PCM · Geriatrics
PCM Qualifying Diagnoses
for Geriatrics.
370 ICD-10-CM codes cover geriatrics patients for Principal Care Management (PCM).
Qualifying Codes
ICD-10 codes for geriatrics.
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 |
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 |
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 |
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 |
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.
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 |
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 |
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 |
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 |
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 |
Other chronic and potentially disabling
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.
No codes match those filters. Clear a filter to widen the search.
Clinical Context
Why geriatrics practices benefit from PCM.
Geriatrics practices can leverage PCM to improve patient outcomes through structured care management, generating $97–$220+ per patient per month in Medicare reimbursement while reducing avoidable hospitalizations.
Related Conditions
Condition monitoring guides.
FAQ
Common questions.
01
What ICD-10 codes qualify geriatrics patients for PCM?
CMS publishes no list of codes that qualify a patient for PCM: eligibility turns on the condition and on documented medical necessity. For geriatrics, 370 billable ICD-10-CM codes cover the conditions PCM manages, spanning 14 conditions including essential hypertension, heart failure, atrial fibrillation and flutter, ischemic heart disease, stroke, tia and cerebrovascular sequelae, peripheral and visceral vascular disease.
02
How does CCN Health support geriatrics practices with PCM?
CCN Health provides turnkey PCM services for geriatrics practices, including patient eligibility identification, enrollment documentation, device provisioning, clinical monitoring, and full Medicare billing support.
03
What is the revenue potential for PCM in geriatrics?
Reimbursement varies by locality and payer contract, so see the PCM billing guide for current figures. Geriatrics practices with a high prevalence of these conditions generally see the most benefit, particularly when PCM is combined with RPM and BHI for patients whose needs are distinct enough to document separately.
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.