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Medical coding resources for physicians and their staff. CodingIntel was founded by consultant and coding expert Betsy Nicoletti.

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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
FOR diabetes (type 2) USE NOTES

with hyperlipidemia

E11.69 DM with other specified complication

Add code for hyperlipemia; document link to condition

with nephropathy

E11.21 DM with nephropathy

with cataract

E11.36 DM with cataract

with neuropathy

E11.40–E11.49

with non-proliferative retinopathy

E11.319 DM with non-proliferative retinopathy

with other circulatory conditions

E11.59 DM with other circulatory conditions

Add code for specific complication, CAD; document link to condition

with hyperglycemia

E11.65 DM with hyperglycemia

with CKD

E11.22 DM with CKD

Add code for stage of CKD

with PAD/PVD

E11.51 DM with PAD/PVD

with foot ulcer

E11.621 DM with foot ulcer

Add code for location and stage of ulcer, L97.-

with other skin ulcer

E11.622 DM with other skin ulcer

Add code for location and stage of ulcer, L97.-

[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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Relevant Search Terms: HCC, risk based coding, diabetes risk coding, ICD-10 diagnosis coding, risk adjustment scores

Last revised September 23, 2021 - Betsy Nicoletti
Tags: HCC diagnosis coding, primary care_diagnosis coding

Wondering about the rules for HCC coding?

Wondering what the rules are for HCC coding, and where you can find them? This video answers your questions. The topic is important to medical practices because risk-adjusted diagnosis coding is part of Medicare Advantage contracts, many commercial contracts and Accountable Care Organizations (ACOs). Sign up for our monthly newsletter to download the whitepaper and watch the video.

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Our mission is to provide accurate, comprehensive, up-to-date coding information, allowing medical practices to increase revenue, decrease coding denials and reduce compliance risk. That's what coding knowledge can do.

In 1988, CodingIntel.com founder Betsy Nicoletti started a Medical Services Organization for a rural hospital, supporting physician practice. She has been a self-employed consultant since 1998. She estimates that in the last 20 years her audience members number over 28,400 at in person events and webinars. She has had 2,500 meetings with clinical providers and reviewed over 43,000 medical notes. She knows what questions need answers and developed this resource to answer those questions. For more about Betsy visit www.betsynicoletti.com.

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