ICD-10-CM Codes, CMS-HCC and RxHCC Models Description …

1 ICD-10-CM Codes, CMS-HCC and RxHCC Models Includes ICD-10 codes valid in FY2019 or FY2020. Diagnosis Description CMS-HCC CMS-HCC CMS-HCC RxHCC CMS-HCC CMS-HCC CMS-HCC RxHCC . Code ESRD Model Model Model Model ESRD Model Model Model Model Category Category Category Category for 2020 Category V22 Category V24 for 2020. V21 V22 V24 V05 Payment for 2020 for 2020 Payment Year Payment Year Payment Year Year A0103 Typhoid pneumonia 115 115 115 Yes Yes Yes No A0104 Typhoid arthritis 39 39 39 Yes Yes Yes No A0105 Typhoid osteomyelitis 39 39 39 Yes Yes Yes No A021 Salmonella sepsis 2 2 2 Yes Yes Yes No A0222 Salmonella pneumonia 115 115 115 Yes Yes Yes No A0223 Salmonella arthritis 39 39 39 Yes Yes Yes No A0224 Salmonella osteomyelitis 39 39 39 Yes Yes Yes No A065 Amebic lung abscess 115 115 115 Yes Yes Yes No A072 Cryptosporidiosis 6 6 6 5 Yes Yes Yes Yes A202 Pneumonic plague 115 115 115 Yes Yes Yes No A207 Septicemic plague 2 2 2 Yes Yes Yes No A212 Pulmonary tularemia 115 115 115 Yes Yes Yes No A221 Pulmonary anthrax 115 115 115 Yes Yes Yes No A227 Anthrax sepsis 2 2 2 Yes Yes Yes No A267 Erysipelothrix sepsis 2 2 2 Yes Yes Yes No A310 Pulmonary mycobacterial infection 6 6 6 5 Yes Yes Yes Yes A312 Disseminated mycobacterium avium-intracellulare complex (DMAC)

2 6 6 6 5 Yes Yes Yes Yes A327 Listerial sepsis 2 2 2 Yes Yes Yes No A3681 Diphtheritic cardiomyopathy 85 85 85 186 Yes Yes Yes Yes A3684 Diphtheritic tubulo-interstitial nephropathy 141 Yes No No No A391 Waterhouse-Friderichsen syndrome 23 23 23 41 Yes Yes Yes Yes A392 Acute meningococcemia 2 2 2 Yes Yes Yes No A393 Chronic meningococcemia 2 2 2 Yes Yes Yes No A394 Meningococcemia, unspecified 2 2 2 Yes Yes Yes No A3983 Meningococcal arthritis 39 39 39 Yes Yes Yes No A3984 Postmeningococcal arthritis 39 39 39 Yes Yes Yes No A400 Sepsis due to streptococcus, group A 2 2 2 Yes Yes Yes No A401 Sepsis due to streptococcus, group B 2 2 2 Yes Yes Yes No A403 Sepsis due to Streptococcus pneumoniae 2 2 2 Yes Yes Yes No A408 Other streptococcal sepsis 2 2 2 Yes Yes Yes No A409 Streptococcal sepsis, unspecified 2 2 2 Yes Yes Yes No A4101 Sepsis due to Methicillin susceptible Staphylococcus aureus 2 2 2 Yes Yes Yes No A4102 Sepsis due to Methicillin resistant Staphylococcus aureus 2 2 2 Yes Yes Yes No A411 Sepsis due to other specified staphylococcus 2 2 2 Yes Yes Yes No A412 Sepsis due to unspecified staphylococcus 2 2 2 Yes Yes Yes No A413 Sepsis due to Hemophilus influenzae 2 2 2 Yes Yes Yes No A414 Sepsis due to anaerobes 2 2 2 Yes Yes Yes No A4150 Gram-negative sepsis, unspecified 2 2 2 Yes Yes Yes No A4151 Sepsis due to Escherichia coli [E.]

3 Coli] 2 2 2 Yes Yes Yes No A4152 Sepsis due to Pseudomonas 2 2 2 Yes Yes Yes No A4153 Sepsis due to Serratia 2 2 2 Yes Yes Yes No A4159 Other Gram-negative sepsis 2 2 2 Yes Yes Yes No A4181 Sepsis due to Enterococcus 2 2 2 Yes Yes Yes No A4189 Other specified sepsis 2 2 2 Yes Yes Yes No A419 Sepsis, unspecified organism 2 2 2 Yes Yes Yes No A420 Pulmonary actinomycosis 115 115 115 Yes Yes Yes No A427 Actinomycotic sepsis 2 2 2 Yes Yes Yes No A430 Pulmonary nocardiosis 115 115 115 Yes Yes Yes No FY19-FY20 ICD10 Payment Codes 2020 Midyear_Final ICD-10-CM Page 1 of 243. Diagnosis Description CMS-HCC CMS-HCC CMS-HCC RxHCC CMS-HCC CMS-HCC CMS-HCC RxHCC . Code ESRD Model Model Model Model ESRD Model Model Model Model Category Category Category Category for 2020 Category V22 Category V24 for 2020. V21 V22 V24 V05 Payment for 2020 for 2020 Payment Year Payment Year Payment Year Year A480 Gas gangrene 106 106 106 Yes Yes Yes No A481 Legionnaires' disease 114 114 114 Yes Yes Yes No A483 Toxic shock syndrome 2 2 2 Yes Yes Yes No A5055 Late congenital syphilitic arthropathy 39 39 39 Yes Yes Yes No A5204 Syphilitic cerebral arteritis 206 No No No Yes A5440 Gonococcal infection of musculoskeletal system.

4 Unspecified 39 39 39 Yes Yes Yes No A5441 Gonococcal spondylopathy 39 39 39 Yes Yes Yes No A5442 Gonococcal arthritis 39 39 39 Yes Yes Yes No A5443 Gonococcal osteomyelitis 39 39 39 Yes Yes Yes No A5449 Gonococcal infection of other musculoskeletal tissue 39 39 39 Yes Yes Yes No A5484 Gonococcal pneumonia 115 115 115 Yes Yes Yes No A5485 Gonococcal peritonitis 33 33 33 Yes Yes Yes No A5486 Gonococcal sepsis 2 2 2 Yes Yes Yes No A666 Bone and joint lesions of yaws 39 39 39 Yes Yes Yes No A6923 Arthritis due to Lyme disease 39 39 39 Yes Yes Yes No A8100 Creutzfeldt-Jakob disease, unspecified 52 52 112 Yes No Yes Yes A8101 Variant Creutzfeldt-Jakob disease 52 52 112 Yes No Yes Yes A8109 Other Creutzfeldt-Jakob disease 52 52 112 Yes No Yes Yes A811 Subacute sclerosing panencephalitis 52 52 112 Yes No Yes Yes A812 Progressive multifocal leukoencephalopathy 52 52 112 Yes No Yes Yes A8181 Kuru 52 52 112 Yes No Yes Yes A8182 Gerstmann-Straussler-Scheinker syndrome 52 52 112 Yes No Yes Yes A8183 Fatal familial insomnia 52 52 112 Yes No Yes Yes A8189 Other atypical virus infections of central nervous system 52 52 112 Yes No Yes Yes A819 Atypical virus infection of central nervous system.

5 Unspecified 52 52 112 Yes No Yes Yes A985 Hemorrhagic fever with renal syndrome 141 Yes No No No B007 Disseminated herpesviral disease 2 2 2 Yes Yes Yes No B0082 Herpes simplex myelitis 72 72 72 157 Yes Yes Yes Yes B0112 Varicella myelitis 72 72 72 157 Yes Yes Yes Yes B0221 Postherpetic geniculate ganglionitis 168 No No No Yes B0222 Postherpetic trigeminal neuralgia 168 No No No Yes B0223 Postherpetic polyneuropathy 168 No No No Yes B0224 Postherpetic myelitis 72 72 72 157 Yes Yes Yes Yes B0229 Other postherpetic nervous system involvement 168 No No No Yes B0682 Rubella arthritis 39 39 39 Yes Yes Yes No B180 Chronic viral hepatitis B with delta-agent 29 29 29 55 Yes Yes Yes Yes B181 Chronic viral hepatitis B without delta-agent 29 29 29 55 Yes Yes Yes Yes B182 Chronic viral hepatitis C 29 29 29 54 Yes Yes Yes Yes B188 Other chronic viral hepatitis 29 29 29 55 Yes Yes Yes Yes B189 Chronic viral hepatitis, unspecified 29 29 29 55 Yes Yes Yes Yes B20 Human immunodeficiency virus [HIV] disease 1 1 1 1 Yes Yes Yes Yes B250 Cytomegaloviral pneumonitis 6 6 6 5 Yes Yes Yes Yes B251 Cytomegaloviral hepatitis 6 6 6 5 Yes Yes Yes Yes B252 Cytomegaloviral pancreatitis 6 6 6 5 Yes Yes Yes Yes B258 Other cytomegaloviral diseases 6 6 6 5 Yes Yes Yes Yes B259 Cytomegaloviral disease, unspecified 6 6 6 5 Yes Yes Yes Yes B2685 Mumps arthritis 39 39 39 Yes Yes Yes No B3324 Viral cardiomyopathy 85 85 85 186 Yes Yes Yes Yes B371 Pulmonary candidiasis 6 6 6 5 Yes Yes Yes Yes B377 Candidal sepsis 2 2 2 5 Yes Yes Yes Yes B377 Candidal sepsis 6 6 6 Yes Yes Yes -- FY19-FY20 ICD10 Payment Codes 2020 Midyear_Final ICD-10-CM Page 2 of 243.

6 Diagnosis Description CMS-HCC CMS-HCC CMS-HCC RxHCC CMS-HCC CMS-HCC CMS-HCC RxHCC . Code ESRD Model Model Model Model ESRD Model Model Model Model Category Category Category Category for 2020 Category V22 Category V24 for 2020. V21 V22 V24 V05 Payment for 2020 for 2020 Payment Year Payment Year Payment Year Year B3781 Candidal esophagitis 6 6 6 5 Yes Yes Yes Yes B380 Acute pulmonary coccidioidomycosis 115 115 115 Yes Yes Yes No B381 Chronic pulmonary coccidioidomycosis 115 115 115 Yes Yes Yes No B382 Pulmonary coccidioidomycosis, unspecified 115 115 115 Yes Yes Yes No B390 Acute pulmonary histoplasmosis capsulati 115 115 115 Yes Yes Yes No B391 Chronic pulmonary histoplasmosis capsulati 115 115 115 Yes Yes Yes No B392 Pulmonary histoplasmosis capsulati, unspecified 115 115 115 Yes Yes Yes No B400 Acute pulmonary blastomycosis 115 115 115 Yes Yes Yes No B401 Chronic pulmonary blastomycosis 115 115 115 Yes Yes Yes No B402 Pulmonary blastomycosis, unspecified 115 115 115 Yes Yes Yes No B410 Pulmonary paracoccidioidomycosis 115 115 115 Yes Yes Yes No B4282 Sporotrichosis arthritis 39 39 39 Yes Yes Yes No B440 Invasive pulmonary aspergillosis 6 6 6 5 Yes Yes Yes Yes B441 Other pulmonary aspergillosis 6 6 6 5 Yes Yes Yes Yes B442 Tonsillar aspergillosis 6 6 6 5 Yes Yes Yes Yes B447 Disseminated aspergillosis 6 6 6 5 Yes Yes Yes Yes B4481 Allergic bronchopulmonary aspergillosis 112 112 112 227 Yes Yes Yes Yes B4489 Other forms of aspergillosis 6 6 6 5 Yes Yes Yes Yes B449 Aspergillosis, unspecified 6 6 6 5 Yes Yes Yes Yes B450 Pulmonary cryptococcosis 6 6 6 5 Yes Yes Yes Yes B451 Cerebral cryptococcosis 6 6 6 5 Yes Yes Yes Yes B452 Cutaneous cryptococcosis 6 6 6 5 Yes Yes Yes Yes B453 Osseous cryptococcosis 6 6 6 5 Yes Yes Yes Yes B457 Disseminated cryptococcosis 6 6 6 5 Yes Yes Yes Yes B458 Other forms of cryptococcosis 6 6 6 5 Yes Yes Yes Yes B459 Cryptococcosis.

7 Unspecified 6 6 6 5 Yes Yes Yes Yes B460 Pulmonary mucormycosis 6 6 6 5 Yes Yes Yes Yes B461 Rhinocerebral mucormycosis 6 6 6 5 Yes Yes Yes Yes B462 Gastrointestinal mucormycosis 6 6 6 5 Yes Yes Yes Yes B463 Cutaneous mucormycosis 6 6 6 5 Yes Yes Yes Yes B464 Disseminated mucormycosis 6 6 6 5 Yes Yes Yes Yes B465 Mucormycosis, unspecified 6 6 6 5 Yes Yes Yes Yes B468 Other zygomycoses 6 6 6 5 Yes Yes Yes Yes B469 Zygomycosis, unspecified 6 6 6 5 Yes Yes Yes Yes B484 Penicillosis 6 6 6 5 Yes Yes Yes Yes B488 Other specified mycoses 6 6 6 5 Yes Yes Yes Yes B520 Plasmodium malariae malaria with nephropathy 141 Yes No No No B582 Toxoplasma meningoencephalitis 6 6 6 5 Yes Yes Yes Yes B583 Pulmonary toxoplasmosis 6 6 6 5 Yes Yes Yes Yes B59 Pneumocystosis 6 6 6 5 Yes Yes Yes Yes B664 Paragonimiasis 115 115 115 Yes Yes Yes No B671 Echinococcus granulosus infection of lung 115 115 115 Yes Yes Yes No B9735 Human immunodeficiency virus, type 2 [HIV 2] as the cause of diseases classified elsewhere 1 1 1 1 Yes Yes Yes Yes C01 Malignant neoplasm of base of tongue 11 11 11 Yes Yes Yes No C020 Malignant neoplasm of dorsal surface of tongue 11 11 11 Yes Yes Yes No C021 Malignant neoplasm of border of tongue 11 11 11 Yes Yes Yes No C022 Malignant neoplasm of ventral surface of tongue 11 11 11 Yes Yes Yes No C023 Malignant neoplasm of anterior two-thirds of tongue, part unspecified 11 11 11 Yes Yes Yes No C024 Malignant neoplasm of lingual tonsil 11 11 11 Yes Yes Yes No C028 Malignant neoplasm of overlapping sites of tongue 11 11 11 Yes Yes Yes No C029 Malignant neoplasm of tongue, unspecified 11 11 11 Yes Yes Yes No FY19-FY20 ICD10 Payment Codes 2020 Midyear_Final ICD-10-CM Page 3 of 243.

8 Diagnosis Description CMS-HCC CMS-HCC CMS-HCC RxHCC CMS-HCC CMS-HCC CMS-HCC RxHCC . Code ESRD Model Model Model Model ESRD Model Model Model Model Category Category Category Category for 2020 Category V22 Category V24 for 2020. V21 V22 V24 V05 Payment for 2020 for 2020 Payment Year Payment Year Payment Year Year C030 Malignant neoplasm of upper gum 11 11 11 Yes Yes Yes No C031 Malignant neoplasm of lower gum 11 11 11 Yes Yes Yes No C039 Malignant neoplasm of gum, unspecified 11 11 11 Yes Yes Yes No C040 Malignant neoplasm of anterior floor of mouth 11 11 11 Yes Yes Yes No C041 Malignant neoplasm of lateral floor of mouth 11 11 11 Yes Yes Yes No C048 Malignant neoplasm of overlapping sites of floor of mouth 11 11 11 Yes Yes Yes No C049 Malignant neoplasm of floor of mouth, unspecified 11 11 11 Yes Yes Yes No C050 Malignant neoplasm of hard palate 11 11 11 Yes Yes Yes No C051 Malignant neoplasm of soft palate 11 11 11 Yes Yes Yes No C052 Malignant neoplasm of uvula 11 11 11 Yes Yes Yes No C058 Malignant neoplasm of overlapping sites of palate 11 11 11 Yes Yes Yes No C059 Malignant neoplasm of palate.

9 Unspecified 11 11 11 Yes Yes Yes No C060 Malignant neoplasm of cheek mucosa 11 11 11 Yes Yes Yes No C061 Malignant neoplasm of vestibule of mouth 11 11 11 Yes Yes Yes No C062 Malignant neoplasm of retromolar area 11 11 11 Yes Yes Yes No C0680 Malignant neoplasm of overlapping sites of unspecified parts of mouth 11 11 11 Yes Yes Yes No C0689 Malignant neoplasm of overlapping sites of other parts of mouth 11 11 11 Yes Yes Yes No C069 Malignant neoplasm of mouth, unspecified 11 11 11 Yes Yes Yes No C07 Malignant neoplasm of parotid gland 11 11 11 Yes Yes Yes No C080 Malignant neoplasm of submandibular gland 11 11 11 Yes Yes Yes No C081 Malignant neoplasm of sublingual gland 11 11 11 Yes Yes Yes No C089 Malignant neoplasm of major salivary gland, unspecified 11 11 11 Yes Yes Yes No C090 Malignant neoplasm of tonsillar fossa 11 11 11 Yes Yes Yes No C091 Malignant neoplasm of tonsillar pillar (anterior) (posterior) 11 11 11 Yes Yes Yes No C098 Malignant neoplasm of overlapping sites of tonsil 11 11 11 Yes Yes Yes No C099 Malignant neoplasm of tonsil , unspecified 11 11 11 Yes Yes Yes No C100 Malignant neoplasm of vallecula 11 11 11 Yes Yes Yes No C101 Malignant neoplasm of anterior surface of epiglottis 11 11 11 Yes Yes Yes No C102 Malignant neoplasm of lateral wall of oropharynx 11 11 11 Yes Yes Yes No C103 Malignant neoplasm of posterior wall of oropharynx 11 11 11 Yes Yes Yes No C104 Malignant neoplasm of branchial cleft 11 11 11 Yes Yes Yes No C108 Malignant neoplasm of overlapping sites of oropharynx 11 11 11 Yes Yes Yes No C109 Malignant neoplasm of oropharynx.

10 Unspecified 11 11 11 Yes Yes Yes No C110 Malignant neoplasm of superior wall of nasopharynx 11 11 11 Yes Yes Yes No C111 Malignant neoplasm of posterior wall of nasopharynx 11 11 11 Yes Yes Yes No C112 Malignant neoplasm of lateral wall of nasopharynx 11 11 11 Yes Yes Yes No C113 Malignant neoplasm of anterior wall of nasopharynx 11 11 11 Yes Yes Yes No C118 Malignant neoplasm of overlapping sites of nasopharynx 11 11 11 Yes Yes Yes No C119 Malignant neoplasm of nasopharynx, unspecified 11 11 11 Yes Yes Yes No C12 Malignant neoplasm of pyriform sinus 11 11 11 Yes Yes Yes No C130 Malignant neoplasm of postcricoid region 11 11 11 Yes Yes Yes No C131 Malignant neoplasm of aryepiglottic fold, hypopharyngeal aspect 11 11 11 Yes Yes Yes No C132 Malignant neoplasm of posterior wall of hypopharynx 11 11 11 Yes Yes Yes No C138 Malignant neoplasm of overlapping sites of hypopharynx 11 11 11 Yes Yes Yes No C139 Malignant neoplasm of hypopharynx, unspecified 11 11 11 Yes Yes Yes No C140 Malignant neoplasm of pharynx, unspecified 11 11 11 Yes Yes Yes No C142 Malignant neoplasm of Waldeyer's ring 11 11 11 Yes Yes Yes No C148 Malignant neoplasm of overlapping sites of lip, oral cavity and pharynx 11 11 11 Yes Yes Yes No C153 Malignant neoplasm of upper third of esophagus 9 9 9 Yes Yes Yes No C154 Malignant neoplasm of middle third of esophagus 9 9 9 Yes Yes Yes No C155 Malignant neoplasm of lower third of esophagus 9 9 9 Yes Yes Yes No FY19-FY20 ICD10 Payment Codes 2020 Midyear_Final ICD-10-CM Page 4 of 243.