A patient presents to the clinic for follow up of type 2 diabetes. The patient is also noted to have peripheral neuropathy. The patient has COPD and is found to have no recent exacerbations. The patient also has a history of depression, reported as stable. Which of the following CMS-HCCs will be captured for this visit? HCC 17: Diabetes with Acute Complications HCC 18: Diabetes with Chronic Complications HCC 19: Diabetes without Complications HCC 58: Major Depressive, Bipolar and Paranoid Disorders HCC 111: Chronic Obstructive Pulmonary Disease

The CMS-HCC model uses a hierarchy system where more severe manifestations of a disease trump less severe ones. The patient has type 2 diabetes with peripheral neuropathy, a chronic complication. This maps to HCC 18 (Diabetes with Chronic Complications). Because HCC 18 is captured, the lower-ranking HCC 19 (Diabetes without Complications) is not. The patient's COPD maps to HCC 111. Assuming the stable depression was monitored or evaluated (meeting MEAT criteria), it would map to an HCC (e.g., 58 or 59). However, among the choices, only option B correctly applies the diabetes hierarchy.

A. This option incorrectly includes HCC 19, which is excluded by the hierarchy when HCC 18 or HCC 17 is present.

C. This option is incorrect because the patient has no documented acute diabetic complication (e.g., DKA), which is required to capture HCC 17.

D. This option incorrectly includes both HCC 18 and HCC 19. The hierarchy rule dictates that only the highest-ranking category within a disease group is used.

1. Centers for Medicare & Medicaid Services (CMS). (2023, April 3). Announcement of Calendar Year (CY) 2024 Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies. Attachment IV: "Hierarchical Condition Category (HCC) List for the CMS-HCC V28 Model." This document details the specific hierarchies, showing that HCC 17 trumps HCC 18, which trumps HCC 19.

2. Berglund, J. (2019). Risk adjustment, documentation and coding. ACDIS. (Official ACDIS publications and training materials explain the principles of HCC hierarchies, including the diabetes example).

3. Department of Health and Human Services. (2023). CMS-HCC V28 ICD-10-CM Mappings. This official crosswalk file demonstrates that diabetes with neuropathy codes map to HCC 18, while uncomplicated diabetes maps to HCC 19.