HCC Coding Guidelines Part 2: Neoplasms, Diabetes, Obesity, Malnutrition, Blood, Mental & Nervous System Disorders

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HCC Coding – Part 2 (ICD-10-CM)

Neoplasms (Cancer)

When coding cancers, always confirm from documentation whether the tumor is benign, in situ, malignant, or of uncertain behavior.

  • Active cancer codes should be reported only if the patient is receiving active treatment (chemotherapy, radiation therapy, or surgery).

After Cancer Removal

If the primary cancer is excised or eradicated, and:

  • there is no ongoing treatment, and
  • there is no evidence of active disease,

then code a personal history of cancer (Z85.-) instead of active cancer.

Cancer can also be reported as current if it is found in a pathology report and documented by the provider, even without active treatment.

Metastatic Cancer

Metastatic (secondary) cancers have the highest HCC weight.
If documentation does not clarify whether it is primary or secondary, certain sites are assumed to be secondary in HCC coding:

  • Bone (C79.5)
  • Brain (C79.3)
  • Diaphragm (C78.6)
  • Heart (C79.89)
  • Liver (C78.7)
  • Lymph nodes (C77.-)
  • Mediastinum (C78.1)
  • Meninges (C79.2)
  • Peritoneum (C78.6)
  • Pleura (C78.2)
  • Retroperitoneum (C78.6)
  • Spinal cord (C79.49)

Current vs. History

  • If the patient is only under surveillance after completing therapy, code Z85.- (Personal history of malignant neoplasm).
  • If drugs like Tamoxifen or Lupron are used for prevention/maintenance, use history code (Z85.-).
  • If these drugs are part of ongoing therapy, code the current malignancy (C00–C96 categories).

Diabetes Mellitus (DM)

Diabetes is a metabolic disease of prolonged high blood sugar. For HCC, the main categories are:

  • Type 1 (E10.-) – Juvenile onset
  • Type 2 (E11.-) – Adult onset

 Note: Type is not decided by insulin use or age.

Coding Guidelines

  • If the patient uses insulin, also assign Z79.4 (Long-term use of insulin).
  • Always code the diabetes first (E10.- or E11.-), then add codes for complications (like nephropathy, retinopathy, neuropathy).
  • Diabetes maps to HCC 17, 18, 19, and 122.

Borderline / Prediabetes

  • Borderline diabetes is coded as R73.03 (Prediabetes), not as diabetes.

Cause-and-Effect Linking Words

To link diabetes with its complications, look for:

  • “due to diabetes”
  • “secondary to diabetes”
  • “associated with diabetes”
  • “caused by diabetes”
  • “diabetic”

Morbid Obesity

  • Defined as BMI ≥ 40.
  • Code: E66.01 (Morbid obesity due to excess calories) or other specific E66.- codes.
  • Document BMI separately with Z68.4- (BMI 40 or greater).

Malnutrition

Indicators include:

  • Involuntary weight loss
  • BMI < 18.5
  • Muscle wasting
  • Poor appetite or reduced intake

Codes: E40–E46 (depending on severity).

Blood and Blood-Forming Organs

  • Anemia (D50–D64) → Some types risk adjust.
  • Pancytopenia (D61.81) → HCC condition.
  • Thrombocytopenia (D69.-) → HCC condition.

 For anemia due to CKD, code both:

  • N18.- (CKD stage) + D63.1 (Anemia in CKD).

Special Notes

  • If provider documents anemia + neutropenia + thrombocytopenia, code only pancytopenia (D61.81).
  • Sickle-cell trait (D57.3) is not HCC, but sickle-cell disease (D57.-) has HCC weight.

Mental Disorders (F codes)

Common HCC conditions:

  • Dementia (F01.-, F03.-)
  • Bipolar disorder (F31.-)
  • Schizophrenia (F20.-)

Other mental disorders:

  • PTSD (F43.1)
  • Delirium tremens (F10.231, etc.)
  • Seasonal Affective Disorder (F33.-, recurrent depression)

Nervous System and Sense Organs (G, H codes)

Includes brain, spinal cord, and peripheral nerves.

Common Terms

  • Parkinson’s disease (G20)
  • Alzheimer’s disease (G30.-)
  • Epilepsy (G40.-)

A single seizure (R56.9) is not epilepsy. Code epilepsy (G40.-) only if documented.

Pain and Paralysis

  • Only facial pain with HCC impact: G50.1 Atypical facial pain.
  • Hemiplegia/paralysis (G81.-) should be coded separately from stroke (I63.-) if documented, even if it resolves before discharge.

Circulatory System

  • Hypertension (I10) → HCC condition.
  • Elevated blood pressure (R03.0) is not hypertension.
  • For secondary hypertension, use I15.- with specificity.

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