PCM · Nephrology
PCM Qualifying Diagnoses
for Nephrology.
180 ICD-10-CM codes cover nephrology patients for Principal Care Management (PCM).
Qualifying Codes
ICD-10 codes for nephrology.
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 |
Endocrine and metabolic
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 |
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.
Musculoskeletal and pain
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
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.
Transplant status and long-term drug therapy
Z94, Z79.4, Z79.01, Z79.02, Z79.899, Z91.1420 codesrpmccmpcmBlood pressure, weight and temperature for graft surveillance, with adherence tracking.
Transplant status and long-term drug therapy
Z94, Z79.4, Z79.01, Z79.02, Z79.899, Z91.1420 codesrpmccmpcmAdded by CCN Health · Devices: Blood pressure cuff, Connected weight scale, Connected thermometer, Blood glucose meter
These are status and secondary codes. They support medical necessity but never stand alone as the reason for the service.
| Code | Official ICD-10-CM description | Programs | Risk adjustment |
|---|---|---|---|
| Z79.01 | Long term (current) use of anticoagulants | rpmccmpcm | not risk adjusted |
| Z79.02 | Long term (current) use of antithrombotics/antiplatelets | rpmccmpcm | not risk adjusted |
| Z79.4 | Long term (current) use of insulin | rpmccmpcm | HCC 38 · Diabetes with Glycemic, Unspecified, or No Complications |
| Z79.899 | Other long term (current) drug therapy | rpmccmpcm | not risk adjusted |
| Z91.141 | Patient's other noncompliance with medication regimen due to financial hardship | rpmccmpcm | not risk adjusted |
| Z91.148 | Patient's other noncompliance with medication regimen for other reason | rpmccmpcm | not risk adjusted |
| Z94.0 | Kidney transplant status | rpmccmpcm | not risk adjusted |
| Z94.1 | Heart transplant status | rpmccmpcm | HCC 221 · Heart Transplant Status/Complications |
| Z94.2 | Lung transplant status | rpmccmpcm | HCC 276 · Lung Transplant Status/Complications |
| Z94.3 | Heart and lungs transplant status | rpmccmpcm | HCC 221 · Heart Transplant Status/Complications |
| Z94.4 | Liver transplant status | rpmccmpcm | HCC 62 · Liver Transplant Status/Complications |
| Z94.5 | Skin transplant status | rpmccmpcm | not risk adjusted |
| Z94.6 | Bone transplant status | rpmccmpcm | not risk adjusted |
| Z94.7 | Corneal transplant status | rpmccmpcm | not risk adjusted |
| Z94.81 | Bone marrow transplant status | rpmccmpcm | HCC 454 · Stem Cell, Including Bone Marrow, Transplant Status/Complications |
| Z94.82 | Intestine transplant status | rpmccmpcm | HCC 77 · Intestine Transplant Status/Complications |
| Z94.83 | Pancreas transplant status | rpmccmpcm | HCC 35 · Pancreas Transplant Status |
| Z94.84 | Stem cells transplant status | rpmccmpcm | HCC 454 · Stem Cell, Including Bone Marrow, Transplant Status/Complications |
| Z94.89 | Other transplanted organ and tissue status | rpmccmpcm | not risk adjusted |
| Z94.9 | Transplanted organ and tissue status, unspecifiedlow specificity | rpmccmpcm | not risk adjusted |
No codes match those filters. Clear a filter to widen the search.
Clinical Context
Why nephrology practices benefit from PCM.
Nephrology 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 nephrology 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 nephrology, 180 billable ICD-10-CM codes cover the conditions PCM manages, spanning 8 conditions including essential hypertension, hypertensive heart and kidney disease, other endocrine, nutritional and metabolic disorders, chronic kidney disease and esrd, glomerular and tubulo-interstitial kidney disease, systemic lupus and connective tissue disease.
How does CCN Health support nephrology practices with PCM?
CCN Health provides turnkey PCM services for nephrology practices, including patient eligibility identification, enrollment documentation, device provisioning, clinical monitoring, and full Medicare billing support.
What is the revenue potential for PCM in nephrology?
Reimbursement varies by locality and payer contract, so see the PCM billing guide for current figures. Nephrology 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.