PCM · Internal Medicine
PCM Qualifying Diagnoses
for Internal Medicine.
1213 ICD-10-CM codes cover internal medicine patients for Principal Care Management (PCM).
Qualifying Codes
ICD-10 codes for internal medicine.
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 |
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.
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 |
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 |
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 |
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.
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 |
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
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.
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.
Other chronic and potentially disabling
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.
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 |
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Clinical Context
Why internal medicine practices benefit from PCM.
Internal Medicine 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 internal medicine 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 internal medicine, 1213 billable ICD-10-CM codes cover the conditions PCM manages, spanning 45 conditions including essential hypertension, hypertensive heart and kidney disease, heart failure, cardiomyopathy and myocarditis, atrial fibrillation and flutter, ischemic heart disease.
02
How does CCN Health support internal medicine practices with PCM?
CCN Health provides turnkey PCM services for internal medicine 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 internal medicine?
Reimbursement varies by locality and payer contract, so see the PCM billing guide for current figures. Internal Medicine 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.