Diabetes coding in Hierarchical Condition Coding (HCC)

CodingIntel members can download our guide to Risk adjusted diagnosis coding for medical practices for more explanation and examples.  This article is specific to diabetes.

9.4% of Americans have diabetes, and in some states, the incidence of diabetes reaches almost 15%. Medical practices in ACOs or with commercial risk contracts can provide the payer with an accurate picture of their patients’ disease burden and health status through diagnosis coding on claims forms.  Since diabetes is so prevalent, this is a good place to start.

HCC coding for Diabetes

HCC 17           Diabetes with acute complications                  RAF 0.302[1]

HCC 18           Diabetes with chronic complications              RAF 0.302

HCC 19           Diabetes without complications                      RAF 0.105

• ICD-10 codes for diabetes with complications carry a RAF three times higher than E11.9, diabetes uncomplicated
• Although the words “controlled” and “uncontrolled” appear in many EMR definitions of diabetes, the ICD-10 definitions are not defined with those words
• Although conditions in the same category count only once, most groups want to capture all of the diabetic complications in the patient’s problem list
• If a patient had a diabetic complication, use it instead of code E11.9
• For E11.69, diabetes with other specified complication, add a code for that additional complication
• For some conditions (see below) add a code for the specific type of disease (CAD, for example) or for the state or severity

[1] All of the values in this guide use the coefficient for a person living in the community, non-dual eligible for Medicare and Medicaid, aged.

Additional resources

The Diagnosis coding section of CodingIntel includes additional resources for HCC and ICD-10 coding.

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