category: Viral Hepatitis
| Code | Official ICD-10-CM description | Programs | Risk adjustment |
|---|---|---|---|
| B15.0 | Hepatitis A with hepatic coma | ccmpcm | not risk adjusted |
| B15.9 | Hepatitis A without hepatic coma | ccmpcm | not risk adjusted |
| B16.0 | Acute hepatitis B with delta-agent with hepatic coma | ccmpcm | not risk adjusted |
| B16.1 | Acute hepatitis B with delta-agent without hepatic coma | ccmpcm | not risk adjusted |
| B16.2 | Acute hepatitis B without delta-agent with hepatic coma | ccmpcm | not risk adjusted |
| B16.9 | Acute hepatitis B without delta-agent and without hepatic coma | ccmpcm | not risk adjusted |
| B17.0 | Acute delta-(super) infection of hepatitis B carrier | ccmpcm | not risk adjusted |
| B17.10 | Acute hepatitis C without hepatic coma | ccmpcm | not risk adjusted |
| B17.11 | Acute hepatitis C with hepatic coma | ccmpcm | not risk adjusted |
| B17.2 | Acute hepatitis E | ccmpcm | not risk adjusted |
| B17.8 | Other specified acute viral hepatitis | ccmpcm | not risk adjusted |
| B17.9 | Acute viral hepatitis, unspecified | ccmpcm | not risk adjusted |
| B18.0 | Chronic viral hepatitis B with delta-agent | ccmpcm | HCC 65 · Chronic Hepatitis |
| B18.1 | Chronic viral hepatitis B without delta-agent | ccmpcm | HCC 65 · Chronic Hepatitis |
| B18.2 | Chronic viral hepatitis C | ccmpcm | HCC 65 · Chronic Hepatitis |
| B18.8 | Other chronic viral hepatitis | ccmpcm | HCC 65 · Chronic Hepatitis |
| B18.9 | Chronic viral hepatitis, unspecified | ccmpcm | HCC 65 · Chronic Hepatitis |
| B19.0 | Unspecified viral hepatitis with hepatic coma | ccmpcm | not risk adjusted |
| B19.10 | Unspecified viral hepatitis B without hepatic coma | ccmpcm | not risk adjusted |
| B19.11 | Unspecified viral hepatitis B with hepatic coma | ccmpcm | not risk adjusted |
| B19.20 | Unspecified viral hepatitis C without hepatic coma | ccmpcm | not risk adjusted |
| B19.21 | Unspecified viral hepatitis C with hepatic coma | ccmpcm | not risk adjusted |
| B19.9 | Unspecified viral hepatitis without hepatic coma | ccmpcm | not risk adjusted |
Chronic liver disease and cirrhosis
K70, K71, K72, K73, K74, K75, K76, K7763 codesrpmccmpcmWeight for ascites surveillance and blood pressure for portal hypertension management.
Chronic liver disease and cirrhosis
K70, K71, K72, K73, K74, K75, K76, K7763 codesrpmccmpcmCMS other chronic or potentially disabling condition · CCW category: Liver Disease, Cirrhosis and Other Liver Conditions (except Viral Hepatitis) · Devices: Connected weight scale, Blood pressure cuff
| Code | Official ICD-10-CM description | Programs | Risk adjustment |
|---|---|---|---|
| K70.0 | Alcoholic fatty liver | rpmccmpcm | not risk adjusted |
| K70.10 | Alcoholic hepatitis without ascites | rpmccmpcm | HCC 65 · Chronic Hepatitis |
| K70.11 | Alcoholic hepatitis with ascites | rpmccmpcm | HCC 65 · Chronic Hepatitis |
| K70.2 | Alcoholic fibrosis and sclerosis of liver | rpmccmpcm | not risk adjusted |
| K70.30 | Alcoholic cirrhosis of liver without ascites | rpmccmpcm | HCC 64 · Cirrhosis of Liver |
| K70.31 | Alcoholic cirrhosis of liver with ascites | rpmccmpcm | HCC 64 · Cirrhosis of Liver |
| K70.40 | Alcoholic hepatic failure without coma | rpmccmpcm | HCC 63 · Chronic Liver Failure/End-Stage Liver Disorders |
| K70.41 | Alcoholic hepatic failure with coma | rpmccmpcm | HCC 63 · Chronic Liver Failure/End-Stage Liver Disorders |
| K70.9 | Alcoholic liver disease, unspecifiedlow specificity | rpmccmpcm | not risk adjusted |
| K71.0 | Toxic liver disease with cholestasis | rpmccmpcm | not risk adjusted |
| K71.10 | Toxic liver disease with hepatic necrosis, without coma | rpmccmpcm | not risk adjusted |
| K71.11 | Toxic liver disease with hepatic necrosis, with coma | rpmccmpcm | not risk adjusted |
| K71.2 | Toxic liver disease with acute hepatitis | rpmccmpcm | not risk adjusted |
| K71.3 | Toxic liver disease with chronic persistent hepatitis | rpmccmpcm | HCC 65 · Chronic Hepatitis |
| K71.4 | Toxic liver disease with chronic lobular hepatitis | rpmccmpcm | HCC 65 · Chronic Hepatitis |
| K71.50 | Toxic liver disease with chronic active hepatitis without ascites | rpmccmpcm | HCC 65 · Chronic Hepatitis |
| K71.51 | Toxic liver disease with chronic active hepatitis with ascites | rpmccmpcm | HCC 65 · Chronic Hepatitis |
| K71.6 | Toxic liver disease with hepatitis, not elsewhere classified | rpmccmpcm | not risk adjusted |
| K71.7 | Toxic liver disease with fibrosis and cirrhosis of liver | rpmccmpcm | HCC 64 · Cirrhosis of Liver |
| K71.8 | Toxic liver disease with other disorders of liver | rpmccmpcm | not risk adjusted |
| K71.9 | Toxic liver disease, unspecifiedlow specificity | rpmccmpcm | not risk adjusted |
| K72.00 | Acute and subacute hepatic failure without coma | rpmccmpcm | not risk adjusted |
| K72.01 | Acute and subacute hepatic failure with coma | rpmccmpcm | not risk adjusted |
| K72.10 | Chronic hepatic failure without coma | rpmccmpcm | HCC 63 · Chronic Liver Failure/End-Stage Liver Disorders |
| K72.11 | Chronic hepatic failure with coma | rpmccmpcm | HCC 63 · Chronic Liver Failure/End-Stage Liver Disorders |
| K72.90 | Hepatic failure, unspecified without coma | rpmccmpcm | HCC 63 · Chronic Liver Failure/End-Stage Liver Disorders |
| K72.91 | Hepatic failure, unspecified with coma | rpmccmpcm | HCC 63 · Chronic Liver Failure/End-Stage Liver Disorders |
| K73.0 | Chronic persistent hepatitis, not elsewhere classified | rpmccmpcm | HCC 65 · Chronic Hepatitis |
| K73.1 | Chronic lobular hepatitis, not elsewhere classified | rpmccmpcm | HCC 65 · Chronic Hepatitis |
| K73.2 | Chronic active hepatitis, not elsewhere classified | rpmccmpcm | HCC 65 · Chronic Hepatitis |
| K73.8 | Other chronic hepatitis, not elsewhere classified | rpmccmpcm | HCC 65 · Chronic Hepatitis |
| K73.9 | Chronic hepatitis, unspecified | rpmccmpcm | HCC 65 · Chronic Hepatitis |
| K74.00 | Hepatic fibrosis, unspecifiedlow specificity | rpmccmpcm | not risk adjusted |
| K74.01 | Hepatic fibrosis, early fibrosis | rpmccmpcm | not risk adjusted |
| K74.02 | Hepatic fibrosis, advanced fibrosis | rpmccmpcm | not risk adjusted |
| K74.1 | Hepatic sclerosis | rpmccmpcm | not risk adjusted |
| K74.2 | Hepatic fibrosis with hepatic sclerosis | rpmccmpcm | not risk adjusted |
| K74.3 | Primary biliary cirrhosis | rpmccmpcm | HCC 68 · Cholangitis and Obstruction of Bile Duct Without Gallstones |
| K74.4 | Secondary biliary cirrhosis | rpmccmpcm | HCC 64 · Cirrhosis of Liver |
| K74.5 | Biliary cirrhosis, unspecified | rpmccmpcm | HCC 68 · Cholangitis and Obstruction of Bile Duct Without Gallstones |
| K74.60 | Unspecified cirrhosis of liver | rpmccmpcm | HCC 64 · Cirrhosis of Liver |
| K74.69 | Other cirrhosis of liver | rpmccmpcm | HCC 64 · Cirrhosis of Liver |
| K75.0 | Abscess of liver | rpmccmpcm | not risk adjusted |
| K75.1 | Phlebitis of portal vein | rpmccmpcm | not risk adjusted |
| K75.2 | Nonspecific reactive hepatitis | rpmccmpcm | not risk adjusted |
| K75.3 | Granulomatous hepatitis, not elsewhere classified | rpmccmpcm | not risk adjusted |
| K75.4 | Autoimmune hepatitis | rpmccmpcm | HCC 65 · Chronic Hepatitis |
| K75.81 | Nonalcoholic steatohepatitis (NASH) | rpmccmpcm | not risk adjusted |
| K75.89 | Other specified inflammatory liver diseases | rpmccmpcm | not risk adjusted |
| K75.9 | Inflammatory liver disease, unspecifiedlow specificity | rpmccmpcm | not risk adjusted |
| K76.0 | Fatty (change of) liver, not elsewhere classified | rpmccmpcm | not risk adjusted |
| K76.1 | Chronic passive congestion of liver | rpmccmpcm | not risk adjusted |
| K76.2 | Central hemorrhagic necrosis of liver | rpmccmpcm | not risk adjusted |
| K76.3 | Infarction of liver | rpmccmpcm | not risk adjusted |
| K76.4 | Peliosis hepatis | rpmccmpcm | not risk adjusted |
| K76.5 | Hepatic veno-occlusive disease | rpmccmpcm | not risk adjusted |
| K76.6 | Portal hypertension | rpmccmpcm | HCC 63 · Chronic Liver Failure/End-Stage Liver Disorders |
| K76.7 | Hepatorenal syndrome | rpmccmpcm | HCC 63 · Chronic Liver Failure/End-Stage Liver Disorders |
| K76.81 | Hepatopulmonary syndrome | rpmccmpcm | HCC 63 · Chronic Liver Failure/End-Stage Liver Disorders |
| K76.82 | Hepatic encephalopathy | rpmccmpcm | HCC 63 · Chronic Liver Failure/End-Stage Liver Disorders |
| K76.89 | Other specified diseases of liver | rpmccmpcm | not risk adjusted |
| K76.9 | Liver disease, unspecifiedlow specificity | rpmccmpcm | not risk adjusted |
| K77 | Liver disorders in diseases classified elsewhere | rpmccmpcm | not risk adjusted |
Inflammatory bowel disease
K50, K51, K52.378 codes in familyccmpcmrtmSymptom and weight tracking against disease-activity indices.
Inflammatory bowel disease
K50, K51, K52.378 codes in familyccmpcmrtmAdded by CCN Health · Devices: Connected weight scale, Patient-reported outcome app (RTM)
This family runs to 78 codes that differ mainly by anatomic site and laterality, which does not change whether the condition supports care management. The codes are not listed one by one here. Code to the site and side documented in the record, within K50, K51, K52.3.
Pressure ulcers and chronic ulcers
L89, L97, L98.4407 codes in familyccmpcmrtmRepositioning and mobility surveillance alongside structured wound assessment.
Pressure ulcers and chronic ulcers
L89, L97, L98.4407 codes in familyccmpcmrtmCMS other chronic or potentially disabling condition · CCW category: Pressure Ulcers and Chronic Ulcers · Devices: Contactless activity and fall radar
This family runs to 407 codes that differ mainly by anatomic site and laterality, which does not change whether the condition supports care management. The codes are not listed one by one here. Code to the site and side documented in the record, within L89, L97, L98.4.
Leukemias and lymphomas
C81, C82, C83, C84, C85, C86, C88, C90, C91, C92, C93, C94, C95, C96, D45, D46, D47556 codes in familyccmpcmTemperature for neutropenic fever surveillance and weight for nutritional status.
Leukemias and lymphomas
C81, C82, C83, C84, C85, C86, C88, C90, C91, C92, C93, C94, C95, C96, D45, D46, D47556 codes in familyccmpcmCMS other chronic or potentially disabling condition · CCW category: Leukemias and Lymphomas · Devices: Connected thermometer, Connected weight scale
This family runs to 556 codes that differ mainly by anatomic site and laterality, which does not change whether the condition supports care management. The codes are not listed one by one here. Code to the site and side documented in the record, within C81, C82, C83, C84, C85, C86, C88, C90, C91, C92, C93, C94, C95, C96, D45, D46, D47.
Breast cancer
C50, D05, Z85.370 codes in familyccmpcmTreatment-toxicity and symptom surveillance during active therapy.
Breast cancer
C50, D05, Z85.370 codes in familyccmpcmCMS chronic condition · CCW category: Cancer, Breast · Devices: Connected weight scale, Patient-reported outcome app (RTM)
Effective 2026-10-01: From 2026-10-01, D05 carcinoma-in-situ codes may not be reported with a C50 malignant neoplasm code for the same patient.
This family runs to 70 codes that differ mainly by anatomic site and laterality, which does not change whether the condition supports care management. The codes are not listed one by one here. Code to the site and side documented in the record, within C50, D05, Z85.3.
Colorectal cancer
C18, C19, C20, C21, D01.0, D01.1, D01.2, Z85.032 codes in familyccmpcmWeight and symptom surveillance during and after treatment.
Colorectal cancer
C18, C19, C20, C21, D01.0, D01.1, D01.2, Z85.032 codes in familyccmpcmCMS chronic condition · CCW category: Cancer, Colorectal · Devices: Connected weight scale, Patient-reported outcome app (RTM)
This family runs to 32 codes that differ mainly by anatomic site and laterality, which does not change whether the condition supports care management. The codes are not listed one by one here. Code to the site and side documented in the record, within C18, C19, C20, C21, D01.0, D01.1, D01.2, Z85.0.
Lung and respiratory cancer
C33, C34, C78.0, Z85.123 codes in familyrpmccmpcmOxygen saturation and weight during treatment.
Lung and respiratory cancer
C33, C34, C78.0, Z85.123 codes in familyrpmccmpcmCMS chronic condition · CCW category: Cancer, Lung · Devices: Pulse oximeter, Connected weight scale
This family runs to 23 codes that differ mainly by anatomic site and laterality, which does not change whether the condition supports care management. The codes are not listed one by one here. Code to the site and side documented in the record, within C33, C34, C78.0, Z85.1.
Prostate cancer
C61, D07.5, Z85.463 codesccmpcmSymptom and treatment-toxicity follow-up.
Prostate cancer
C61, D07.5, Z85.463 codesccmpcmCMS chronic condition · CCW category: Cancer, Prostate · Devices: Patient-reported outcome app (RTM)
| Code | Official ICD-10-CM description | Programs | Risk adjustment |
|---|---|---|---|
| C61 | Malignant neoplasm of prostate | ccmpcm | HCC 23 · Prostate, Breast, and Other Cancers and Tumors |
| D07.5 | Carcinoma in situ of prostate | ccmpcm | not risk adjusted |
| Z85.46 | Personal history of malignant neoplasm of prostate | ccmpcm | not risk adjusted |
Urologic and gynecologic cancer
C64, C65, C66, C67, C68, C54, C55, D07.0, Z85.538 codes in familyccmpcmBlood pressure and renal-function surveillance where nephrectomy or nephrotoxic therapy is involved.
Urologic and gynecologic cancer
C64, C65, C66, C67, C68, C54, C55, D07.0, Z85.538 codes in familyccmpcmCMS chronic condition · CCW category: Cancer, Urologic (Kidney, Renal Pelvis, and Ureter) · Devices: Blood pressure cuff, Patient-reported outcome app (RTM)
This family runs to 38 codes that differ mainly by anatomic site and laterality, which does not change whether the condition supports care management. The codes are not listed one by one here. Code to the site and side documented in the record, within C64, C65, C66, C67, C68, C54, C55, D07.0, Z85.5.
Glaucoma
H40, H42253 codes in familyccmAdherence to topical therapy and attendance at pressure checks. No remote physiologic parameter, so this supports CCM rather than RPM.
Glaucoma
H40, H42253 codes in familyccmCMS chronic condition · CCW category: Glaucoma
This family runs to 253 codes that differ mainly by anatomic site and laterality, which does not change whether the condition supports care management. The codes are not listed one by one here. Code to the site and side documented in the record, within H40, H42.
Cataract
H25, H26, H28100 codes in familyccmFalls and functional risk in the elderly. No remote physiologic parameter.
Cataract
H25, H26, H28100 codes in familyccmCMS chronic condition · CCW category: Cataract
This family runs to 100 codes that differ mainly by anatomic site and laterality, which does not change whether the condition supports care management. The codes are not listed one by one here. Code to the site and side documented in the record, within H25, H26, H28.
Blindness and visual impairment
H53.4, H5469 codes in familyccmFalls and safety surveillance in the home.
Blindness and visual impairment
H53.4, H5469 codes in familyccmCMS other chronic or potentially disabling condition · CCW category: Sensory - Blindness and Visual Impairment · Devices: Contactless activity and fall radar
This family runs to 69 codes that differ mainly by anatomic site and laterality, which does not change whether the condition supports care management. The codes are not listed one by one here. Code to the site and side documented in the record, within H53.4, H54.
Deafness and hearing impairment
H90, H9139 codesccmCare coordination and communication support.
Deafness and hearing impairment
H90, H9139 codesccmCMS other chronic or potentially disabling condition · CCW category: Sensory - Deafness and Hearing Impairment
| Code | Official ICD-10-CM description | Programs | Risk adjustment |
|---|---|---|---|
| H90.0 | Conductive hearing loss, bilateral | ccm | not risk adjusted |
| H90.11 | Conductive hearing loss, unilateral, right ear, with unrestricted hearing on the contralateral side | ccm | not risk adjusted |
| H90.12 | Conductive hearing loss, unilateral, left ear, with unrestricted hearing on the contralateral side | ccm | not risk adjusted |
| H90.2 | Conductive hearing loss, unspecified | ccm | not risk adjusted |
| H90.3 | Sensorineural hearing loss, bilateral | ccm | not risk adjusted |
| H90.41 | Sensorineural hearing loss, unilateral, right ear, with unrestricted hearing on the contralateral side | ccm | not risk adjusted |
| H90.42 | Sensorineural hearing loss, unilateral, left ear, with unrestricted hearing on the contralateral side | ccm | not risk adjusted |
| H90.5 | Unspecified sensorineural hearing loss | ccm | not risk adjusted |
| H90.6 | Mixed conductive and sensorineural hearing loss, bilateral | ccm | not risk adjusted |
| H90.71 | Mixed conductive and sensorineural hearing loss, unilateral, right ear, with unrestricted hearing on the contralateral side | ccm | not risk adjusted |
| H90.72 | Mixed conductive and sensorineural hearing loss, unilateral, left ear, with unrestricted hearing on the contralateral side | ccm | not risk adjusted |
| H90.8 | Mixed conductive and sensorineural hearing loss, unspecified | ccm | not risk adjusted |
| H90.A11 | Conductive hearing loss, unilateral, right ear with restricted hearing on the contralateral side | ccm | not risk adjusted |
| H90.A12 | Conductive hearing loss, unilateral, left ear with restricted hearing on the contralateral side | ccm | not risk adjusted |
| H90.A21 | Sensorineural hearing loss, unilateral, right ear, with restricted hearing on the contralateral side | ccm | not risk adjusted |
| H90.A22 | Sensorineural hearing loss, unilateral, left ear, with restricted hearing on the contralateral side | ccm | not risk adjusted |
| H90.A31 | Mixed conductive and sensorineural hearing loss, unilateral, right ear with restricted hearing on the contralateral side | ccm | not risk adjusted |
| H90.A32 | Mixed conductive and sensorineural hearing loss, unilateral, left ear with restricted hearing on the contralateral side | ccm | not risk adjusted |
| H91.01 | Ototoxic hearing loss, right ear | ccm | not risk adjusted |
| H91.02 | Ototoxic hearing loss, left ear | ccm | not risk adjusted |
| H91.03 | Ototoxic hearing loss, bilateral | ccm | not risk adjusted |
| H91.09 | Ototoxic hearing loss, unspecified ear | ccm | not risk adjusted |
| H91.10 | Presbycusis, unspecified ear | ccm | not risk adjusted |
| H91.11 | Presbycusis, right ear | ccm | not risk adjusted |
| H91.12 | Presbycusis, left ear | ccm | not risk adjusted |
| H91.13 | Presbycusis, bilateral | ccm | not risk adjusted |
| H91.20 | Sudden idiopathic hearing loss, unspecified ear | ccm | not risk adjusted |
| H91.21 | Sudden idiopathic hearing loss, right ear | ccm | not risk adjusted |
| H91.22 | Sudden idiopathic hearing loss, left ear | ccm | not risk adjusted |
| H91.23 | Sudden idiopathic hearing loss, bilateral | ccm | not risk adjusted |
| H91.3 | Deaf nonspeaking, not elsewhere classified | ccm | not risk adjusted |
| H91.8X1 | Other specified hearing loss, right ear | ccm | not risk adjusted |
| H91.8X2 | Other specified hearing loss, left ear | ccm | not risk adjusted |
| H91.8X3 | Other specified hearing loss, bilateral | ccm | not risk adjusted |
| H91.8X9 | Other specified hearing loss, unspecified ear | ccm | not risk adjusted |
| H91.90 | Unspecified hearing loss, unspecified ear | ccm | not risk adjusted |
| H91.91 | Unspecified hearing loss, right ear | ccm | not risk adjusted |
| H91.92 | Unspecified hearing loss, left ear | ccm | not risk adjusted |
| H91.93 | Unspecified hearing loss, bilateral | ccm | not risk adjusted |
Diabetic retinopathy and diabetic eye disease
E08.3, E09.3, E10.3, E11.3, E13.3, H35.0, H36319 codes in familyccmpcmGlycemic and blood pressure control are the modifiable drivers. Screening attendance is the care-coordination target.
Diabetic retinopathy and diabetic eye disease
E08.3, E09.3, E10.3, E11.3, E13.3, H35.0, H36319 codes in familyccmpcmCMS chronic condition · CCW category: Diabetes · Devices: Blood glucose meter, Continuous glucose monitor, Blood pressure cuff
This family runs to 319 codes that differ mainly by anatomic site and laterality, which does not change whether the condition supports care management. The codes are not listed one by one here. Code to the site and side documented in the record, within E08.3, E09.3, E10.3, E11.3, E13.3, H35.0, H36.
Immunodeficiency and immune disorders
D80, D81, D82, D83, D84, D86, D8983 codes in familyccmpcmTemperature surveillance for infection risk.
Immunodeficiency and immune disorders
D80, D81, D82, D83, D84, D86, D8983 codes in familyccmpcmAdded by CCN Health · Devices: Connected thermometer
This family runs to 83 codes that differ mainly by anatomic site and laterality, which does not change whether the condition supports care management. The codes are not listed one by one here. Code to the site and side documented in the record, within D80, D81, D82, D83, D84, D86, D89.
Transplant status and long-term drug therapy
Z94, Z79.4, Z79.01, Z79.02, Z79.899, Z91.1420 codesrpmccmpcmBlood pressure, weight and temperature for graft surveillance, with adherence tracking.
Transplant status and long-term drug therapy
Z94, Z79.4, Z79.01, Z79.02, Z79.899, Z91.1420 codesrpmccmpcmAdded by CCN Health · Devices: Blood pressure cuff, Connected weight scale, Connected thermometer, Blood glucose meter
These are status and secondary codes. They support medical necessity but never stand alone as the reason for the service.
| Code | Official ICD-10-CM description | Programs | Risk adjustment |
|---|---|---|---|
| Z79.01 | Long term (current) use of anticoagulants | rpmccmpcm | not risk adjusted |
| Z79.02 | Long term (current) use of antithrombotics/antiplatelets | rpmccmpcm | not risk adjusted |
| Z79.4 | Long term (current) use of insulin | rpmccmpcm | HCC 38 · Diabetes with Glycemic, Unspecified, or No Complications |
| Z79.899 | Other long term (current) drug therapy | rpmccmpcm | not risk adjusted |
| Z91.141 | Patient's other noncompliance with medication regimen due to financial hardship | rpmccmpcm | not risk adjusted |
| Z91.148 | Patient's other noncompliance with medication regimen for other reason | rpmccmpcm | not risk adjusted |
| Z94.0 | Kidney transplant status | rpmccmpcm | not risk adjusted |
| Z94.1 | Heart transplant status | rpmccmpcm | HCC 221 · Heart Transplant Status/Complications |
| Z94.2 | Lung transplant status | rpmccmpcm | HCC 276 · Lung Transplant Status/Complications |
| Z94.3 | Heart and lungs transplant status | rpmccmpcm | HCC 221 · Heart Transplant Status/Complications |
| Z94.4 | Liver transplant status | rpmccmpcm | HCC 62 · Liver Transplant Status/Complications |
| Z94.5 | Skin transplant status | rpmccmpcm | not risk adjusted |
| Z94.6 | Bone transplant status | rpmccmpcm | not risk adjusted |
| Z94.7 | Corneal transplant status | rpmccmpcm | not risk adjusted |
| Z94.81 | Bone marrow transplant status | rpmccmpcm | HCC 454 · Stem Cell, Including Bone Marrow, Transplant Status/Complications |
| Z94.82 | Intestine transplant status | rpmccmpcm | HCC 77 · Intestine Transplant Status/Complications |
| Z94.83 | Pancreas transplant status | rpmccmpcm | HCC 35 · Pancreas Transplant Status |
| Z94.84 | Stem cells transplant status | rpmccmpcm | HCC 454 · Stem Cell, Including Bone Marrow, Transplant Status/Complications |
| Z94.89 | Other transplanted organ and tissue status | rpmccmpcm | not risk adjusted |
| Z94.9 | Transplanted organ and tissue status, unspecifiedlow specificity | rpmccmpcm | not risk adjusted |
No codes match those filters. Clear a filter to widen the search.
Frequently Asked Questions
ICD-10 eligibility questions.
01
Which ICD-10 codes qualify a patient for RPM?
None, and all of them. CMS publishes no list of ICD-10 codes that qualify a patient for remote patient monitoring. Eligibility turns on the condition and on documented medical necessity, so the practical test is whether the condition has a physiologic parameter an FDA-cleared device can measure. In practice the codes that appear most often on RPM claims are I10 (essential hypertension), E11.65 (type 2 diabetes with hyperglycemia), I50.32 (chronic diastolic heart failure), J44.1 (COPD with exacerbation), N18.30 (CKD stage 3) and G47.33 (obstructive sleep apnea). One condition is enough, and there is no minimum duration.
02
How many chronic conditions does CCM require?
Two or more, each expected to last at least 12 months or until the death of the patient, and together placing the patient at significant risk of death, acute exacerbation or functional decline. The two conditions do not have to be related. Common pairs are hypertension with diabetes, heart failure with CKD, COPD with depression, and diabetes with obesity.
03
What is the difference between PCM and CCM eligibility?
PCM covers a single high-risk condition expected to last at least three months, where that one condition drives the majority of the care plan. CCM requires two or more conditions expected to last 12 months or longer. PCM and CCM cannot be billed for the same patient in the same month, so when a patient qualifies for both, CCM is usually the better fit because it covers the whole problem list.
04
Which diagnoses support BHI?
Any behavioral health condition being managed in the primary care setting, including F32 and F33 (major depressive disorder), F41.1 (generalized anxiety disorder), F43.10 (post-traumatic stress disorder), the F31 bipolar codes, F10.20 (alcohol dependence) and F11.20 (opioid dependence). BHI also needs an initiating visit and the use of a validated instrument such as PHQ-9 or GAD-7, with the score recorded in the care plan.
05
Which conditions support RTM?
Musculoskeletal and respiratory conditions where therapy adherence, function or pain response is what you are tracking, rather than a vital sign. Common examples are the M17 knee osteoarthritis codes, M54.50, M54.51 and M54.59 for low back pain, M79.7 (fibromyalgia), the J44 COPD codes and the J45 asthma codes. Note that M54.5 itself was deleted on 1 October 2021 and will be rejected, so low back pain must be coded to one of the three replacement codes.
06
Can one patient be enrolled in more than one program?
Yes, provided each service addresses a distinct clinical need and the time is documented separately. A patient can receive RPM, CCM, BHI and RTM in the same month. The one hard exclusion is that PCM and CCM cannot both be billed for the same patient in the same month. Reimbursement varies by program and locality, so see the program stacking guide and the individual billing guides for current figures rather than assuming a combined total.
07
Does the specific ICD-10 code I choose actually matter?
Yes, in two ways. Medical necessity has to be visible on the claim, so the code must describe the condition you are actually monitoring. And specificity drives risk adjustment: N18.9 (chronic kidney disease, unspecified) maps to no HCC at all, while N18.30 through N18.6 map to HCC 329, and E11.22 (type 2 diabetes with chronic kidney disease) maps to HCC 37 where E11.9 maps only to HCC 38. This directory flags the unspecified codes whose own family does risk-adjust, so you can see where a more specific code is available.
08
What changes on 1 October 2026?
The FY2027 code set takes effect. Within the conditions listed here, 11 new codes arrive and 3 current codes are deleted. The cardiology changes matter most: I42.0 (dilated cardiomyopathy) splits into I42.00, I42.01 and I42.09, I42.8 splits into I42.81 (arrhythmogenic cardiomyopathy) and I42.89, and I49.8 splits into I49.81 (Brugada syndrome), I49.82 (ventricular bigeminy) and I49.89. Codes affected are flagged in the tables below.
Sources & Compliance
Code set. Every code on this page is drawn from the official ICD-10-CM ICD-10-CM FY2026 (valid 2025-10-01 through 2026-09-30) released by CDC/NCHS, and only codes flagged valid for submission are listed. ICD-10-CM is published by the federal government and is in the public domain, so the descriptions here are the official long descriptors reproduced verbatim rather than summarized. The next code set, ICD-10-CM FY2027 (valid from 2026-10-01), is already reflected in the change flags.
Eligibility is not a code list. CMS does not publish a list of ICD-10 codes that qualify a patient for RPM, CCM, PCM, BHI, or RTM. Eligibility turns on the condition and on documented medical necessity. The programs shown against each condition are CCN Health’s clinical assessment of which programs that condition can support, not a statement of CMS approval.
Risk adjustment. HCC labels and category assignments come from the CMS-HCC V28 model for the 2026 payment year. Risk adjustment depends on the full encounter record, not on a single code, and the flags here are a prompt to check specificity rather than a payment guarantee.
CPT® notice. CPT is a registered trademark of the American Medical Association. CPT codes, descriptions, and other data only are copyright 2026 American Medical Association. All rights reserved. CPT is provided “as is” without warranty of any kind.
Sources. ICD-10-CM files, CDC/NCHS (cdc.gov); CMS Chronic Conditions Data Warehouse condition categories (ccwdata.org); CMS-HCC risk adjustment model software and ICD-10 mappings (cms.gov); AHRQ Clinical Classifications Software Refined (ahrq.gov).
Disclaimer. This page is informational and does not constitute billing, clinical, or legal advice. Diagnosis coding must reflect the documentation in the medical record. Verify all codes against the official CMS and CDC/NCHS publications and your contracted payer agreements before billing.