HCC Coding Guidelines Part 3: Circulatory, Respiratory, Digestive, Genitourinary, Skin, Musculoskeletal & Injury Conditions (ICD-10-CM)

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In this part of our HCC coding series, we’ll cover several major body systems using ICD-10-CM guidelines. These conditions are highly relevant for risk adjustment and HCC capture, so accurate coding is critical.


1. Diseases of the Circulatory System


Hypertension and Chronic Kidney Disease (CKD)


In ICD-10-CM, hypertension and CKD have an assumed causal relationship.


Example: I12.9 – Hypertensive CKD, Stage 1–4.


For hypertension and heart disease, a provider must clearly document the linkage (e.g., “hypertensive heart disease”).


 Note: Hypertension without complications does not map to an HCC.


Myocardial Infarction (MI)


Commonly called a heart attack.


In ICD-10-CM, acute MI is coded from category I21.


Example: I21.3 – ST elevation (STEMI) of unspecified site.


NSTEMI is coded as I21.4.



Coding Tip: Acute MI is reportable only if it is ≤4 weeks old. After that, it is considered an old MI (I25.2 – Old myocardial infarction).


Cerebrovascular Accident (CVA / Stroke)


Initial/acute CVA is coded from I63.- (cerebral infarction).


Example: I63.9 – Cerebral infarction, unspecified.


Sequela (late effects) of CVA are coded from I69.-. There is no time limit—if a residual condition is linked to the prior stroke, use an I69 code.


Example: I69.351 – Hemiplegia following cerebral infarction, right dominant side.



Always document whether the weakness or hemiparesis is an acute stroke symptom or a residual late effect.


Other Circulatory Conditions


Sick Sinus Syndrome – coded as I49.5.


Assign only if the condition is evaluated or treated during the encounter.


2. Diseases of the Respiratory System


Chronic Obstructive Pulmonary Disease (COPD)


ICD-10-CM provides more detail than ICD-9.


Example codes:


J44.9 – COPD, unspecified


J44.1 – COPD with acute exacerbation


J44.0 – COPD with lower respiratory infection



Asthma: coded from J45.-, with specificity for severity and control.


Emphysema: coded from J43.-.


Do not default to J44.9 if the provider specifies a more accurate type.



3. Diseases of the Digestive System


Ulcers with perforation (e.g., gastric or duodenal) map to HCCs.


K56.41 – Fecal impaction has an HCC value.


GERD: coded from K21.- (e.g., K21.9 – GERD without esophagitis) – this also maps to an HCC.


4. Diseases of the Genitourinary System


Chronic Kidney Disease (CKD)


Coded by stage: N18.1–N18.6.


Example: N18.6 – End-stage renal disease (ESRD).


Hypertensive CKD: use combination codes from I12.-.


Example: I12.0 – Hypertensive CKD with Stage 5 CKD or ESRD.


Acute on chronic kidney disease: use both N17.- (acute) + N18.- (chronic).



Diabetes with CKD


Always use a combination code.


Example: E11.22 – Type 2 diabetes with diabetic CKD.


Add the CKD stage (e.g., N18.5 for Stage 5 CKD).



Complications of Genitourinary Devices


Example: T83.511A – Infection due to cystostomy catheter.


5. Diseases of the Skin and Subcutaneous Tissue


Skin Ulcer


Code to the specific site and severity.


Example: L97.421 – Non-pressure chronic ulcer of right heel, limited to breakdown of skin.



Pressure Ulcer


Requires two elements:


1. Site (e.g., L89.213 – Pressure ulcer of right buttock, stage 3).



2. Stage (Stages 1–4, unstageable, or deep tissue).



Healed pressure ulcers are not coded.


Healing pressure ulcers are coded to their current stage.


6. Diseases of Musculoskeletal System


Not all arthritis types map to HCCs.


Look for infectious or systemic causes:


M00.- – Pyogenic arthritis


M05.- – Rheumatoid arthritis with rheumatoid factor


M02.- – Reactive arthritis


7. Injury and Poisoning


Only third-degree burns map to HCCs.


Example: T21.33XA – Burn of third degree of abdominal wall, initial encounter.


Certain fractures (e.g., skull, spine, pelvis) are HCC-relevant.


Example: S72.001A – Fracture of unspecified neck of right femur, initial encounter.


Use “A” (initial encounter) for active treatment, not follow-ups.


Key Takeaway:

In HCC coding, detail matters. Always capture the specificity of diagnosis, note whether conditions are acute, chronic, or sequela, and use ICD-

10-CM combination codes whenever applicable.


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