HCC Category Descriptor / Example Diagnoses 2020 HCC …

1 2020 Home Centered Care Institute 1 HCC Category HCC Category Descriptor / Example Diagnoses 2020 HCC Value ICD-10 Code 1 HIV/AIDS Human immunodeficiency virus [HIV] disease B20 2 Septicemia, Sepsis, Systemic Inflammatory Response Syndrome/Shock Gram-negative sepsis, unspecified Sepsis, unspecified organism 6 Opportunistic Infections Pneumocystis B59 8 Metastatic Cancer and Acute Leukemia Secondary malignant neoplasm of unspecified site 9 Lung and Other Severe Cancers Malignant neoplasm of lower lobe, unspecified bronchus or lung Multiple myeloma in remission Other Severe ( , Mesothelioma, Pancreas, Gallbladder, Liver, Stomach, Esophagus, Small intestine) 10 Lymphoma and Other Cancers Secondary and unspecified malignant neoplasm of lymph node, unspecified Hodgkin lymphoma, unspecified, unspecified site Unspecified B-cell lymphoma, unspecified site Non-Hodgkin lymphoma, unspecified, unspecified site Other ( , Brain, Endocrine, Ovary, Connective & Soft tissue, Peripheral nerves) 11 Colorectal, Bladder, and Other Cancers Malignant neoplasm of colon, unspecified Malignant neoplasm of bladder, unspecified Malignant neoplasm of unspecified kidney, except renal pelvis Other ( , Mouth, Tongue, Salivary Glands, Nasopharynx, Sinuses, Ear, Labia, Cervix)

2 12 Breast, Prostate, and Other Cancers and Tumors Malignant neoplasm of unspecified site of unspecified female breast Malignant neoplasm of prostate C61 Malignant neoplasm of endometrium Other ( , Penis, Eye, Musculoskeletal, Melanoma, Brain benign, Merkel cell, Carcinoid) 17 Diabetes with Acute Complications Type 1 diabetes mellitus with ketoacidosis without coma Type 2 diabetes mellitus with ketoacidosis without coma 18 Diabetes with Chronic Complications Type 2 diabetes mellitus with diabetic chronic kidney disease Type 2 diabetes mellitus with other circulatory complications 19 Diabetes without Complication Type 2 diabetes mellitus without complications 21 Protein-Calorie Malnutrition Mild protein-calorie malnutrition 22 Morbid Obesity Body mass index (BMI) , adult Class 2 (BMI )

3 Severe obesity with serious comorbidity in adult 23 Other Significant Endocrine and Metabolic Disorders Hyperparathyroidism, unspecified Secondary hyperparathyroidism of renal origin 2020 Home Centered Care Institute 2 HCC Category HCC Category Descriptor / Example Diagnoses 2019 HCC Value ICD-10 Code 27 End-Stage Liver Disease Chronic hepatic failure without coma 28 Cirrhosis of Liver Alcoholic cirrhosis of liver without ascites Other cirrhosis of liver 29 Chronic Hepatitis Chronic viral hepatitis, unspecified 33 Intestinal Obstruction/Perforation Fecal impaction 34 Chronic Pancreatitis Other chronic pancreatitis 35 Inflammatory Bowel Disease Crohn's disease, unspecified, without complications Other ulcerative colitis without complications 39 Bone/Join/Muscle Infections/Necrosis Arthritis due to other bacteria, unspecified joint Direct infection of unspec.

4 Joint in infectious and parasitic diseases classified elsewhere Other reactive arthropathies, unspecified site Reactive arthropathy, unspecified Osteomyelitis, unspecified 40 Rheumatoid Arthritis and Inflammatory Connective Tissue Disease Other rheumatoid arthritis with rheumatoid factor of unspecified site Rheumatoid arthritis with rheumatoid factor, unspecified Rheumatoid arthritis without rheumatoid factor, unspecified site 46 Severe Hematological Disorders Refractory anemia, unspecified Sickle-cell disease without crisis 47 Disorders of Immunity Antineoplastic chemotherapy induced pancytopenia Neutropenia, unspecified 48 Coagulation Defects and Other Specified Hematologic Disorders Sickle-cell trait Senile Purpura Thrombocytopenia, unspecified 51 Dementia with Complications Alzheimer s disease with behavioral complications 52 Dementia without Complication Alzheimer s disease without behavioral complications 54 Substance Use with Psychotic Complications Alcohol dependence with withdrawal delirium Cannabis abuse with psychotic disorder, unspecified 55 Substance Use Disorder, Moderate/Severe, or Substance Use with Complications Alcohol dependence, uncomplicated Alcohol dependence, in remission Opioid dependence, uncomplicated Opioid dependence, in remission 2020 Home Centered Care Institute 3 HCC Category HCC Category Descriptor / Example Diagnoses 2019 HCC Value ICD-10 Code 56 Substance Use Disorder, Mild, Except Alcohol and Cannabis Drug abuse (can specify amphetamines, barbiturates, cocaine, hallucinogens.)

5 Opioids, etc.) 57 Schizophrenia Schizophrenia, unspecified 58 Reactive and Unspecified Psychosis Atypical psychosis F29 Unspecified psychosis not due to a substance or known physiological condition F29 59 Major Depressive, Bipolar, and Paranoid Disorders Major depressive disorder, recurrent, mild 60 Personality Disorders Personality disorder, Unspec. (others: Antisocial, Borderline, Manipulative, Narcissistic, etc.) 70 Quadriplegia Quadriplegia, unspecified Functional quadriplegia 71 Paraplegia Paraplegia, unspecified 72 Spinal cord Disorders/ Injuries Myelitis, unspecified Unspecified injury at unspecified level of thoracic spinal cord, subsequent encounter Unspecified injury at unspecified level of thoracic spinal cord, sequela Complete lesion of unspecified level of lumbar spinal cord, sequela Incomplete lesion of unspecified level of lumbar spinal cord, subsequent encounter 73 Amyotrophic Lateral Sclerosis and Other Motor Neuron Disease Amyotrophic lateral sclerosis 74 Cerebral Palsy 75 Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome, Inflammatory and Toxic Neuropathy Myasthenia gravis without (acute)

6 Exacerbation Myoneural disorder, unspecified 76 Muscular Dystrophy 77 Multiple Sclerosis G35 78 Parkinson s and Huntington s Diseases Parkinson's disease G20 Huntington's disease G10 79 Seizure Disorders and Convulsions Other seizures Epilepsy, unspecified, not intractable, without status epilepticus 80 Coma, Brain Compression/Anoxic Damage Persistent vegetative state Anoxic brain damage, not elsewhere classified 82 Respirator Dependence/Tracheostomy Status Encounter for attention to tracheostomy Dependence on respirator [ventilator] status 83 Respiratory Arrest 2020 Home Centered Care Institute 4 HCC Category HCC Category Descriptor / Example Diagnoses 2019 HCC Value ICD-10 Code 84 Cardio-Respiratory Failure and Shock Chronic respiratory failure with hypoxia Chronic respiratory failure with hypercapnia 85 Congestive Heart Failure Hypertensive heart disease with heart failure Pulmonary hypertension, unspecified Cardiomyopathy, unspecified Unspecified systolic (congestive) heart failure Chronic Systolic (congestive) heart failure Unspecified diastolic (congestive)

7 Heart failure Heart failure, unspecified 86 Acute Myocardial Infarction Other myocardial infarction type 87 Unstable Angina and Other Acute Ischemic Heart Disease Unstable angina 88 Angina Pectoris Angina pectoris, unspecified Stable angina 96 Specified Heart Arrhythmias Unspecified atrial fibrillation Sick sinus syndrome Supraventricular Tachycardia 99 Cerebral Hemorrhage Other nontraumatic subarachnoid hemorrhage Other nontraumatic intracerebral hemorrhage 100 Ischemic or Unspecified Stroke Cerebral infarction due to thrombosis of unspecified carotid artery Cerebral infarction, unspecified 103 Hemiplegia/Hemiparesis Hemiplegia and hemiparesis following unspec. cerebrovascular disease affecting unspec. side 104 Monoplegia, Other Paralytic Syndromes Monoplegia, unspecified affecting unspecified side 106 Atherosclerosis of the Extremities with Ulceration or Gangrene Gas gangrene Gangrene, not elsewhere classified I96 107 Vascular Disease with Complications Chronic pulmonary embolism Embolism and thrombosis of arteries of extremities, unspecified Varicose veins of unspecified lower extremity with ulcer of unspecified site 108 Vascular Disease Atherosclerosis of aorta Aortic aneurysm of unspecified site, without rupture Peripheral vascular disease.

8 Unspecified Phlebitis & thrombophlebitis of unspecified deep vessels of unspecified lower extremity Acute embolism & thrombosis of unspecified deep veins of unspecified lower extremity Chronic embolism & thrombosis of unspecified deep veins of unspecified lower 2020 Home Centered Care Institute 5 HCC Category HCC Category Descriptor / Example Diagnoses 2019 HCC Value ICD-10 Code 110 Cystic Fibrosis Cystic fibrosis, unspecified 111 Chronic Obstructive Pulmonary Disease Emphysema, unspecified Chronic obstructive pulmonary disease, unspecified 112 Fibrosis of Lung and Other Chronic Lung Disorders Pulmonary fibrosis, unspecified Interstitial pulmonary disease, unspecified 114 Aspiration and Specified Bacterial Pneumonias Pneumonitis due to inhalation of food and vomit 115 Pneumococcal Pneumonia, Empyema, Lung Abscess Pneumonia due to Streptococcus pneumoniae J13 Abscess of lung with pneumonia 122 Proliferative Diabetic Retinopathy and Vitreous Hemorrhage Vitreous hemorrhage, unspecified eye Vitreous hemorrhage, bilateral 124 Exudative Macular Degeneration Exudative age-related macular degeneration, unspecified eye, stage unspecified 134 Dialysis Status Other mechanical complication of intraperitoneal dialysis catheter, sequela 135 Acute Renal Failure Other acute kidney failure 136 Chronic Kidney Disease, Stage 5 137 Chronic Kidney Disease, Severe (Stage 4) 138 Chronic kidney disease, Moderate (Stage 3)

9 157 Pressure Ulcer of Skin with Necrosis Through to Muscle, Tendon, or Bone Pressure ulcer of unspecified site, stage 4 158 Pressure Ulcer of Skin with Full Thickness Skin Loss Pressure ulcer of unspecified site, stage 3 Pressure ulcer of unspecified site, unstageable 159 Pressure Ulcer of Skin with partial Thickness Skin Loss Pressure ulcer of unspecified site, stage 2 161 Chronic Ulcer of Skin, Except Pressure Non-pressure chronic ulcer of skin of other sites with unspecified severity 162 Severe Skin Burn or Condition Burns involving 10-19% of body surface with 10-19% third degree burns 166 Severe Head Injury Unspecified intracranial injury with loss of consciousness greater than 24 hours with return to pre-existing conscious level, initial encounter 167 Major Head Injury Unspecified fracture of skull, sequela Unspecified fracture of facial bones, sequela Diffuse traumatic brain injury without loss of consciousness, sequela Diffuse traumatic brain injury with loss of consciousness of unspecified duration, sequela Traumatic subdural hemorrhage without loss of consciousness, sequela Traumatic subarachnoid hemorrhage without loss of consciousness, sequela 2020 Home Centered Care Institute 6 HCC Category HCC Category Descriptor / Example Diagnoses 2019 HCC Value ICD-10 Code 169 Vertebral Fractures without Spinal Cord Injury Collapsed vertebra, not elsewhere classified, site unspec.

10 , initial encounter for fracture Age-related osteoporosis with current pathological fracture, vertebra(e), initial encounter for fracture Fracture of neck, unspecified, initial encounter Wedge compression fracture of unspecified thoracic vertebra, initial encounter for closed fracture Other fracture of sacrum, initial encounter for closed fracture Fracture of coccyx, initial encounter for closed fracture Age-related osteoporosis with current pathological fracture, vertebra(e), initial encounter for fracture 170 Hip Fracture/Dislocation Pathological fracture, unspecified femur, initial encounter for fracture Pathological fracture in neoplastic disease, hip, unspecified, initial encounter for fracture Unspecified fracture of unspecified ilium, initial encounter for closed fracture Unspecified fracture of unspecified acetabulum, initial encounter for closed fracture Unspecified fracture of unspecified ischium, initial encounter for closed fracture Fracture of other parts of pelvis, initial encounter for closed fracture 173 Traumatic Amputations and Complications partial traumatic transmetacarpal amputation of unspecified hand, i