RPM · Internal Medicine
RPM Qualifying Diagnoses
for Internal Medicine.
1004 ICD-10-CM codes cover internal medicine patients for Remote Patient Monitoring (RPM).
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 |
Other cardiac dysrhythmias and conduction disorders
I44, I45, I47, I4939 codesrpmccmSymptomatic rhythm capture and heart rate trending.
Other cardiac dysrhythmias and conduction disorders
I44, I45, I47, I4939 codesrpmccmAdded by CCN Health · Devices: Single-lead ECG, Blood pressure cuff
| Code | Official ICD-10-CM description | Programs | Risk adjustment |
|---|---|---|---|
| I44.0 | Atrioventricular block, first degree | rpmccm | not risk adjusted |
| I44.1 | Atrioventricular block, second degree | rpmccm | not risk adjusted |
| I44.2 | Atrioventricular block, complete | rpmccm | HCC 238 · Specified Heart Arrhythmias |
| I44.30 | Unspecified atrioventricular blocklow specificity | rpmccm | not risk adjusted |
| I44.39 | Other atrioventricular block | rpmccm | not risk adjusted |
| I44.4 | Left anterior fascicular block | rpmccm | not risk adjusted |
| I44.5 | Left posterior fascicular block | rpmccm | not risk adjusted |
| I44.60 | Unspecified fascicular blocklow specificity | rpmccm | not risk adjusted |
| I44.69 | Other fascicular block | rpmccm | not risk adjusted |
| I44.7 | Left bundle-branch block, unspecifiedlow specificity | rpmccm | not risk adjusted |
| I45.0 | Right fascicular block | rpmccm | not risk adjusted |
| I45.10 | Unspecified right bundle-branch block | rpmccm | not risk adjusted |
| I45.19 | Other right bundle-branch block | rpmccm | not risk adjusted |
| I45.2 | Bifascicular block | rpmccm | not risk adjusted |
| I45.3 | Trifascicular block | rpmccm | not risk adjusted |
| I45.4 | Nonspecific intraventricular block | rpmccm | not risk adjusted |
| I45.5 | Other specified heart block | rpmccm | not risk adjusted |
| I45.6 | Pre-excitation syndrome | rpmccm | not risk adjusted |
| I45.81 | Long QT syndrome | rpmccm | not risk adjusted |
| I45.89 | Other specified conduction disorders | rpmccm | not risk adjusted |
| I45.9 | Conduction disorder, unspecified | rpmccm | not risk adjusted |
| I47.0 | Re-entry ventricular arrhythmia | rpmccm | HCC 238 · Specified Heart Arrhythmias |
| I47.10 | Supraventricular tachycardia, unspecifiedlow specificity | rpmccm | not risk adjusted |
| I47.11 | Inappropriate sinus tachycardia, so stated | rpmccm | not risk adjusted |
| I47.19 | Other supraventricular tachycardia | rpmccm | not risk adjusted |
| I47.20 | Ventricular tachycardia, unspecified | rpmccm | HCC 238 · Specified Heart Arrhythmias |
| I47.21 | Torsades de pointes | rpmccm | HCC 238 · Specified Heart Arrhythmias |
| I47.29 | Other ventricular tachycardia | rpmccm | HCC 238 · Specified Heart Arrhythmias |
| I47.9 | Paroxysmal tachycardia, unspecified | rpmccm | HCC 238 · Specified Heart Arrhythmias |
| I49.01 | Ventricular fibrillation | rpmccm | HCC 213 · Cardio-Respiratory Failure and Shock |
| I49.02 | Ventricular flutter | rpmccm | HCC 213 · Cardio-Respiratory Failure and Shock |
| I49.1 | Atrial premature depolarization | rpmccm | not risk adjusted |
| I49.2 | Junctional premature depolarization | rpmccm | HCC 238 · Specified Heart Arrhythmias |
| I49.3 | Ventricular premature depolarization | rpmccm | not risk adjusted |
| I49.40 | Unspecified premature depolarizationlow specificity | rpmccm | not risk adjusted |
| I49.49 | Other premature depolarization | rpmccm | not risk adjusted |
| I49.5 | Sick sinus syndrome | rpmccm | HCC 238 · Specified Heart Arrhythmias |
| I49.8 | Other specified cardiac arrhythmiasdeleted 2026-10-01 | rpmccm | not risk adjusted |
| I49.9 | Cardiac arrhythmia, unspecifiedlow specificity | rpmccm | not risk adjusted |
Ischemic heart disease
I20, I24, I2567 codesrpmccmpcmBlood pressure and heart rate against anti-anginal and secondary-prevention targets.
Ischemic heart disease
I20, I24, I2567 codesrpmccmpcmCMS chronic condition · CCW category: Ischemic Heart Disease · Devices: Blood pressure cuff, Single-lead ECG
| Code | Official ICD-10-CM description | Programs | Risk adjustment |
|---|---|---|---|
| I20.0 | Unstable angina | rpmccmpcm | HCC 229 · Unstable Angina and Other Acute Ischemic Heart Disease |
| I20.1 | Angina pectoris with documented spasm | rpmccmpcm | not risk adjusted |
| I20.2 | Refractory angina pectoris | rpmccmpcm | not risk adjusted |
| I20.81 | Angina pectoris with coronary microvascular dysfunction | rpmccmpcm | not risk adjusted |
| I20.89 | Other forms of angina pectoris | rpmccmpcm | not risk adjusted |
| I20.9 | Angina pectoris, unspecifiedlow specificity | rpmccmpcm | not risk adjusted |
| I24.0 | Acute coronary thrombosis not resulting in myocardial infarction | rpmccmpcm | HCC 229 · Unstable Angina and Other Acute Ischemic Heart Disease |
| I24.1 | Dressler's syndrome | rpmccmpcm | HCC 229 · Unstable Angina and Other Acute Ischemic Heart Disease |
| I24.81 | Acute coronary microvascular dysfunction | rpmccmpcm | HCC 229 · Unstable Angina and Other Acute Ischemic Heart Disease |
| I24.89 | Other forms of acute ischemic heart disease | rpmccmpcm | HCC 229 · Unstable Angina and Other Acute Ischemic Heart Disease |
| I24.9 | Acute ischemic heart disease, unspecified | rpmccmpcm | HCC 229 · Unstable Angina and Other Acute Ischemic Heart Disease |
| I25.10 | Atherosclerotic heart disease of native coronary artery without angina pectoris | rpmccmpcm | not risk adjusted |
| I25.110 | Atherosclerotic heart disease of native coronary artery with unstable angina pectoris | rpmccmpcm | HCC 229 · Unstable Angina and Other Acute Ischemic Heart Disease |
| I25.111 | Atherosclerotic heart disease of native coronary artery with angina pectoris with documented spasm | rpmccmpcm | not risk adjusted |
| I25.112 | Atherosclerotic heart disease of native coronary artery with refractory angina pectoris | rpmccmpcm | not risk adjusted |
| I25.118 | Atherosclerotic heart disease of native coronary artery with other forms of angina pectoris | rpmccmpcm | not risk adjusted |
| I25.119 | Atherosclerotic heart disease of native coronary artery with unspecified angina pectorislow specificity | rpmccmpcm | not risk adjusted |
| I25.2 | Old myocardial infarction | rpmccmpcm | not risk adjusted |
| I25.3 | Aneurysm of heart | rpmccmpcm | not risk adjusted |
| I25.41 | Coronary artery aneurysm | rpmccmpcm | not risk adjusted |
| I25.42 | Coronary artery dissection | rpmccmpcm | not risk adjusted |
| I25.5 | Ischemic cardiomyopathy | rpmccmpcm | not risk adjusted |
| I25.6 | Silent myocardial ischemia | rpmccmpcm | not risk adjusted |
| I25.700 | Atherosclerosis of coronary artery bypass graft(s), unspecified, with unstable angina pectoris | rpmccmpcm | HCC 229 · Unstable Angina and Other Acute Ischemic Heart Disease |
| I25.701 | Atherosclerosis of coronary artery bypass graft(s), unspecified, with angina pectoris with documented spasmlow specificity | rpmccmpcm | not risk adjusted |
| I25.702 | Atherosclerosis of coronary artery bypass graft(s), unspecified, with refractory angina pectorislow specificity | rpmccmpcm | not risk adjusted |
| I25.708 | Atherosclerosis of coronary artery bypass graft(s), unspecified, with other forms of angina pectorislow specificity | rpmccmpcm | not risk adjusted |
| I25.709 | Atherosclerosis of coronary artery bypass graft(s), unspecified, with unspecified angina pectorislow specificity | rpmccmpcm | not risk adjusted |
| I25.710 | Atherosclerosis of autologous vein coronary artery bypass graft(s) with unstable angina pectoris | rpmccmpcm | HCC 229 · Unstable Angina and Other Acute Ischemic Heart Disease |
| I25.711 | Atherosclerosis of autologous vein coronary artery bypass graft(s) with angina pectoris with documented spasm | rpmccmpcm | not risk adjusted |
| I25.712 | Atherosclerosis of autologous vein coronary artery bypass graft(s) with refractory angina pectoris | rpmccmpcm | not risk adjusted |
| I25.718 | Atherosclerosis of autologous vein coronary artery bypass graft(s) with other forms of angina pectoris | rpmccmpcm | not risk adjusted |
| I25.719 | Atherosclerosis of autologous vein coronary artery bypass graft(s) with unspecified angina pectorislow specificity | rpmccmpcm | not risk adjusted |
| I25.720 | Atherosclerosis of autologous artery coronary artery bypass graft(s) with unstable angina pectoris | rpmccmpcm | HCC 229 · Unstable Angina and Other Acute Ischemic Heart Disease |
| I25.721 | Atherosclerosis of autologous artery coronary artery bypass graft(s) with angina pectoris with documented spasm | rpmccmpcm | not risk adjusted |
| I25.722 | Atherosclerosis of autologous artery coronary artery bypass graft(s) with refractory angina pectoris | rpmccmpcm | not risk adjusted |
| I25.728 | Atherosclerosis of autologous artery coronary artery bypass graft(s) with other forms of angina pectoris | rpmccmpcm | not risk adjusted |
| I25.729 | Atherosclerosis of autologous artery coronary artery bypass graft(s) with unspecified angina pectorislow specificity | rpmccmpcm | not risk adjusted |
| I25.730 | Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with unstable angina pectoris | rpmccmpcm | HCC 229 · Unstable Angina and Other Acute Ischemic Heart Disease |
| I25.731 | Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with angina pectoris with documented spasm | rpmccmpcm | not risk adjusted |
| I25.732 | Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with refractory angina pectoris | rpmccmpcm | not risk adjusted |
| I25.738 | Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with other forms of angina pectoris | rpmccmpcm | not risk adjusted |
| I25.739 | Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with unspecified angina pectorislow specificity | rpmccmpcm | not risk adjusted |
| I25.750 | Atherosclerosis of native coronary artery of transplanted heart with unstable angina | rpmccmpcm | HCC 229 · Unstable Angina and Other Acute Ischemic Heart Disease |
| I25.751 | Atherosclerosis of native coronary artery of transplanted heart with angina pectoris with documented spasm | rpmccmpcm | not risk adjusted |
| I25.752 | Atherosclerosis of native coronary artery of transplanted heart with refractory angina pectoris | rpmccmpcm | not risk adjusted |
| I25.758 | Atherosclerosis of native coronary artery of transplanted heart with other forms of angina pectoris | rpmccmpcm | not risk adjusted |
| I25.759 | Atherosclerosis of native coronary artery of transplanted heart with unspecified angina pectorislow specificity | rpmccmpcm | not risk adjusted |
| I25.760 | Atherosclerosis of bypass graft of coronary artery of transplanted heart with unstable angina | rpmccmpcm | HCC 229 · Unstable Angina and Other Acute Ischemic Heart Disease |
| I25.761 | Atherosclerosis of bypass graft of coronary artery of transplanted heart with angina pectoris with documented spasm | rpmccmpcm | not risk adjusted |
| I25.762 | Atherosclerosis of bypass graft of coronary artery of transplanted heart with refractory angina pectoris | rpmccmpcm | not risk adjusted |
| I25.768 | Atherosclerosis of bypass graft of coronary artery of transplanted heart with other forms of angina pectoris | rpmccmpcm | not risk adjusted |
| I25.769 | Atherosclerosis of bypass graft of coronary artery of transplanted heart with unspecified angina pectorislow specificity | rpmccmpcm | not risk adjusted |
| I25.790 | Atherosclerosis of other coronary artery bypass graft(s) with unstable angina pectoris | rpmccmpcm | HCC 229 · Unstable Angina and Other Acute Ischemic Heart Disease |
| I25.791 | Atherosclerosis of other coronary artery bypass graft(s) with angina pectoris with documented spasm | rpmccmpcm | not risk adjusted |
| I25.792 | Atherosclerosis of other coronary artery bypass graft(s) with refractory angina pectoris | rpmccmpcm | not risk adjusted |
| I25.798 | Atherosclerosis of other coronary artery bypass graft(s) with other forms of angina pectoris | rpmccmpcm | not risk adjusted |
| I25.799 | Atherosclerosis of other coronary artery bypass graft(s) with unspecified angina pectorislow specificity | rpmccmpcm | not risk adjusted |
| I25.810 | Atherosclerosis of coronary artery bypass graft(s) without angina pectoris | rpmccmpcm | not risk adjusted |
| I25.811 | Atherosclerosis of native coronary artery of transplanted heart without angina pectoris | rpmccmpcm | not risk adjusted |
| I25.812 | Atherosclerosis of bypass graft of coronary artery of transplanted heart without angina pectoris | rpmccmpcm | not risk adjusted |
| I25.82 | Chronic total occlusion of coronary artery | rpmccmpcm | not risk adjusted |
| I25.83 | Coronary atherosclerosis due to lipid rich plaque | rpmccmpcm | not risk adjusted |
| I25.84 | Coronary atherosclerosis due to calcified coronary lesion | rpmccmpcm | not risk adjusted |
| I25.85 | Chronic coronary microvascular dysfunction | rpmccmpcm | not risk adjusted |
| I25.89 | Other forms of chronic ischemic heart disease | rpmccmpcm | not risk adjusted |
| I25.9 | Chronic ischemic heart disease, unspecifiedlow specificity | rpmccmpcm | not risk adjusted |
Myocardial infarction and its sequelae
I21, I22, I23, I25.228 codesrpmccmpcmPost-discharge blood pressure and heart rate surveillance during the highest-risk readmission window.
Myocardial infarction and its sequelae
I21, I22, I23, I25.228 codesrpmccmpcmCMS chronic condition · CCW category: Acute Myocardial Infarction · Devices: Blood pressure cuff, Single-lead ECG
I21 and I22 describe an acute event. For ongoing management most practices carry I25.2 (old myocardial infarction) once the acute episode has closed.
| Code | Official ICD-10-CM description | Programs | Risk adjustment |
|---|---|---|---|
| I21.01 | ST elevation (STEMI) myocardial infarction involving left main coronary artery | rpmccmpcm | HCC 228 · Acute Myocardial Infarction |
| I21.02 | ST elevation (STEMI) myocardial infarction involving left anterior descending coronary artery | rpmccmpcm | HCC 228 · Acute Myocardial Infarction |
| I21.09 | ST elevation (STEMI) myocardial infarction involving other coronary artery of anterior wall | rpmccmpcm | HCC 228 · Acute Myocardial Infarction |
| I21.11 | ST elevation (STEMI) myocardial infarction involving right coronary artery | rpmccmpcm | HCC 228 · Acute Myocardial Infarction |
| I21.19 | ST elevation (STEMI) myocardial infarction involving other coronary artery of inferior wall | rpmccmpcm | HCC 228 · Acute Myocardial Infarction |
| I21.21 | ST elevation (STEMI) myocardial infarction involving left circumflex coronary artery | rpmccmpcm | HCC 228 · Acute Myocardial Infarction |
| I21.29 | ST elevation (STEMI) myocardial infarction involving other sites | rpmccmpcm | HCC 228 · Acute Myocardial Infarction |
| I21.3 | ST elevation (STEMI) myocardial infarction of unspecified site | rpmccmpcm | HCC 228 · Acute Myocardial Infarction |
| I21.4 | Non-ST elevation (NSTEMI) myocardial infarction | rpmccmpcm | HCC 228 · Acute Myocardial Infarction |
| I21.9 | Acute myocardial infarction, unspecified | rpmccmpcm | HCC 228 · Acute Myocardial Infarction |
| I21.A1 | Myocardial infarction type 2 | rpmccmpcm | HCC 228 · Acute Myocardial Infarction |
| I21.A9 | Other myocardial infarction type | rpmccmpcm | HCC 228 · Acute Myocardial Infarction |
| I21.B | Myocardial infarction with coronary microvascular dysfunction | rpmccmpcm | HCC 228 · Acute Myocardial Infarction |
| I22.0 | Subsequent ST elevation (STEMI) myocardial infarction of anterior wall | rpmccmpcm | HCC 228 · Acute Myocardial Infarction |
| I22.1 | Subsequent ST elevation (STEMI) myocardial infarction of inferior wall | rpmccmpcm | HCC 228 · Acute Myocardial Infarction |
| I22.2 | Subsequent non-ST elevation (NSTEMI) myocardial infarction | rpmccmpcm | HCC 228 · Acute Myocardial Infarction |
| I22.8 | Subsequent ST elevation (STEMI) myocardial infarction of other sites | rpmccmpcm | HCC 228 · Acute Myocardial Infarction |
| I22.9 | Subsequent ST elevation (STEMI) myocardial infarction of unspecified site | rpmccmpcm | HCC 228 · Acute Myocardial Infarction |
| I23.0 | Hemopericardium as current complication following acute myocardial infarction | rpmccmpcm | HCC 229 · Unstable Angina and Other Acute Ischemic Heart Disease |
| I23.1 | Atrial septal defect as current complication following acute myocardial infarction | rpmccmpcm | HCC 229 · Unstable Angina and Other Acute Ischemic Heart Disease |
| I23.2 | Ventricular septal defect as current complication following acute myocardial infarction | rpmccmpcm | HCC 229 · Unstable Angina and Other Acute Ischemic Heart Disease |
| I23.3 | Rupture of cardiac wall without hemopericardium as current complication following acute myocardial infarction | rpmccmpcm | HCC 229 · Unstable Angina and Other Acute Ischemic Heart Disease |
| I23.4 | Rupture of chordae tendineae as current complication following acute myocardial infarction | rpmccmpcm | HCC 229 · Unstable Angina and Other Acute Ischemic Heart Disease |
| I23.5 | Rupture of papillary muscle as current complication following acute myocardial infarction | rpmccmpcm | HCC 229 · Unstable Angina and Other Acute Ischemic Heart Disease |
| I23.6 | Thrombosis of atrium, auricular appendage, and ventricle as current complications following acute myocardial infarction | rpmccmpcm | HCC 229 · Unstable Angina and Other Acute Ischemic Heart Disease |
| I23.7 | Postinfarction angina | rpmccmpcm | HCC 229 · Unstable Angina and Other Acute Ischemic Heart Disease |
| I23.8 | Other current complications following acute myocardial infarction | rpmccmpcm | HCC 229 · Unstable Angina and Other Acute Ischemic Heart Disease |
| I25.2 | Old myocardial infarction | rpmccmpcm | not risk adjusted |
Stroke, TIA and cerebrovascular sequelae
G45, G46, I63.9, I65, I66, I67, I69.3, I69.9140 codes in familyrpmccmpcmBlood pressure control is the dominant secondary-prevention lever. Activity and fall sensing supports the deficits captured by the I69 sequela codes.
Stroke, TIA and cerebrovascular sequelae
G45, G46, I63.9, I65, I66, I67, I69.3, I69.9140 codes in familyrpmccmpcmCMS chronic condition · CCW category: Stroke/Transient Ischemic Attack · Devices: Blood pressure cuff, Contactless activity and fall radar
I69 codes carry the deficit, so they are usually the ones that justify ongoing care management rather than the acute I63 code.
This family runs to 140 codes that differ mainly by anatomic site and laterality, which does not change whether the condition supports care management. The codes are not listed one by one here. Code to the site and side documented in the record, within G45, G46, I63.9, I65, I66, I67, I69.3, I69.9.
Peripheral and visceral vascular disease
I70, I71, I72, I73, I77, I79318 codes in familyrpmccmpcmBlood pressure and peripheral perfusion, often alongside diabetic foot surveillance.
Peripheral and visceral vascular disease
I70, I71, I72, I73, I77, I79318 codes in familyrpmccmpcmCMS other chronic or potentially disabling condition · CCW category: Peripheral Vascular Disease (PVD) · Devices: Blood pressure cuff, Pulse oximeter
This family runs to 318 codes that differ mainly by anatomic site and laterality, which does not change whether the condition supports care management. The codes are not listed one by one here. Code to the site and side documented in the record, within I70, I71, I72, I73, I77, I79.
Chronic venous disease and thromboembolism
I80, I82, I83, I87, I26297 codes in familyrpmccmAnticoagulation management with symptom and oxygenation checks.
Chronic venous disease and thromboembolism
I80, I82, I83, I87, I26297 codes in familyrpmccmAdded by CCN Health · Devices: Blood pressure cuff, Pulse oximeter
This family runs to 297 codes that differ mainly by anatomic site and laterality, which does not change whether the condition supports care management. The codes are not listed one by one here. Code to the site and side documented in the record, within I80, I82, I83, I87, I26.
Heart valve disorders
I05, I06, I07, I08, I34, I35, I36, I3742 codesrpmccmBlood pressure and weight surveillance between echocardiograms.
Heart valve disorders
I05, I06, I07, I08, I34, I35, I36, I3742 codesrpmccmAdded by CCN Health · Devices: Blood pressure cuff, Connected weight scale
| Code | Official ICD-10-CM description | Programs | Risk adjustment |
|---|---|---|---|
| I05.0 | Rheumatic mitral stenosis | rpmccm | not risk adjusted |
| I05.1 | Rheumatic mitral insufficiency | rpmccm | not risk adjusted |
| I05.2 | Rheumatic mitral stenosis with insufficiency | rpmccm | not risk adjusted |
| I05.8 | Other rheumatic mitral valve diseases | rpmccm | not risk adjusted |
| I05.9 | Rheumatic mitral valve disease, unspecified | rpmccm | not risk adjusted |
| I06.0 | Rheumatic aortic stenosis | rpmccm | not risk adjusted |
| I06.1 | Rheumatic aortic insufficiency | rpmccm | not risk adjusted |
| I06.2 | Rheumatic aortic stenosis with insufficiency | rpmccm | not risk adjusted |
| I06.8 | Other rheumatic aortic valve diseases | rpmccm | not risk adjusted |
| I06.9 | Rheumatic aortic valve disease, unspecified | rpmccm | not risk adjusted |
| I07.0 | Rheumatic tricuspid stenosis | rpmccm | not risk adjusted |
| I07.1 | Rheumatic tricuspid insufficiency | rpmccm | not risk adjusted |
| I07.2 | Rheumatic tricuspid stenosis and insufficiency | rpmccm | not risk adjusted |
| I07.8 | Other rheumatic tricuspid valve diseases | rpmccm | not risk adjusted |
| I07.9 | Rheumatic tricuspid valve disease, unspecified | rpmccm | not risk adjusted |
| I08.0 | Rheumatic disorders of both mitral and aortic valves | rpmccm | not risk adjusted |
| I08.1 | Rheumatic disorders of both mitral and tricuspid valves | rpmccm | not risk adjusted |
| I08.2 | Rheumatic disorders of both aortic and tricuspid valves | rpmccm | not risk adjusted |
| I08.3 | Combined rheumatic disorders of mitral, aortic and tricuspid valves | rpmccm | not risk adjusted |
| I08.8 | Other rheumatic multiple valve diseases | rpmccm | not risk adjusted |
| I08.9 | Rheumatic multiple valve disease, unspecified | rpmccm | not risk adjusted |
| I34.0 | Nonrheumatic mitral (valve) insufficiency | rpmccm | not risk adjusted |
| I34.1 | Nonrheumatic mitral (valve) prolapse | rpmccm | not risk adjusted |
| I34.2 | Nonrheumatic mitral (valve) stenosis | rpmccm | not risk adjusted |
| I34.81 | Nonrheumatic mitral (valve) annulus calcification | rpmccm | not risk adjusted |
| I34.89 | Other nonrheumatic mitral valve disorders | rpmccm | not risk adjusted |
| I34.9 | Nonrheumatic mitral valve disorder, unspecified | rpmccm | not risk adjusted |
| I35.0 | Nonrheumatic aortic (valve) stenosis | rpmccm | not risk adjusted |
| I35.1 | Nonrheumatic aortic (valve) insufficiency | rpmccm | not risk adjusted |
| I35.2 | Nonrheumatic aortic (valve) stenosis with insufficiency | rpmccm | not risk adjusted |
| I35.8 | Other nonrheumatic aortic valve disorders | rpmccm | not risk adjusted |
| I35.9 | Nonrheumatic aortic valve disorder, unspecified | rpmccm | not risk adjusted |
| I36.0 | Nonrheumatic tricuspid (valve) stenosis | rpmccm | not risk adjusted |
| I36.1 | Nonrheumatic tricuspid (valve) insufficiency | rpmccm | not risk adjusted |
| I36.2 | Nonrheumatic tricuspid (valve) stenosis with insufficiency | rpmccm | not risk adjusted |
| I36.8 | Other nonrheumatic tricuspid valve disorders | rpmccm | not risk adjusted |
| I36.9 | Nonrheumatic tricuspid valve disorder, unspecified | rpmccm | not risk adjusted |
| I37.0 | Nonrheumatic pulmonary valve stenosis | rpmccm | not risk adjusted |
| I37.1 | Nonrheumatic pulmonary valve insufficiency | rpmccm | not risk adjusted |
| I37.2 | Nonrheumatic pulmonary valve stenosis with insufficiency | rpmccm | not risk adjusted |
| I37.8 | Other nonrheumatic pulmonary valve disorders | rpmccm | not risk adjusted |
| I37.9 | Nonrheumatic pulmonary valve disorder, unspecified | rpmccm | not risk adjusted |
Endocrine and metabolic
Type 2 diabetes mellitus
E1187 codesrpmccmpcmBlood glucose by meter or CGM, commonly paired with blood pressure and weight because the comorbidities travel together.
Type 2 diabetes mellitus
E1187 codesrpmccmpcmCMS chronic condition · CCW category: Diabetes · Devices: Blood glucose meter, Continuous glucose monitor, Blood pressure cuff, Connected weight scale
Code to the complication. E11.9 (without complications) is accurate only when the record truly documents none, and it carries no HCC weight.
Read the type 2 diabetes mellitus monitoring guide
| Code | Official ICD-10-CM description | Programs | Risk adjustment |
|---|---|---|---|
| E11.00 | Type 2 diabetes mellitus with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHC) | rpmccmpcm | HCC 36 · Diabetes with Severe Acute Complications |
| E11.01 | Type 2 diabetes mellitus with hyperosmolarity with coma | rpmccmpcm | HCC 36 · Diabetes with Severe Acute Complications |
| E11.10 | Type 2 diabetes mellitus with ketoacidosis without coma | rpmccmpcm | HCC 36 · Diabetes with Severe Acute Complications |
| E11.11 | Type 2 diabetes mellitus with ketoacidosis with coma | rpmccmpcm | HCC 36 · Diabetes with Severe Acute Complications |
| E11.21 | Type 2 diabetes mellitus with diabetic nephropathy | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.22 | Type 2 diabetes mellitus with diabetic chronic kidney disease | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.29 | Type 2 diabetes mellitus with other diabetic kidney complication | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.311 | Type 2 diabetes mellitus with unspecified diabetic retinopathy with macular edema | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.319 | Type 2 diabetes mellitus with unspecified diabetic retinopathy without macular edema | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3211 | Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3212 | Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3213 | Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3219 | Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3291 | Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3292 | Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3293 | Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3299 | Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3311 | Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3312 | Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3313 | Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3319 | Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3391 | Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3392 | Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3393 | Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3399 | Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3411 | Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3412 | Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3413 | Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3419 | Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3491 | Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3492 | Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3493 | Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3499 | Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3511 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3512 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3513 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3519 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3521 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3522 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3523 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3529 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3531 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3532 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3533 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3539 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3541 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3542 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3543 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3549 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3551 | Type 2 diabetes mellitus with stable proliferative diabetic retinopathy, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3552 | Type 2 diabetes mellitus with stable proliferative diabetic retinopathy, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3553 | Type 2 diabetes mellitus with stable proliferative diabetic retinopathy, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3559 | Type 2 diabetes mellitus with stable proliferative diabetic retinopathy, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3591 | Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3592 | Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3593 | Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.3599 | Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.36 | Type 2 diabetes mellitus with diabetic cataract | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.37X1 | Type 2 diabetes mellitus with diabetic macular edema, resolved following treatment, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.37X2 | Type 2 diabetes mellitus with diabetic macular edema, resolved following treatment, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.37X3 | Type 2 diabetes mellitus with diabetic macular edema, resolved following treatment, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.37X9 | Type 2 diabetes mellitus with diabetic macular edema, resolved following treatment, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.39 | Type 2 diabetes mellitus with other diabetic ophthalmic complication | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.40 | Type 2 diabetes mellitus with diabetic neuropathy, unspecified | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.41 | Type 2 diabetes mellitus with diabetic mononeuropathy | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.42 | Type 2 diabetes mellitus with diabetic polyneuropathy | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.43 | Type 2 diabetes mellitus with diabetic autonomic (poly)neuropathy | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.44 | Type 2 diabetes mellitus with diabetic amyotrophy | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.49 | Type 2 diabetes mellitus with other diabetic neurological complication | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.51 | Type 2 diabetes mellitus with diabetic peripheral angiopathy without gangrene | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.52 | Type 2 diabetes mellitus with diabetic peripheral angiopathy with gangrene | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.59 | Type 2 diabetes mellitus with other circulatory complications | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.610 | Type 2 diabetes mellitus with diabetic neuropathic arthropathy | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.618 | Type 2 diabetes mellitus with other diabetic arthropathy | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.620 | Type 2 diabetes mellitus with diabetic dermatitis | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.621 | Type 2 diabetes mellitus with foot ulcer | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.622 | Type 2 diabetes mellitus with other skin ulcer | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.628 | Type 2 diabetes mellitus with other skin complications | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.630 | Type 2 diabetes mellitus with periodontal disease | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.638 | Type 2 diabetes mellitus with other oral complications | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.641 | Type 2 diabetes mellitus with hypoglycemia with coma | rpmccmpcm | HCC 36 · Diabetes with Severe Acute Complications |
| E11.649 | Type 2 diabetes mellitus with hypoglycemia without coma | rpmccmpcm | HCC 38 · Diabetes with Glycemic, Unspecified, or No Complications |
| E11.65 | Type 2 diabetes mellitus with hyperglycemia | rpmccmpcm | HCC 38 · Diabetes with Glycemic, Unspecified, or No Complications |
| E11.69 | Type 2 diabetes mellitus with other specified complication | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E11.8 | Type 2 diabetes mellitus with unspecified complications | rpmccmpcm | HCC 38 · Diabetes with Glycemic, Unspecified, or No Complications |
| E11.9 | Type 2 diabetes mellitus without complications | rpmccmpcm | HCC 38 · Diabetes with Glycemic, Unspecified, or No Complications |
| E11.A | Type 2 diabetes mellitus without complications in remission | rpmccmpcm | not risk adjusted |
Type 1 diabetes mellitus
E1087 codesrpmccmpcmCGM trend and time-in-range review, with meter confirmation where CGM is not in use.
Type 1 diabetes mellitus
E1087 codesrpmccmpcmCMS chronic condition · CCW category: Diabetes · Devices: Continuous glucose monitor, Blood glucose meter
| Code | Official ICD-10-CM description | Programs | Risk adjustment |
|---|---|---|---|
| E10.10 | Type 1 diabetes mellitus with ketoacidosis without coma | rpmccmpcm | HCC 36 · Diabetes with Severe Acute Complications |
| E10.11 | Type 1 diabetes mellitus with ketoacidosis with coma | rpmccmpcm | HCC 36 · Diabetes with Severe Acute Complications |
| E10.21 | Type 1 diabetes mellitus with diabetic nephropathy | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.22 | Type 1 diabetes mellitus with diabetic chronic kidney disease | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.29 | Type 1 diabetes mellitus with other diabetic kidney complication | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.311 | Type 1 diabetes mellitus with unspecified diabetic retinopathy with macular edema | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.319 | Type 1 diabetes mellitus with unspecified diabetic retinopathy without macular edema | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3211 | Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3212 | Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3213 | Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3219 | Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3291 | Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3292 | Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3293 | Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3299 | Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3311 | Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3312 | Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3313 | Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3319 | Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3391 | Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3392 | Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3393 | Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3399 | Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3411 | Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3412 | Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3413 | Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3419 | Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3491 | Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3492 | Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3493 | Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3499 | Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3511 | Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3512 | Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3513 | Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3519 | Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3521 | Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3522 | Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3523 | Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3529 | Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3531 | Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3532 | Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3533 | Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3539 | Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3541 | Type 1 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3542 | Type 1 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3543 | Type 1 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3549 | Type 1 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3551 | Type 1 diabetes mellitus with stable proliferative diabetic retinopathy, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3552 | Type 1 diabetes mellitus with stable proliferative diabetic retinopathy, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3553 | Type 1 diabetes mellitus with stable proliferative diabetic retinopathy, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3559 | Type 1 diabetes mellitus with stable proliferative diabetic retinopathy, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3591 | Type 1 diabetes mellitus with proliferative diabetic retinopathy without macular edema, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3592 | Type 1 diabetes mellitus with proliferative diabetic retinopathy without macular edema, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3593 | Type 1 diabetes mellitus with proliferative diabetic retinopathy without macular edema, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.3599 | Type 1 diabetes mellitus with proliferative diabetic retinopathy without macular edema, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.36 | Type 1 diabetes mellitus with diabetic cataract | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.37X1 | Type 1 diabetes mellitus with diabetic macular edema, resolved following treatment, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.37X2 | Type 1 diabetes mellitus with diabetic macular edema, resolved following treatment, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.37X3 | Type 1 diabetes mellitus with diabetic macular edema, resolved following treatment, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.37X9 | Type 1 diabetes mellitus with diabetic macular edema, resolved following treatment, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.39 | Type 1 diabetes mellitus with other diabetic ophthalmic complication | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.40 | Type 1 diabetes mellitus with diabetic neuropathy, unspecified | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.41 | Type 1 diabetes mellitus with diabetic mononeuropathy | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.42 | Type 1 diabetes mellitus with diabetic polyneuropathy | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.43 | Type 1 diabetes mellitus with diabetic autonomic (poly)neuropathy | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.44 | Type 1 diabetes mellitus with diabetic amyotrophy | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.49 | Type 1 diabetes mellitus with other diabetic neurological complication | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.51 | Type 1 diabetes mellitus with diabetic peripheral angiopathy without gangrene | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.52 | Type 1 diabetes mellitus with diabetic peripheral angiopathy with gangrene | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.59 | Type 1 diabetes mellitus with other circulatory complications | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.610 | Type 1 diabetes mellitus with diabetic neuropathic arthropathy | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.618 | Type 1 diabetes mellitus with other diabetic arthropathy | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.620 | Type 1 diabetes mellitus with diabetic dermatitis | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.621 | Type 1 diabetes mellitus with foot ulcer | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.622 | Type 1 diabetes mellitus with other skin ulcer | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.628 | Type 1 diabetes mellitus with other skin complications | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.630 | Type 1 diabetes mellitus with periodontal disease | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.638 | Type 1 diabetes mellitus with other oral complications | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.641 | Type 1 diabetes mellitus with hypoglycemia with coma | rpmccmpcm | HCC 36 · Diabetes with Severe Acute Complications |
| E10.649 | Type 1 diabetes mellitus with hypoglycemia without coma | rpmccmpcm | HCC 38 · Diabetes with Glycemic, Unspecified, or No Complications |
| E10.65 | Type 1 diabetes mellitus with hyperglycemia | rpmccmpcm | HCC 38 · Diabetes with Glycemic, Unspecified, or No Complications |
| E10.69 | Type 1 diabetes mellitus with other specified complication | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E10.8 | Type 1 diabetes mellitus with unspecified complications | rpmccmpcm | HCC 38 · Diabetes with Glycemic, Unspecified, or No Complications |
| E10.9 | Type 1 diabetes mellitus without complications | rpmccmpcm | HCC 38 · Diabetes with Glycemic, Unspecified, or No Complications |
| E10.A0 | Type 1 diabetes mellitus, presymptomatic, unspecifiedlow specificity | rpmccmpcm | not risk adjusted |
| E10.A1 | Type 1 diabetes mellitus, presymptomatic, Stage 1 | rpmccmpcm | not risk adjusted |
| E10.A2 | Type 1 diabetes mellitus, presymptomatic, Stage 2 | rpmccmpcm | not risk adjusted |
Diabetes due to underlying condition, drugs or chemicals
E08, E09, E13258 codesrpmccmpcmGlucose monitoring during and after the exposure or treatment that caused the hyperglycemia.
Diabetes due to underlying condition, drugs or chemicals
E08, E09, E13258 codesrpmccmpcmCMS chronic condition · CCW category: Diabetes · Devices: Blood glucose meter, Continuous glucose monitor
E08 and E09 require the underlying condition or the drug to be coded first. Steroid-induced hyperglycemia belongs in E09, not E11.
| Code | Official ICD-10-CM description | Programs | Risk adjustment |
|---|---|---|---|
| E08.00 | Diabetes mellitus due to underlying condition with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHC) | rpmccmpcm | HCC 36 · Diabetes with Severe Acute Complications |
| E08.01 | Diabetes mellitus due to underlying condition with hyperosmolarity with coma | rpmccmpcm | HCC 36 · Diabetes with Severe Acute Complications |
| E08.10 | Diabetes mellitus due to underlying condition with ketoacidosis without coma | rpmccmpcm | HCC 36 · Diabetes with Severe Acute Complications |
| E08.11 | Diabetes mellitus due to underlying condition with ketoacidosis with coma | rpmccmpcm | HCC 36 · Diabetes with Severe Acute Complications |
| E08.21 | Diabetes mellitus due to underlying condition with diabetic nephropathy | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.22 | Diabetes mellitus due to underlying condition with diabetic chronic kidney disease | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.29 | Diabetes mellitus due to underlying condition with other diabetic kidney complication | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.311 | Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy with macular edema | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.319 | Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy without macular edema | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3211 | Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3212 | Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3213 | Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3219 | Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3291 | Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3292 | Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3293 | Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3299 | Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3311 | Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3312 | Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3313 | Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3319 | Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3391 | Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy without macular edema, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3392 | Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy without macular edema, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3393 | Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy without macular edema, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3399 | Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy without macular edema, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3411 | Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy with macular edema, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3412 | Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy with macular edema, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3413 | Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy with macular edema, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3419 | Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy with macular edema, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3491 | Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy without macular edema, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3492 | Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy without macular edema, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3493 | Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy without macular edema, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3499 | Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy without macular edema, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3511 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with macular edema, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3512 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with macular edema, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3513 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with macular edema, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3519 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with macular edema, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3521 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment involving the macula, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3522 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment involving the macula, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3523 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment involving the macula, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3529 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment involving the macula, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3531 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3532 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3533 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3539 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3541 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3542 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3543 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3549 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3551 | Diabetes mellitus due to underlying condition with stable proliferative diabetic retinopathy, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3552 | Diabetes mellitus due to underlying condition with stable proliferative diabetic retinopathy, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3553 | Diabetes mellitus due to underlying condition with stable proliferative diabetic retinopathy, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3559 | Diabetes mellitus due to underlying condition with stable proliferative diabetic retinopathy, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3591 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy without macular edema, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3592 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy without macular edema, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3593 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy without macular edema, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.3599 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy without macular edema, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.36 | Diabetes mellitus due to underlying condition with diabetic cataract | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.37X1 | Diabetes mellitus due to underlying condition with diabetic macular edema, resolved following treatment, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.37X2 | Diabetes mellitus due to underlying condition with diabetic macular edema, resolved following treatment, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.37X3 | Diabetes mellitus due to underlying condition with diabetic macular edema, resolved following treatment, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.37X9 | Diabetes mellitus due to underlying condition with diabetic macular edema, resolved following treatment, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.39 | Diabetes mellitus due to underlying condition with other diabetic ophthalmic complication | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.40 | Diabetes mellitus due to underlying condition with diabetic neuropathy, unspecified | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.41 | Diabetes mellitus due to underlying condition with diabetic mononeuropathy | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.42 | Diabetes mellitus due to underlying condition with diabetic polyneuropathy | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.43 | Diabetes mellitus due to underlying condition with diabetic autonomic (poly)neuropathy | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.44 | Diabetes mellitus due to underlying condition with diabetic amyotrophy | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.49 | Diabetes mellitus due to underlying condition with other diabetic neurological complication | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.51 | Diabetes mellitus due to underlying condition with diabetic peripheral angiopathy without gangrene | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.52 | Diabetes mellitus due to underlying condition with diabetic peripheral angiopathy with gangrene | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.59 | Diabetes mellitus due to underlying condition with other circulatory complications | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.610 | Diabetes mellitus due to underlying condition with diabetic neuropathic arthropathy | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.618 | Diabetes mellitus due to underlying condition with other diabetic arthropathy | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.620 | Diabetes mellitus due to underlying condition with diabetic dermatitis | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.621 | Diabetes mellitus due to underlying condition with foot ulcer | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.622 | Diabetes mellitus due to underlying condition with other skin ulcer | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.628 | Diabetes mellitus due to underlying condition with other skin complications | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.630 | Diabetes mellitus due to underlying condition with periodontal disease | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.638 | Diabetes mellitus due to underlying condition with other oral complications | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.641 | Diabetes mellitus due to underlying condition with hypoglycemia with coma | rpmccmpcm | HCC 36 · Diabetes with Severe Acute Complications |
| E08.649 | Diabetes mellitus due to underlying condition with hypoglycemia without coma | rpmccmpcm | HCC 38 · Diabetes with Glycemic, Unspecified, or No Complications |
| E08.65 | Diabetes mellitus due to underlying condition with hyperglycemia | rpmccmpcm | HCC 38 · Diabetes with Glycemic, Unspecified, or No Complications |
| E08.69 | Diabetes mellitus due to underlying condition with other specified complication | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E08.8 | Diabetes mellitus due to underlying condition with unspecified complications | rpmccmpcm | HCC 38 · Diabetes with Glycemic, Unspecified, or No Complications |
| E08.9 | Diabetes mellitus due to underlying condition without complications | rpmccmpcm | HCC 38 · Diabetes with Glycemic, Unspecified, or No Complications |
| E09.00 | Drug or chemical induced diabetes mellitus with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHC) | rpmccmpcm | not risk adjusted |
| E09.01 | Drug or chemical induced diabetes mellitus with hyperosmolarity with coma | rpmccmpcm | not risk adjusted |
| E09.10 | Drug or chemical induced diabetes mellitus with ketoacidosis without coma | rpmccmpcm | not risk adjusted |
| E09.11 | Drug or chemical induced diabetes mellitus with ketoacidosis with coma | rpmccmpcm | not risk adjusted |
| E09.21 | Drug or chemical induced diabetes mellitus with diabetic nephropathy | rpmccmpcm | not risk adjusted |
| E09.22 | Drug or chemical induced diabetes mellitus with diabetic chronic kidney disease | rpmccmpcm | not risk adjusted |
| E09.29 | Drug or chemical induced diabetes mellitus with other diabetic kidney complication | rpmccmpcm | not risk adjusted |
| E09.311 | Drug or chemical induced diabetes mellitus with unspecified diabetic retinopathy with macular edema | rpmccmpcm | not risk adjusted |
| E09.319 | Drug or chemical induced diabetes mellitus with unspecified diabetic retinopathy without macular edema | rpmccmpcm | not risk adjusted |
| E09.3211 | Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, right eye | rpmccmpcm | not risk adjusted |
| E09.3212 | Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, left eye | rpmccmpcm | not risk adjusted |
| E09.3213 | Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, bilateral | rpmccmpcm | not risk adjusted |
| E09.3219 | Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, unspecified eye | rpmccmpcm | not risk adjusted |
| E09.3291 | Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, right eye | rpmccmpcm | not risk adjusted |
| E09.3292 | Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, left eye | rpmccmpcm | not risk adjusted |
| E09.3293 | Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, bilateral | rpmccmpcm | not risk adjusted |
| E09.3299 | Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, unspecified eye | rpmccmpcm | not risk adjusted |
| E09.3311 | Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, right eye | rpmccmpcm | not risk adjusted |
| E09.3312 | Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, left eye | rpmccmpcm | not risk adjusted |
| E09.3313 | Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, bilateral | rpmccmpcm | not risk adjusted |
| E09.3319 | Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, unspecified eye | rpmccmpcm | not risk adjusted |
| E09.3391 | Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, right eye | rpmccmpcm | not risk adjusted |
| E09.3392 | Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, left eye | rpmccmpcm | not risk adjusted |
| E09.3393 | Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, bilateral | rpmccmpcm | not risk adjusted |
| E09.3399 | Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, unspecified eye | rpmccmpcm | not risk adjusted |
| E09.3411 | Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, right eye | rpmccmpcm | not risk adjusted |
| E09.3412 | Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, left eye | rpmccmpcm | not risk adjusted |
| E09.3413 | Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, bilateral | rpmccmpcm | not risk adjusted |
| E09.3419 | Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, unspecified eye | rpmccmpcm | not risk adjusted |
| E09.3491 | Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, right eye | rpmccmpcm | not risk adjusted |
| E09.3492 | Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, left eye | rpmccmpcm | not risk adjusted |
| E09.3493 | Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, bilateral | rpmccmpcm | not risk adjusted |
| E09.3499 | Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, unspecified eye | rpmccmpcm | not risk adjusted |
| E09.3511 | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with macular edema, right eye | rpmccmpcm | not risk adjusted |
| E09.3512 | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with macular edema, left eye | rpmccmpcm | not risk adjusted |
| E09.3513 | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with macular edema, bilateral | rpmccmpcm | not risk adjusted |
| E09.3519 | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with macular edema, unspecified eye | rpmccmpcm | not risk adjusted |
| E09.3521 | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, right eye | rpmccmpcm | not risk adjusted |
| E09.3522 | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, left eye | rpmccmpcm | not risk adjusted |
| E09.3523 | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, bilateral | rpmccmpcm | not risk adjusted |
| E09.3529 | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, unspecified eye | rpmccmpcm | not risk adjusted |
| E09.3531 | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, right eye | rpmccmpcm | not risk adjusted |
| E09.3532 | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, left eye | rpmccmpcm | not risk adjusted |
| E09.3533 | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, bilateral | rpmccmpcm | not risk adjusted |
| E09.3539 | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, unspecified eye | rpmccmpcm | not risk adjusted |
| E09.3541 | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, right eye | rpmccmpcm | not risk adjusted |
| E09.3542 | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, left eye | rpmccmpcm | not risk adjusted |
| E09.3543 | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, bilateral | rpmccmpcm | not risk adjusted |
| E09.3549 | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, unspecified eye | rpmccmpcm | not risk adjusted |
| E09.3551 | Drug or chemical induced diabetes mellitus with stable proliferative diabetic retinopathy, right eye | rpmccmpcm | not risk adjusted |
| E09.3552 | Drug or chemical induced diabetes mellitus with stable proliferative diabetic retinopathy, left eye | rpmccmpcm | not risk adjusted |
| E09.3553 | Drug or chemical induced diabetes mellitus with stable proliferative diabetic retinopathy, bilateral | rpmccmpcm | not risk adjusted |
| E09.3559 | Drug or chemical induced diabetes mellitus with stable proliferative diabetic retinopathy, unspecified eye | rpmccmpcm | not risk adjusted |
| E09.3591 | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy without macular edema, right eye | rpmccmpcm | not risk adjusted |
| E09.3592 | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy without macular edema, left eye | rpmccmpcm | not risk adjusted |
| E09.3593 | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy without macular edema, bilateral | rpmccmpcm | not risk adjusted |
| E09.3599 | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy without macular edema, unspecified eye | rpmccmpcm | not risk adjusted |
| E09.36 | Drug or chemical induced diabetes mellitus with diabetic cataract | rpmccmpcm | not risk adjusted |
| E09.37X1 | Drug or chemical induced diabetes mellitus with diabetic macular edema, resolved following treatment, right eye | rpmccmpcm | not risk adjusted |
| E09.37X2 | Drug or chemical induced diabetes mellitus with diabetic macular edema, resolved following treatment, left eye | rpmccmpcm | not risk adjusted |
| E09.37X3 | Drug or chemical induced diabetes mellitus with diabetic macular edema, resolved following treatment, bilateral | rpmccmpcm | not risk adjusted |
| E09.37X9 | Drug or chemical induced diabetes mellitus with diabetic macular edema, resolved following treatment, unspecified eye | rpmccmpcm | not risk adjusted |
| E09.39 | Drug or chemical induced diabetes mellitus with other diabetic ophthalmic complication | rpmccmpcm | not risk adjusted |
| E09.40 | Drug or chemical induced diabetes mellitus with neurological complications with diabetic neuropathy, unspecified | rpmccmpcm | not risk adjusted |
| E09.41 | Drug or chemical induced diabetes mellitus with neurological complications with diabetic mononeuropathy | rpmccmpcm | not risk adjusted |
| E09.42 | Drug or chemical induced diabetes mellitus with neurological complications with diabetic polyneuropathy | rpmccmpcm | not risk adjusted |
| E09.43 | Drug or chemical induced diabetes mellitus with neurological complications with diabetic autonomic (poly)neuropathy | rpmccmpcm | not risk adjusted |
| E09.44 | Drug or chemical induced diabetes mellitus with neurological complications with diabetic amyotrophy | rpmccmpcm | not risk adjusted |
| E09.49 | Drug or chemical induced diabetes mellitus with neurological complications with other diabetic neurological complication | rpmccmpcm | not risk adjusted |
| E09.51 | Drug or chemical induced diabetes mellitus with diabetic peripheral angiopathy without gangrene | rpmccmpcm | not risk adjusted |
| E09.52 | Drug or chemical induced diabetes mellitus with diabetic peripheral angiopathy with gangrene | rpmccmpcm | not risk adjusted |
| E09.59 | Drug or chemical induced diabetes mellitus with other circulatory complications | rpmccmpcm | not risk adjusted |
| E09.610 | Drug or chemical induced diabetes mellitus with diabetic neuropathic arthropathy | rpmccmpcm | not risk adjusted |
| E09.618 | Drug or chemical induced diabetes mellitus with other diabetic arthropathy | rpmccmpcm | not risk adjusted |
| E09.620 | Drug or chemical induced diabetes mellitus with diabetic dermatitis | rpmccmpcm | not risk adjusted |
| E09.621 | Drug or chemical induced diabetes mellitus with foot ulcer | rpmccmpcm | not risk adjusted |
| E09.622 | Drug or chemical induced diabetes mellitus with other skin ulcer | rpmccmpcm | not risk adjusted |
| E09.628 | Drug or chemical induced diabetes mellitus with other skin complications | rpmccmpcm | not risk adjusted |
| E09.630 | Drug or chemical induced diabetes mellitus with periodontal disease | rpmccmpcm | not risk adjusted |
| E09.638 | Drug or chemical induced diabetes mellitus with other oral complications | rpmccmpcm | not risk adjusted |
| E09.641 | Drug or chemical induced diabetes mellitus with hypoglycemia with coma | rpmccmpcm | not risk adjusted |
| E09.649 | Drug or chemical induced diabetes mellitus with hypoglycemia without coma | rpmccmpcm | not risk adjusted |
| E09.65 | Drug or chemical induced diabetes mellitus with hyperglycemia | rpmccmpcm | not risk adjusted |
| E09.69 | Drug or chemical induced diabetes mellitus with other specified complication | rpmccmpcm | not risk adjusted |
| E09.8 | Drug or chemical induced diabetes mellitus with unspecified complications | rpmccmpcm | not risk adjusted |
| E09.9 | Drug or chemical induced diabetes mellitus without complications | rpmccmpcm | not risk adjusted |
| E13.00 | Other specified diabetes mellitus with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHC) | rpmccmpcm | HCC 36 · Diabetes with Severe Acute Complications |
| E13.01 | Other specified diabetes mellitus with hyperosmolarity with coma | rpmccmpcm | HCC 36 · Diabetes with Severe Acute Complications |
| E13.10 | Other specified diabetes mellitus with ketoacidosis without coma | rpmccmpcm | HCC 36 · Diabetes with Severe Acute Complications |
| E13.11 | Other specified diabetes mellitus with ketoacidosis with coma | rpmccmpcm | HCC 36 · Diabetes with Severe Acute Complications |
| E13.21 | Other specified diabetes mellitus with diabetic nephropathy | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.22 | Other specified diabetes mellitus with diabetic chronic kidney disease | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.29 | Other specified diabetes mellitus with other diabetic kidney complication | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.311 | Other specified diabetes mellitus with unspecified diabetic retinopathy with macular edema | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.319 | Other specified diabetes mellitus with unspecified diabetic retinopathy without macular edema | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3211 | Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3212 | Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3213 | Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3219 | Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3291 | Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3292 | Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3293 | Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3299 | Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3311 | Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3312 | Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3313 | Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3319 | Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3391 | Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3392 | Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3393 | Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3399 | Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3411 | Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3412 | Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3413 | Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3419 | Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3491 | Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3492 | Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3493 | Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3499 | Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3511 | Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3512 | Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3513 | Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3519 | Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3521 | Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3522 | Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3523 | Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3529 | Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3531 | Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3532 | Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3533 | Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3539 | Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3541 | Other specified diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3542 | Other specified diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3543 | Other specified diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3549 | Other specified diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3551 | Other specified diabetes mellitus with stable proliferative diabetic retinopathy, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3552 | Other specified diabetes mellitus with stable proliferative diabetic retinopathy, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3553 | Other specified diabetes mellitus with stable proliferative diabetic retinopathy, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3559 | Other specified diabetes mellitus with stable proliferative diabetic retinopathy, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3591 | Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edema, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3592 | Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edema, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3593 | Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edema, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.3599 | Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edema, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.36 | Other specified diabetes mellitus with diabetic cataract | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.37X1 | Other specified diabetes mellitus with diabetic macular edema, resolved following treatment, right eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.37X2 | Other specified diabetes mellitus with diabetic macular edema, resolved following treatment, left eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.37X3 | Other specified diabetes mellitus with diabetic macular edema, resolved following treatment, bilateral | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.37X9 | Other specified diabetes mellitus with diabetic macular edema, resolved following treatment, unspecified eye | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.39 | Other specified diabetes mellitus with other diabetic ophthalmic complication | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.40 | Other specified diabetes mellitus with diabetic neuropathy, unspecified | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.41 | Other specified diabetes mellitus with diabetic mononeuropathy | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.42 | Other specified diabetes mellitus with diabetic polyneuropathy | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.43 | Other specified diabetes mellitus with diabetic autonomic (poly)neuropathy | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.44 | Other specified diabetes mellitus with diabetic amyotrophy | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.49 | Other specified diabetes mellitus with other diabetic neurological complication | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.51 | Other specified diabetes mellitus with diabetic peripheral angiopathy without gangrene | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.52 | Other specified diabetes mellitus with diabetic peripheral angiopathy with gangrene | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.59 | Other specified diabetes mellitus with other circulatory complications | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.610 | Other specified diabetes mellitus with diabetic neuropathic arthropathy | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.618 | Other specified diabetes mellitus with other diabetic arthropathy | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.620 | Other specified diabetes mellitus with diabetic dermatitis | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.621 | Other specified diabetes mellitus with foot ulcer | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.622 | Other specified diabetes mellitus with other skin ulcer | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.628 | Other specified diabetes mellitus with other skin complications | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.630 | Other specified diabetes mellitus with periodontal disease | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.638 | Other specified diabetes mellitus with other oral complications | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.641 | Other specified diabetes mellitus with hypoglycemia with coma | rpmccmpcm | HCC 36 · Diabetes with Severe Acute Complications |
| E13.649 | Other specified diabetes mellitus with hypoglycemia without coma | rpmccmpcm | HCC 38 · Diabetes with Glycemic, Unspecified, or No Complications |
| E13.65 | Other specified diabetes mellitus with hyperglycemia | rpmccmpcm | HCC 38 · Diabetes with Glycemic, Unspecified, or No Complications |
| E13.69 | Other specified diabetes mellitus with other specified complication | rpmccmpcm | HCC 37 · Diabetes with Chronic Complications |
| E13.8 | Other specified diabetes mellitus with unspecified complications | rpmccmpcm | HCC 38 · Diabetes with Glycemic, Unspecified, or No Complications |
| E13.9 | Other specified diabetes mellitus without complications | rpmccmpcm | HCC 38 · Diabetes with Glycemic, Unspecified, or No Complications |
Obesity
E66, Z68.3, Z68.425 codesrpmccmWeight trend against a documented target, usually alongside blood pressure or glucose.
Obesity
E66, Z68.3, Z68.425 codesrpmccmCMS other chronic or potentially disabling condition · CCW category: Obesity · Devices: Connected weight scale, Blood pressure cuff
Z68 BMI codes are secondary codes. They never stand alone: code the obesity or the underlying condition first.
Effective 2026-10-01: Z68.1 gains finer detail at the low end on 2026-10-01 with Z68.18 (BMI 18.4 or less) and Z68.19 (BMI 18.5 to 19.9).
Read the obesity monitoring guide
| Code | Official ICD-10-CM description | Programs | Risk adjustment |
|---|---|---|---|
| E66.01 | Morbid (severe) obesity due to excess calories | rpmccm | HCC 48 · Morbid Obesity |
| E66.09 | Other obesity due to excess calories | rpmccm | not risk adjusted |
| E66.1 | Drug-induced obesity | rpmccm | not risk adjusted |
| E66.2 | Morbid (severe) obesity with alveolar hypoventilation | rpmccm | HCC 48 · Morbid Obesity |
| E66.3 | Overweight | rpmccm | not risk adjusted |
| E66.811 | Obesity, class 1 | rpmccm | not risk adjusted |
| E66.812 | Obesity, class 2 | rpmccm | not risk adjusted |
| E66.813 | Obesity, class 3 | rpmccm | HCC 48 · Morbid Obesity |
| E66.89 | Other obesity not elsewhere classified | rpmccm | not risk adjusted |
| E66.9 | Obesity, unspecifiedlow specificity | rpmccm | not risk adjusted |
| Z68.30 | Body mass index [BMI] 30.0-30.9, adult | rpmccm | not risk adjusted |
| Z68.31 | Body mass index [BMI] 31.0-31.9, adult | rpmccm | not risk adjusted |
| Z68.32 | Body mass index [BMI] 32.0-32.9, adult | rpmccm | not risk adjusted |
| Z68.33 | Body mass index [BMI] 33.0-33.9, adult | rpmccm | not risk adjusted |
| Z68.34 | Body mass index [BMI] 34.0-34.9, adult | rpmccm | not risk adjusted |
| Z68.35 | Body mass index [BMI] 35.0-35.9, adult | rpmccm | not risk adjusted |
| Z68.36 | Body mass index [BMI] 36.0-36.9, adult | rpmccm | not risk adjusted |
| Z68.37 | Body mass index [BMI] 37.0-37.9, adult | rpmccm | not risk adjusted |
| Z68.38 | Body mass index [BMI] 38.0-38.9, adult | rpmccm | not risk adjusted |
| Z68.39 | Body mass index [BMI] 39.0-39.9, adult | rpmccm | not risk adjusted |
| Z68.41 | Body mass index [BMI] 40.0-44.9, adult | rpmccm | HCC 48 · Morbid Obesity |
| Z68.42 | Body mass index [BMI] 45.0-49.9, adult | rpmccm | HCC 48 · Morbid Obesity |
| Z68.43 | Body mass index [BMI] 50.0-59.9, adult | rpmccm | HCC 48 · Morbid Obesity |
| Z68.44 | Body mass index [BMI] 60.0-69.9, adult | rpmccm | HCC 48 · Morbid Obesity |
| Z68.45 | Body mass index [BMI] 70 or greater, adult | rpmccm | HCC 48 · Morbid Obesity |
Cystic fibrosis and metabolic developmental disorders
E84, E70, E71, E72, E74, E75, E76, E77, E79, E80183 codes in familyrpmccmpcmrtmLung function and oxygenation for cystic fibrosis, with weight as a nutritional marker.
Cystic fibrosis and metabolic developmental disorders
E84, E70, E71, E72, E74, E75, E76, E77, E79, E80183 codes in familyrpmccmpcmrtmCMS other chronic or potentially disabling condition · CCW category: Cystic Fibrosis and Other Metabolic Developmental Disorders · Devices: Spirometer or peak flow meter, Pulse oximeter, Connected weight scale
This family runs to 183 codes that differ mainly by anatomic site and laterality, which does not change whether the condition supports care management. The codes are not listed one by one here. Code to the site and side documented in the record, within E84, E70, E71, E72, E74, E75, E76, E77, E79, E80.
Respiratory
COPD, emphysema and bronchiectasis
J40, J41, J42, J43, J44, J4718 codesrpmccmpcmrtmOxygen saturation is the primary signal, with symptom scores and inhaler adherence supporting RTM.
COPD, emphysema and bronchiectasis
J40, J41, J42, J43, J44, J4718 codesrpmccmpcmrtmCMS chronic condition · CCW category: Chronic Obstructive Pulmonary Disease · Devices: Pulse oximeter, Spirometer or peak flow meter
Read the copd, emphysema and bronchiectasis monitoring guide
| Code | Official ICD-10-CM description | Programs | Risk adjustment |
|---|---|---|---|
| J40 | Bronchitis, not specified as acute or chronic | rpmccmpcmrtm | not risk adjusted |
| J41.0 | Simple chronic bronchitis | rpmccmpcmrtm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J41.1 | Mucopurulent chronic bronchitis | rpmccmpcmrtm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J41.8 | Mixed simple and mucopurulent chronic bronchitis | rpmccmpcmrtm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J42 | Unspecified chronic bronchitis | rpmccmpcmrtm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J43.0 | Unilateral pulmonary emphysema [MacLeod's syndrome] | rpmccmpcmrtm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J43.1 | Panlobular emphysema | rpmccmpcmrtm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J43.2 | Centrilobular emphysema | rpmccmpcmrtm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J43.8 | Other emphysema | rpmccmpcmrtm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J43.9 | Emphysema, unspecified | rpmccmpcmrtm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J44.0 | Chronic obstructive pulmonary disease with (acute) lower respiratory infection | rpmccmpcmrtm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J44.1 | Chronic obstructive pulmonary disease with (acute) exacerbation | rpmccmpcmrtm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J44.81 | Bronchiolitis obliterans and bronchiolitis obliterans syndrome | rpmccmpcmrtm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J44.89 | Other specified chronic obstructive pulmonary disease | rpmccmpcmrtm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J44.9 | Chronic obstructive pulmonary disease, unspecified | rpmccmpcmrtm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J47.0 | Bronchiectasis with acute lower respiratory infection | rpmccmpcmrtm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J47.1 | Bronchiectasis with (acute) exacerbation | rpmccmpcmrtm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J47.9 | Bronchiectasis, uncomplicated | rpmccmpcmrtm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
Asthma
J4518 codesrpmccmrtmPeak flow and symptom frequency. Inhaler adherence and technique are the classic RTM targets.
Asthma
J4518 codesrpmccmrtmCMS chronic condition · CCW category: Asthma · Devices: Spirometer or peak flow meter, Pulse oximeter, Patient-reported outcome app (RTM)
| Code | Official ICD-10-CM description | Programs | Risk adjustment |
|---|---|---|---|
| J45.20 | Mild intermittent asthma, uncomplicated | rpmccmrtm | not risk adjusted |
| J45.21 | Mild intermittent asthma with (acute) exacerbation | rpmccmrtm | not risk adjusted |
| J45.22 | Mild intermittent asthma with status asthmaticus | rpmccmrtm | not risk adjusted |
| J45.30 | Mild persistent asthma, uncomplicated | rpmccmrtm | not risk adjusted |
| J45.31 | Mild persistent asthma with (acute) exacerbation | rpmccmrtm | not risk adjusted |
| J45.32 | Mild persistent asthma with status asthmaticus | rpmccmrtm | not risk adjusted |
| J45.40 | Moderate persistent asthma, uncomplicated | rpmccmrtm | not risk adjusted |
| J45.41 | Moderate persistent asthma with (acute) exacerbation | rpmccmrtm | not risk adjusted |
| J45.42 | Moderate persistent asthma with status asthmaticus | rpmccmrtm | not risk adjusted |
| J45.50 | Severe persistent asthma, uncomplicated | rpmccmrtm | HCC 279 · Severe Persistent Asthma |
| J45.51 | Severe persistent asthma with (acute) exacerbation | rpmccmrtm | HCC 279 · Severe Persistent Asthma |
| J45.52 | Severe persistent asthma with status asthmaticus | rpmccmrtm | HCC 279 · Severe Persistent Asthma |
| J45.901 | Unspecified asthma with (acute) exacerbationlow specificity | rpmccmrtm | not risk adjusted |
| J45.902 | Unspecified asthma with status asthmaticuslow specificity | rpmccmrtm | not risk adjusted |
| J45.909 | Unspecified asthma, uncomplicatedlow specificity | rpmccmrtm | not risk adjusted |
| J45.990 | Exercise induced bronchospasm | rpmccmrtm | not risk adjusted |
| J45.991 | Cough variant asthma | rpmccmrtm | not risk adjusted |
| J45.998 | Other asthma | rpmccmrtm | not risk adjusted |
Respiratory failure and oxygen dependence
J96, J98.4, Z99.11, Z99.12, Z99.8116 codesrpmccmpcmContinuous or scheduled oxygen saturation with alerting thresholds.
Respiratory failure and oxygen dependence
J96, J98.4, Z99.11, Z99.12, Z99.8116 codesrpmccmpcmAdded by CCN Health · Devices: Pulse oximeter
Z99.81 (dependence on supplemental oxygen) is a secondary code that supports medical necessity. It never stands alone.
| Code | Official ICD-10-CM description | Programs | Risk adjustment |
|---|---|---|---|
| J96.00 | Acute respiratory failure, unspecified whether with hypoxia or hypercapnia | rpmccmpcm | HCC 213 · Cardio-Respiratory Failure and Shock |
| J96.01 | Acute respiratory failure with hypoxia | rpmccmpcm | HCC 213 · Cardio-Respiratory Failure and Shock |
| J96.02 | Acute respiratory failure with hypercapnia | rpmccmpcm | HCC 213 · Cardio-Respiratory Failure and Shock |
| J96.10 | Chronic respiratory failure, unspecified whether with hypoxia or hypercapnia | rpmccmpcm | HCC 213 · Cardio-Respiratory Failure and Shock |
| J96.11 | Chronic respiratory failure with hypoxia | rpmccmpcm | HCC 213 · Cardio-Respiratory Failure and Shock |
| J96.12 | Chronic respiratory failure with hypercapnia | rpmccmpcm | HCC 213 · Cardio-Respiratory Failure and Shock |
| J96.20 | Acute and chronic respiratory failure, unspecified whether with hypoxia or hypercapnia | rpmccmpcm | HCC 213 · Cardio-Respiratory Failure and Shock |
| J96.21 | Acute and chronic respiratory failure with hypoxia | rpmccmpcm | HCC 213 · Cardio-Respiratory Failure and Shock |
| J96.22 | Acute and chronic respiratory failure with hypercapnia | rpmccmpcm | HCC 213 · Cardio-Respiratory Failure and Shock |
| J96.90 | Respiratory failure, unspecified, unspecified whether with hypoxia or hypercapnia | rpmccmpcm | HCC 213 · Cardio-Respiratory Failure and Shock |
| J96.91 | Respiratory failure, unspecified with hypoxia | rpmccmpcm | HCC 213 · Cardio-Respiratory Failure and Shock |
| J96.92 | Respiratory failure, unspecified with hypercapnia | rpmccmpcm | HCC 213 · Cardio-Respiratory Failure and Shock |
| J98.4 | Other disorders of lung | rpmccmpcm | not risk adjusted |
| Z99.11 | Dependence on respirator [ventilator] status | rpmccmpcm | HCC 211 · Respirator Dependence/Tracheostomy Status/Complications |
| Z99.12 | Encounter for respirator [ventilator] dependence during power failure | rpmccmpcm | HCC 211 · Respirator Dependence/Tracheostomy Status/Complications |
| Z99.81 | Dependence on supplemental oxygen | rpmccmpcm | not risk adjusted |
Interstitial and occupational lung disease
J60, J61, J62, J63, J64, J65, J66, J67, J68, J69, J70, J80, J82, J8474 codesrpmccmpcmResting and ambulatory oxygen saturation, which often falls before symptoms change.
Interstitial and occupational lung disease
J60, J61, J62, J63, J64, J65, J66, J67, J68, J69, J70, J80, J82, J8474 codesrpmccmpcmAdded by CCN Health · Devices: Pulse oximeter, Spirometer or peak flow meter
| Code | Official ICD-10-CM description | Programs | Risk adjustment |
|---|---|---|---|
| J60 | Coalworker's pneumoconiosis | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J61 | Pneumoconiosis due to asbestos and other mineral fibers | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J62.0 | Pneumoconiosis due to talc dust | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J62.8 | Pneumoconiosis due to other dust containing silica | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J63.0 | Aluminosis (of lung) | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J63.1 | Bauxite fibrosis (of lung) | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J63.2 | Berylliosis | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J63.3 | Graphite fibrosis (of lung) | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J63.4 | Siderosis | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J63.5 | Stannosis | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J63.6 | Pneumoconiosis due to other specified inorganic dusts | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J64 | Unspecified pneumoconiosis | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J65 | Pneumoconiosis associated with tuberculosis | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J66.0 | Byssinosis | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J66.1 | Flax-dressers' disease | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J66.2 | Cannabinosis | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J66.8 | Airway disease due to other specific organic dusts | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J67.0 | Farmer's lung | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J67.1 | Bagassosis | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J67.2 | Bird fancier's lung | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J67.3 | Suberosis | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J67.4 | Maltworker's lung | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J67.5 | Mushroom-worker's lung | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J67.6 | Maple-bark-stripper's lung | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J67.7 | Air conditioner and humidifier lung | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J67.8 | Hypersensitivity pneumonitis due to other organic dusts | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J67.9 | Hypersensitivity pneumonitis due to unspecified organic dust | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J68.0 | Bronchitis and pneumonitis due to chemicals, gases, fumes and vapors | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J68.1 | Pulmonary edema due to chemicals, gases, fumes and vapors | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J68.2 | Upper respiratory inflammation due to chemicals, gases, fumes and vapors, not elsewhere classified | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J68.3 | Other acute and subacute respiratory conditions due to chemicals, gases, fumes and vapors | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J68.4 | Chronic respiratory conditions due to chemicals, gases, fumes and vapors | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J68.8 | Other respiratory conditions due to chemicals, gases, fumes and vapors | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J68.9 | Unspecified respiratory condition due to chemicals, gases, fumes and vapors | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J69.0 | Pneumonitis due to inhalation of food and vomit | rpmccmpcm | HCC 282 · Aspiration and Specified Bacterial Pneumonias |
| J69.1 | Pneumonitis due to inhalation of oils and essences | rpmccmpcm | HCC 282 · Aspiration and Specified Bacterial Pneumonias |
| J69.8 | Pneumonitis due to inhalation of other solids and liquids | rpmccmpcm | HCC 282 · Aspiration and Specified Bacterial Pneumonias |
| J70.0 | Acute pulmonary manifestations due to radiation | rpmccmpcm | not risk adjusted |
| J70.1 | Chronic and other pulmonary manifestations due to radiation | rpmccmpcm | not risk adjusted |
| J70.2 | Acute drug-induced interstitial lung disorders | rpmccmpcm | not risk adjusted |
| J70.3 | Chronic drug-induced interstitial lung disorders | rpmccmpcm | not risk adjusted |
| J70.4 | Drug-induced interstitial lung disorders, unspecified | rpmccmpcm | not risk adjusted |
| J70.5 | Respiratory conditions due to smoke inhalation | rpmccmpcm | not risk adjusted |
| J70.8 | Respiratory conditions due to other specified external agents | rpmccmpcm | not risk adjusted |
| J70.9 | Respiratory conditions due to unspecified external agent | rpmccmpcm | not risk adjusted |
| J80 | Acute respiratory distress syndrome | rpmccmpcm | HCC 213 · Cardio-Respiratory Failure and Shock |
| J82.81 | Chronic eosinophilic pneumonia | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J82.82 | Acute eosinophilic pneumonia | rpmccmpcm | not risk adjusted |
| J82.83 | Eosinophilic asthma | rpmccmpcm | not risk adjusted |
| J82.89 | Other pulmonary eosinophilia, not elsewhere classified | rpmccmpcm | not risk adjusted |
| J84.01 | Alveolar proteinosis | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J84.02 | Pulmonary alveolar microlithiasis | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J84.03 | Idiopathic pulmonary hemosiderosis | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J84.09 | Other alveolar and parieto-alveolar conditions | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J84.10 | Pulmonary fibrosis, unspecified | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J84.111 | Idiopathic interstitial pneumonia, not otherwise specified | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J84.112 | Idiopathic pulmonary fibrosis | rpmccmpcm | HCC 278 · Idiopathic Pulmonary Fibrosis and Lung Involvement in Systemic Sclerosis |
| J84.113 | Idiopathic non-specific interstitial pneumonitis | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J84.114 | Acute interstitial pneumonitis | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J84.115 | Respiratory bronchiolitis interstitial lung disease | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J84.116 | Cryptogenic organizing pneumonia | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J84.117 | Desquamative interstitial pneumonia | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J84.170 | Interstitial lung disease with progressive fibrotic phenotype in diseases classified elsewhere | rpmccmpcm | HCC 278 · Idiopathic Pulmonary Fibrosis and Lung Involvement in Systemic Sclerosis |
| J84.178 | Other interstitial pulmonary diseases with fibrosis in diseases classified elsewhere | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J84.2 | Lymphoid interstitial pneumonia | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J84.81 | Lymphangioleiomyomatosis | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J84.82 | Adult pulmonary Langerhans cell histiocytosis | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J84.83 | Surfactant mutations of the lung | rpmccmpcm | not risk adjusted |
| J84.841 | Neuroendocrine cell hyperplasia of infancy | rpmccmpcm | not risk adjusted |
| J84.842 | Pulmonary interstitial glycogenosis | rpmccmpcm | not risk adjusted |
| J84.843 | Alveolar capillary dysplasia with vein misalignment | rpmccmpcm | not risk adjusted |
| J84.848 | Other interstitial lung diseases of childhood | rpmccmpcm | not risk adjusted |
| J84.89 | Other specified interstitial pulmonary diseases | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
| J84.9 | Interstitial pulmonary disease, unspecified | rpmccmpcm | HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders |
Sleep apnea and sleep-wake disorders
G4743 codesrpmccmOvernight oxygen saturation and respiration, plus PAP adherence where the device reports it.
Sleep apnea and sleep-wake disorders
G4743 codesrpmccmAdded by CCN Health · Devices: Sleep and respiration monitor, Pulse oximeter
Not a CCW category, but sleep apnea is one of the most common comorbidities enrolled alongside hypertension, heart failure and obesity.
| Code | Official ICD-10-CM description | Programs | Risk adjustment |
|---|---|---|---|
| G47.00 | Insomnia, unspecified | rpmccm | not risk adjusted |
| G47.01 | Insomnia due to medical condition | rpmccm | not risk adjusted |
| G47.09 | Other insomnia | rpmccm | not risk adjusted |
| G47.10 | Hypersomnia, unspecified | rpmccm | not risk adjusted |
| G47.11 | Idiopathic hypersomnia with long sleep time | rpmccm | not risk adjusted |
| G47.12 | Idiopathic hypersomnia without long sleep time | rpmccm | not risk adjusted |
| G47.13 | Recurrent hypersomnia | rpmccm | not risk adjusted |
| G47.14 | Hypersomnia due to medical condition | rpmccm | not risk adjusted |
| G47.19 | Other hypersomnia | rpmccm | not risk adjusted |
| G47.20 | Circadian rhythm sleep disorder, unspecified type | rpmccm | not risk adjusted |
| G47.21 | Circadian rhythm sleep disorder, delayed sleep phase type | rpmccm | not risk adjusted |
| G47.22 | Circadian rhythm sleep disorder, advanced sleep phase type | rpmccm | not risk adjusted |
| G47.23 | Circadian rhythm sleep disorder, irregular sleep wake type | rpmccm | not risk adjusted |
| G47.24 | Circadian rhythm sleep disorder, free running type | rpmccm | not risk adjusted |
| G47.25 | Circadian rhythm sleep disorder, jet lag type | rpmccm | not risk adjusted |
| G47.26 | Circadian rhythm sleep disorder, shift work type | rpmccm | not risk adjusted |
| G47.27 | Circadian rhythm sleep disorder in conditions classified elsewhere | rpmccm | not risk adjusted |
| G47.29 | Other circadian rhythm sleep disorder | rpmccm | not risk adjusted |
| G47.30 | Sleep apnea, unspecified | rpmccm | not risk adjusted |
| G47.31 | Primary central sleep apnea | rpmccm | not risk adjusted |
| G47.32 | High altitude periodic breathing | rpmccm | not risk adjusted |
| G47.33 | Obstructive sleep apnea (adult) (pediatric) | rpmccm | not risk adjusted |
| G47.34 | Idiopathic sleep related nonobstructive alveolar hypoventilation | rpmccm | not risk adjusted |
| G47.35 | Congenital central alveolar hypoventilation syndrome | rpmccm | not risk adjusted |
| G47.36 | Sleep related hypoventilation in conditions classified elsewhere | rpmccm | not risk adjusted |
| G47.37 | Central sleep apnea in conditions classified elsewhere | rpmccm | not risk adjusted |
| G47.39 | Other sleep apnea | rpmccm | not risk adjusted |
| G47.411 | Narcolepsy with cataplexy | rpmccm | not risk adjusted |
| G47.419 | Narcolepsy without cataplexy | rpmccm | not risk adjusted |
| G47.421 | Narcolepsy in conditions classified elsewhere with cataplexy | rpmccm | not risk adjusted |
| G47.429 | Narcolepsy in conditions classified elsewhere without cataplexy | rpmccm | not risk adjusted |
| G47.50 | Parasomnia, unspecified | rpmccm | not risk adjusted |
| G47.51 | Confusional arousals | rpmccm | not risk adjusted |
| G47.52 | REM sleep behavior disorder | rpmccm | not risk adjusted |
| G47.53 | Recurrent isolated sleep paralysis | rpmccm | not risk adjusted |
| G47.54 | Parasomnia in conditions classified elsewhere | rpmccm | not risk adjusted |
| G47.59 | Other parasomnia | rpmccm | not risk adjusted |
| G47.61 | Periodic limb movement disorder | rpmccm | not risk adjusted |
| G47.62 | Sleep related leg cramps | rpmccm | not risk adjusted |
| G47.63 | Sleep related bruxism | rpmccm | not risk adjusted |
| G47.69 | Other sleep related movement disorders | rpmccm | not risk adjusted |
| G47.8 | Other sleep disorders | rpmccm | not risk adjusted |
| G47.9 | Sleep disorder, unspecified | rpmccm | not risk adjusted |
Kidney and urologic
Chronic kidney disease and ESRD
N18, N19, Z99.2, Z94.012 codesrpmccmpcmBlood pressure and weight for volume management. Weight change between dialysis sessions is the practical signal in late-stage disease.
Chronic kidney disease and ESRD
N18, N19, Z99.2, Z94.012 codesrpmccmpcmCMS chronic condition · CCW category: Chronic Kidney Disease · Devices: Blood pressure cuff, Connected weight scale
Stage the disease. N18.9 (unspecified) carries no HCC weight and invites review, while N18.30 through N18.6 do.
Read the chronic kidney disease and esrd monitoring guide
| Code | Official ICD-10-CM description | Programs | Risk adjustment |
|---|---|---|---|
| N18.1 | Chronic kidney disease, stage 1 | rpmccmpcm | not risk adjusted |
| N18.2 | Chronic kidney disease, stage 2 (mild) | rpmccmpcm | not risk adjusted |
| N18.30 | Chronic kidney disease, stage 3 unspecified | rpmccmpcm | HCC 329 · Chronic Kidney Disease, Moderate (Stage 3, Except 3B) |
| N18.31 | Chronic kidney disease, stage 3a | rpmccmpcm | HCC 329 · Chronic Kidney Disease, Moderate (Stage 3, Except 3B) |
| N18.32 | Chronic kidney disease, stage 3b | rpmccmpcm | HCC 328 · Chronic Kidney Disease, Moderate (Stage 3B) |
| N18.4 | Chronic kidney disease, stage 4 (severe) | rpmccmpcm | HCC 327 · Chronic Kidney Disease, Severe (Stage 4) |
| N18.5 | Chronic kidney disease, stage 5 | rpmccmpcm | HCC 326 · Chronic Kidney Disease, Stage 5 |
| N18.6 | End stage renal disease | rpmccmpcm | HCC 326 · Chronic Kidney Disease, Stage 5 |
| N18.9 | Chronic kidney disease, unspecifiedlow specificity | rpmccmpcm | not risk adjusted |
| N19 | Unspecified kidney failure | rpmccmpcm | not risk adjusted |
| Z94.0 | Kidney transplant status | rpmccmpcm | not risk adjusted |
| Z99.2 | Dependence on renal dialysis | rpmccmpcm | not risk adjusted |
Glomerular and tubulo-interstitial kidney disease
N00, N01, N02, N03, N04, N05, N06, N07, N08, N11, N13, N14, N15, N16, N25, N26148 codes in familyrpmccmpcmBlood pressure and weight, with proteinuria followed by laboratory.
Glomerular and tubulo-interstitial kidney disease
N00, N01, N02, N03, N04, N05, N06, N07, N08, N11, N13, N14, N15, N16, N25, N26148 codes in familyrpmccmpcmCMS chronic condition · CCW category: Chronic Kidney Disease · Devices: Blood pressure cuff, Connected weight scale
This family runs to 148 codes that differ mainly by anatomic site and laterality, which does not change whether the condition supports care management. The codes are not listed one by one here. Code to the site and side documented in the record, within N00, N01, N02, N03, N04, N05, N06, N07, N08, N11, N13, N14, N15, N16, N25, N26.
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 |
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 |
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.
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 RPM.
Internal Medicine practices can leverage RPM 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 RPM?
CMS publishes no list of codes that qualify a patient for RPM: eligibility turns on the condition and on documented medical necessity. For internal medicine, 1004 billable ICD-10-CM codes cover the conditions RPM manages, spanning 28 conditions including essential hypertension, hypertensive heart and kidney disease, heart failure, cardiomyopathy and myocarditis, atrial fibrillation and flutter, other cardiac dysrhythmias and conduction disorders.
02
How does CCN Health support internal medicine practices with RPM?
CCN Health provides turnkey RPM 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 RPM in internal medicine?
Reimbursement varies by locality and payer contract, so see the RPM billing guide for current figures. Internal Medicine practices with a high prevalence of these conditions generally see the most benefit, particularly when RPM 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.