Versions List of CMS-HCC Risk Adjustment Models

Model diagnosis codes are found here:

https://www.cms.gov/medicare/health-plans/medicareadvtgspecratestats/risk-adjustors

Past models include:

2017 CMS-HCC PACE/ESRD Model V21

CMS-HCC Model V22

2018 CMS-HCC PACE/ESRD Model V21

CMS-HCC Model V22

79 HCC Codes

2019 CMS-HCC PACE/ESRD Model V21

CMS-HCC Model V22 & V23

2020 CMS-HCC PACE/ESRD Model V21 &

CMS-HCC Model V22 & V24

CMS.GOV Model Software/ICD-10 Mappings

Once at the website, in the search box:

2018 ICD-10 Mappings

If you search for 2019 ICD-10-CM, look for a result that says

WITH CODING GUIDELINES, CODE TABLES AND INDEX

search box: 2018 ICD-10 Mappings, 2nd page in results is 2018 ICD-10 CM and GEMSs

WITH CODING GUIDELINES, CODE TABLES AND INDEX

compiled Aug 2020

Disclaimer: This guidance is to be used for an easy reference; the ICD-9-CM and ICD-10-CM code books and the Official Guidelines for Coding and Reporting are the authoritative references for accurate and complete coding. This blog may contain references or links to statutes, regulations, or other policy materials. It is not intended to take the place of either the written law or regulations. The information presented herein is for general informational purposes only and is accurate as of the date of publication.

Comments

Table VI-4. Disease Hierarchies for the 2017 CMS-HCC Model

If the Disease Group is Listed in this column… …Then drop the Disease Group(s) listed in this column is found here : Announcement of Calendar Year (CY) 2017 Medicare Advantage Capitation Rates and Medicare Advantage and Part D Payment Policies and Final Call Letter Found at: https://www.cms.gov/Medicare/HealthPlans/MedicareAdvtgSpecRateStats/Downloads/Announcement2017.pdf P 87 If the Disease Group is Listed in this column… …Then drop the Disease Group(s) listed in this column Disclaimer: This guidance is to be used for an easy reference; the ICD-9-CM and ICD-10-CM code books and the Official Guidelines for Coding and Reporting are the authoritative references for accurate and complete coding. This blog may contain references or links to statutes, regulations, or other policy materials. It is not intended to take the place of either the written law or regulations. The information presented herein is for general informational purposes only and is accurate as of the date of

Guidelines for HIV coding

Chapter 1: Certain Infectious and Parasitic diseases (A00-B99) Human Immunodeficiency virus (HIV) Infections B20 Human immunodeficiency virus (HIV) disease (symptomatic) R75 Inconclusive laboratory evidence of human immunodeficiency virus (HIV) Z20.6 Contact with and exposure to human immunodeficiency virus (HIV) Z11.4 Encounter for screening for human immunodeficiency virus (HIV) Z71.7 human immunodeficiency virus [HIV] counseling Z21 Asymptomatic human immunodeficiency virus (HIV) infection status “Confirmation” does NOT require documentation for positive serology or culture for HIV; the provider’s diagnostic statement that the patient is HIV positive, or has an HIV-related illness is sufficient. Once a patient is diagnosed with B20, they should never be assigned R75 or Z21. Sequencing of HIV Codes B20 should be sequenced as the first-listed diagnosis when patient is treated for an HIV related condition. Any non-related conditions get sequenced following t

Preliminary ICD-10-CM CMS HCC Mappings

The link below take you to the Preliminary ICD-10-CM Codes, CMS-HCC and RxHCC Models, Includes FY2014 preliminary list of ICD-10 codes HCC Mappings from CMS. Last modified 9/30/2014. Preliminary ICD-10-CM Mappings Diagnosis Code Description CMS-HCC PACE/ESRD Model Category V21 CMS-HCC Model Category V22 (clinically revised model implemented in 2014) RxHCC Model Category V04 CMS-HCC PACE/ESRD Model for 2015 Payment Year CMS-HCC Model for 2015 Payment Year RxHCC Model for 2015 Payment Year #HCC #ICD10 #CMS #ICD9 #RiskAdjustment #MedicalCoding #Mappings Disclaimer : This guidance is to be used for an easy reference; the ICD-9-CM and ICD-10-CM code books and the Official Guidelines for Coding and Reporting are the authoritative references for accurate and complete coding. This blog may contain references or links to statutes, regulations, or other policy materials.

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