PCM · Internal Medicine
PCM Qualifying Diagnoses
for Internal Medicine.
46 ICD-10 codes qualify internal medicine patients for Principal Care Management (PCM).
Qualifying Codes
ICD-10 codes for internal medicine.
Atrial Fibrillation
2 codesParoxysmal atrial fibrillation
Paroxysmal atrial fibrillation
Unspecified atrial fibrillation
Unspecified atrial fibrillation
Autoimmune
3 codesSystemic lupus erythematosus, unspecified
Systemic lupus erythematosus, unspecified
Crohn's disease, unspecified, without complications
Crohn's disease, unspecified, without complications
Ulcerative colitis, unspecified, without complications
Ulcerative colitis, unspecified, without complications
Cancer
5 codesMalignant neoplasm of breast, unspecified
Care coordination for active treatment; symptom monitoring
Malignant neoplasm of breast, unspecified
Care coordination for active treatment; symptom monitoring
Malignant neoplasm of lung, unspecified
SpO2 monitoring during treatment
Malignant neoplasm of lung, unspecified
SpO2 monitoring during treatment
Malignant neoplasm of prostate
Malignant neoplasm of prostate
Malignant neoplasm of colon, unspecified
Malignant neoplasm of colon, unspecified
Malignant neoplasm of kidney, unspecified
Malignant neoplasm of kidney, unspecified
Chronic Kidney Disease
4 codesChronic kidney disease, stage 3 unspecified
BP + weight monitoring; fluid management critical
Chronic kidney disease, stage 3 unspecified
BP + weight monitoring; fluid management critical
Chronic kidney disease, stage 3a
Chronic kidney disease, stage 3a
Chronic kidney disease, stage 3b
Chronic kidney disease, stage 3b
Chronic kidney disease, stage 4 (severe)
Pre-dialysis monitoring; aggressive BP and fluid control
Chronic kidney disease, stage 4 (severe)
Pre-dialysis monitoring; aggressive BP and fluid control
COPD
3 codesCOPD with (acute) lower respiratory infection
COPD with (acute) lower respiratory infection
COPD with (acute) exacerbation
SpO2 monitoring critical; exacerbation history drives RPM enrollment
COPD with (acute) exacerbation
SpO2 monitoring critical; exacerbation history drives RPM enrollment
COPD, unspecified
COPD, unspecified
Coronary Artery Disease
1 codeAtherosclerotic heart disease of native coronary artery without angina
Atherosclerotic heart disease of native coronary artery without angina
Epilepsy
2 codesEpilepsy, unspecified, not intractable, without status epilepticus
Epilepsy, unspecified, not intractable, without status epilepticus
Epilepsy, unspecified, intractable, without status epilepticus
Epilepsy, unspecified, intractable, without status epilepticus
Heart Failure
4 codesLeft ventricular failure, unspecified
Daily weight + BP monitoring critical for fluid management
Left ventricular failure, unspecified
Daily weight + BP monitoring critical for fluid management
Unspecified systolic (HFrEF) heart failure
Unspecified systolic (HFrEF) heart failure
Unspecified diastolic (HFpEF) heart failure
Unspecified diastolic (HFpEF) heart failure
Heart failure, unspecified
Heart failure, unspecified
Hypertension
4 codesEssential (primary) hypertension
Most common RPM diagnosis; twice-daily BP monitoring recommended
Essential (primary) hypertension
Most common RPM diagnosis; twice-daily BP monitoring recommended
Hypertensive heart disease without heart failure
Hypertensive heart disease without heart failure
Hypertensive chronic kidney disease, stage 1–4/unspecified
Hypertensive chronic kidney disease, stage 1–4/unspecified
Other secondary hypertension
Other secondary hypertension
Liver Disease
1 codeUnspecified cirrhosis of liver
Unspecified cirrhosis of liver
Migraine
1 codeMigraine, unspecified, intractable, without status migrainosus
Migraine, unspecified, intractable, without status migrainosus
Multiple Sclerosis
1 codeMultiple sclerosis
Multiple sclerosis
Neuropathy
1 codeHereditary motor and sensory neuropathy
Hereditary motor and sensory neuropathy
Parkinson's Disease
1 codeParkinson's disease
Fall detection + activity monitoring; medication adherence tracking
Parkinson's disease
Fall detection + activity monitoring; medication adherence tracking
Respiratory Failure
1 codeChronic respiratory failure, unspecified
Chronic respiratory failure, unspecified
Rheumatoid Arthritis
2 codesRheumatoid arthritis with rheumatoid factor, multiple sites
Rheumatoid arthritis with rheumatoid factor, multiple sites
Rheumatoid arthritis, unspecified
Rheumatoid arthritis, unspecified
Sleep Disorders
1 codeObstructive sleep apnea
Most common sleep disorder for RPM; CPAP compliance monitoring
Obstructive sleep apnea
Most common sleep disorder for RPM; CPAP compliance monitoring
Thyroid Disorders
1 codeThyrotoxicosis, unspecified without thyrotoxic crisis
Weight + heart rate monitoring during medication titration
Thyrotoxicosis, unspecified without thyrotoxic crisis
Weight + heart rate monitoring during medication titration
Type 1 Diabetes
3 codesType 1 diabetes mellitus with ketoacidosis without coma
Type 1 diabetes mellitus with ketoacidosis without coma
Type 1 diabetes mellitus with diabetic neuropathy, unspecified
Type 1 diabetes mellitus with diabetic neuropathy, unspecified
Type 1 diabetes mellitus with hyperglycemia
CGM or BGM monitoring; tight glucose control target
Type 1 diabetes mellitus with hyperglycemia
CGM or BGM monitoring; tight glucose control target
Type 2 Diabetes
4 codesType 2 diabetes mellitus with hyperosmolarity without NKHHC
Type 2 diabetes mellitus with hyperosmolarity without NKHHC
Type 2 diabetes mellitus with diabetic neuropathy, unspecified
Type 2 diabetes mellitus with diabetic neuropathy, unspecified
Type 2 diabetes mellitus with hyperglycemia
Most common diabetes RPM diagnosis; CGM or daily BGM
Type 2 diabetes mellitus with hyperglycemia
Most common diabetes RPM diagnosis; CGM or daily BGM
Type 2 diabetes mellitus with unspecified complications
Type 2 diabetes mellitus with unspecified complications
Venous Thromboembolism
1 codeAcute embolism and thrombosis of unspecified deep veins of lower extremity
Acute embolism and thrombosis of unspecified deep veins of lower extremity
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.
What ICD-10 codes qualify internal medicine patients for PCM?
There are 46 ICD-10 codes that qualify internal medicine patients for Principal Care Management (PCM). These include codes across 21 diagnosis categories: Atrial Fibrillation, Autoimmune, Cancer, Chronic Kidney Disease, COPD, Coronary Artery Disease, Epilepsy, Heart Failure, Hypertension, Liver Disease, Migraine, Multiple Sclerosis, Neuropathy, Parkinson's Disease, Respiratory Failure, Rheumatoid Arthritis, Sleep Disorders, Thyroid Disorders, Type 1 Diabetes, Type 2 Diabetes, Venous Thromboembolism.
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. Most practices are fully operational within 1 week.
What is the revenue potential for PCM in internal medicine?
PCM generates $68–149 per patient per month in Medicare reimbursement. Internal Medicine practices with a high prevalence of qualifying conditions can scale rapidly, especially when PCM is stacked with other eligible programs like RPM and BHI.