Wiki CKD N18.30, N18.31, N18.32 are no longer HCC's for 2021

[DMcLain]

Good morning,
I see in the ICD-10 for 2021 the new codes for CKD stage 3 -- no problem -- EXCEPT these codes are no longer HCC's. In 2020, N18.3 was an HCC. I have searched for information to confirm the accuracy, but have not been able to find anything clearly saying that stage 3 would not longer be risk adjusted.

Can anyone shed light on this for me?

Greatly appreciative,
Darlene McLain

 

[rvillaroza]

Hi,

The list from CMS Risk Adjustment stated that N18.3- still has HCC of 138
Reference: https://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/Risk-Adjustors

ICD-10-CM Codes, CMS-HCC and RxHCC Models
Includes ICD-10 codes valid in FY2020 or FY2021.
Diagnosis Code	Description	CMS-HCC Model Category V21	CMS-HCC Model Category V22	CMS-HCC Model Category V24	RxHCC Model Category V05	CMS-HCC ESRD Model for 2021 Payment Year	CMS-HCC Model Category V22 for 2021 Payment Year	CMS-HCC Model Category V24 for 2021 Payment Year	RxHCC Model for 2021 Payment Year
N183	Chronic kidney disease, stage 3 (moderate)	138​		138​		Yes	No	Yes	No
N1830	Chronic kidney disease, stage 3 unspecified	138​		138​		Yes	No	Yes	No
N1831	Chronic kidney disease, stage 3a	138​		138​		Yes	No	Yes	No
N1832	Chronic kidney disease, stage 3b	138​		138​		Yes	No	Yes	No

 

[Emily.S]

Yes, rvillaroza has it right - the new codes are listed in the mid-year mappings from CMS as being in HCC 138.

Just something to keep in mind - this type of discrepancy happens because of the timing of when the ICD-10-CM books are printed vs. when CMS publishes the updated mappings. I try to go straight to the source to determine if something is an HCC rather than solely relying on the indicators in my code book, for this reason!

 

[Rachel.Sack]

I guess it depends on which model you are using. We use model V22 where I work in PACE and only CKD 4 and higher map to a HCC. I wish CKD 3 was a HCC on that model, we have a high number of patients (which we call participants) with stage 3.