Resource HCC V28 CMS Model

ICD 10 CM Codes that were not in the V24 CMS HCC Model that are in the V28 CMS HCC Model and should currently be abstracted for encounter dates that qualify for the 2024 payment year.* Due to the blended model no ICD 10 CM Codes are excluded from capture at this time. ​ ​ Added ICD 10 CM Codes For V28 Quick List​ ​ ​ ICD 10 CM Code Description 2020 CMS-HCC (V24) 2024 CMS-HCC (V28) 2020 CMS-HCC Model (V24) for 2024 Payment Year 2024 CMS-HCC Model (V28) for 2024 Payment Year I3131 Malignant pericardial effusion in diseases classified elsewhere 17 No Yes J910 Malignant pleural effusion 17 No Yes R180 Malignant ascites 17 No Yes D3A00 Benign carcinoid tumor of unspecified site 22 No Yes D3A010 Benign carcinoid tumor of the duodenum 22 No Yes D3A011 Benign carcinoid tumor of the jejunum 22 No Yes D3A012 Benign carcinoid tumor of the ileum 22 No Yes D3A019 Benign carcinoid tumor of the small intestine, unspecified portion 22 No Yes D3A020 Benign carcinoid tumor of the appendix 22 No Yes D3A021 Benign carcinoid tumor of the cecum 22 No Yes D3A022 Benign carcinoid tumor of the ascending colon 22 No Yes D3A023 Benign carcinoid tumor of the transverse colon 22 No Yes D3A024 Benign carcinoid tumor of the descending colon 22 No Yes D3A025 Benign carcinoid tumor of the sigmoid colon 22 No Yes D3A026 Benign carcinoid tumor of the rectum 22 No Yes D3A029 Benign carcinoid tumor of the large intestine, unspecified portion 22 No Yes D3A090 Benign carcinoid tumor of the bronchus and lung 22 No Yes D3A091 Benign carcinoid tumor of the thymus 22 No Yes D3A092 Benign carcinoid tumor of the stomach 22 No Yes D3A093 Benign carcinoid tumor of the kidney 22 No Yes D3A094 Benign carcinoid tumor of the foregut, unspecified 22 No Yes D3A095 Benign carcinoid tumor of the midgut, unspecified 22 No Yes D3A096 Benign carcinoid tumor of the hindgut, unspecified 22 No Yes D3A098 Benign carcinoid tumors of other sites 22 No Yes D3A8 Other benign neuroendocrine tumors 22 No Yes E8300 Disorder of copper metabolism, unspecified 50 No Yes E8301 Wilson's disease 50 No Yes E8309 Other disorders of copper metabolism 50 No Yes E8331 Familial hypophosphatemia 50 No Yes K717 Toxic liver disease with fibrosis and cirrhosis of liver 64 No Yes K7010 Alcoholic hepatitis without ascites 65 No Yes K7011 Alcoholic hepatitis with ascites 65 No Yes K713 Toxic liver disease with chronic persistent hepatitis 65 No Yes K714 Toxic liver disease with chronic lobular hepatitis 65 No Yes K7150 Toxic liver disease with chronic active hepatitis without ascites 65 No Yes K7151 Toxic liver disease with chronic active hepatitis with ascites 65 No Yes K8301 Primary sclerosing cholangitis 68 No Yes K8309 Other cholangitis 68 No Yes K831 Obstruction of bile duct 68 No Yes Q442 Atresia of bile ducts 68 No Yes Q443 Congenital stenosis and stricture of bile ducts 68 No Yes P771 Stage 1 necrotizing enterocolitis in newborn 78 No Yes P772 Stage 2 necrotizing enterocolitis in newborn 78 No Yes P773 Stage 3 necrotizing enterocolitis in newborn 78 No Yes P779 Necrotizing enterocolitis in newborn, unspecified 78 No Yes P780 Perinatal intestinal perforation 78 No Yes Q400 Congenital hypertrophic pyloric stenosis 78 No Yes Q410 Congenital absence, atresia and stenosis of duodenum 78 No Yes Q411 Congenital absence, atresia and stenosis of jejunum 78 No Yes Q412 Congenital absence, atresia and stenosis of ileum 78 No Yes Q418 Congenital absence, atresia and stenosis of other specified parts of small intestine 78 No Yes Q419 Congenital absence, atresia and stenosis of small intestine, part unspecified 78 No Yes Q420 Congenital absence, atresia and stenosis of rectum with fistula 78 No Yes Q421 Congenital absence, atresia and stenosis of rectum without fistula 78 No Yes Q422 Congenital absence, atresia and stenosis of anus with fistula 78 No Yes Q423 Congenital absence, atresia and stenosis of anus without fistula 78 No Yes Q428 Congenital absence, atresia and stenosis of other parts of large intestine 78 No Yes Q429 Congenital absence, atresia and stenosis of large intestine, part unspecified 78 No Yes Q431 Hirschsprung's disease 78 No Yes Q432 Other congenital functional disorders of colon 78 No Yes Q433 Congenital malformations of intestinal fixation 78 No Yes N493 Fournier gangrene 92 No Yes D8686 Sarcoid arthropathy 93 No Yes D8687 Sarcoid myositis 93 No Yes G7241 Inclusion body myositis [IBM] 93 No Yes D644 Congenital dyserythropoietic anemia 109 No Yes P550 Rh isoimmunization of newborn 109 No Yes P551 ABO isoimmunization of newborn 109 No Yes P558 Other hemolytic diseases of newborn 109 No Yes P559 Hemolytic disease of newborn, unspecified 109 No Yes P560 Hydrops fetalis due to isoimmunization 109 No Yes P5690 Hydrops fetalis due to unspecified hemolytic disease 109 No Yes P5699 Hydrops fetalis due to other hemolytic disease 109 No Yes P040 Newborn affected by maternal anesthesia and analgesia in pregnancy, labor and delivery 137 No Yes P0411 Newborn affected by maternal antineoplastic chemotherapy 137 No Yes P0412 Newborn affected by maternal cytotoxic drugs 137 No Yes P0413 Newborn affected by maternal use of anticonvulsants 137 No Yes P0414 Newborn affected by maternal use of opiates 137 No Yes P0415 Newborn affected by maternal use of antidepressants 137 No Yes P0416 Newborn affected by maternal use of amphetamines 137 No Yes P0417 Newborn affected by maternal use of sedative-hypnotics 137 No Yes P0418 Newborn affected by other maternal medication 137 No Yes P0419 Newborn affected by maternal use of unspecified medication 137 No Yes P041A Newborn affected by maternal use of anxiolytics 137 No Yes P042 Newborn affected by maternal use of tobacco 137 No Yes P043 Newborn affected by maternal use of alcohol 137 No Yes P0440 Newborn affected by maternal use of unspecified drugs of addiction 137 No Yes P0441 Newborn affected by maternal use of cocaine 137 No Yes P0442 Newborn affected by maternal use of hallucinogens 137 No Yes P0449 Newborn affected by maternal use of other drugs of addiction 137 No Yes P045 Newborn affected by maternal use of nutritional chemical substances 137 No Yes P046 Newborn affected by maternal exposure to environmental chemical substances 137 No Yes P0481 Newborn affected by maternal use of cannabis 137 No Yes P0489 Newborn affected by other maternal noxious substances 137 No Yes P049 Newborn affected by maternal noxious substance, unspecified 137 No Yes P930 Grey baby syndrome 137 No Yes P938 Other reactions and intoxications due to drugs administered to newborn 137 No Yes P961 Neonatal withdrawal symptoms from maternal use of drugs of addiction 137 No Yes P962 Withdrawal symptoms from therapeutic use of drugs in newborn 137 No Yes F5000 Anorexia nervosa, unspecified 153 No Yes F5001 Anorexia nervosa, restricting type 153 No Yes F5002 Anorexia nervosa, binge eating/purging type 153 No Yes F502 Bulimia nervosa 153 No Yes G14 Postpolio syndrome 182 No Yes P115 Birth injury to spine and spinal cord 182 No Yes P570 Kernicterus due to isoimmunization 192 No Yes P578 Other specified kernicterus 192 No Yes P579 Kernicterus, unspecified 192 No Yes P90 Convulsions of newborn 201 No Yes P910 Neonatal cerebral ischemia 202 No Yes P911 Acquired periventricular cysts of newborn 202 No Yes P912 Neonatal cerebral leukomalacia 202 No Yes P913 Neonatal cerebral irritability 202 No Yes P914 Neonatal cerebral depression 202 No Yes P915 Neonatal coma 202 No Yes P9160 Hypoxic ischemic encephalopathy [HIE], unspecified 202 No Yes P9161 Mild hypoxic ischemic encephalopathy [HIE] 202 No Yes P9162 Moderate hypoxic ischemic encephalopathy [HIE] 202 No Yes P9163 Severe hypoxic ischemic encephalopathy [HIE] 202 No Yes P91811 Neonatal encephalopathy in diseases classified elsewhere 202 No Yes P91819 Neonatal encephalopathy, unspecified 202 No Yes P9188 Other specified disturbances of cerebral status of newborn 202 No Yes P919 Disturbance of cerebral status of newborn, unspecified 202 No Yes P2881 Respiratory arrest of newborn 212 No Yes P220 Respiratory distress syndrome of newborn 213 No Yes P260 Tracheobronchial hemorrhage originating in the perinatal period 213 No Yes P261 Massive pulmonary hemorrhage originating in the perinatal period 213 No Yes P268 Other pulmonary hemorrhages originating in the perinatal period 213 No Yes P269 Unspecified pulmonary hemorrhage originating in the perinatal period 213 No Yes P270 Wilson-Mikity syndrome 213 No Yes P271 Bronchopulmonary dysplasia originating in the perinatal period 213 No Yes P278 Other chronic respiratory diseases originating in the perinatal period 213 No Yes P279 Unspecified chronic respiratory disease originating in the perinatal period 213 No Yes P280 Primary atelectasis of newborn 213 No Yes P2810 Unspecified atelectasis of newborn 213 No Yes P2811 Resorption atelectasis without respiratory distress syndrome 213 No Yes P2819 Other atelectasis of newborn 213 No Yes P285 Respiratory failure of newborn 213 No Yes P2981 Cardiac arrest of newborn 213 No Yes T82512A Breakdown (mechanical) of artificial heart, initial encounter 223 No Yes T82522A Displacement of artificial heart, initial encounter 223 No Yes T82532A Leakage of artificial heart, initial encounter 223 No Yes T82592A Other mechanical complication of artificial heart, initial encounter 223 No Yes

 

[Lori]

Continued P290 Neonatal cardiac failure 225 No Yes P100 Subdural hemorrhage due to birth injury 248 No Yes P101 Cerebral hemorrhage due to birth injury 248 No Yes P102 Intraventricular hemorrhage due to birth injury 248 No Yes P103 Subarachnoid hemorrhage due to birth injury 248 No Yes P104 Tentorial tear due to birth injury 248 No Yes P108 Other intracranial lacerations and hemorrhages due to birth injury 248 No Yes P109 Unspecified intracranial laceration and hemorrhage due to birth injury 248 No Yes P110 Cerebral edema due to birth injury 248 No Yes P111 Other specified brain damage due to birth injury 248 No Yes P112 Unspecified brain damage due to birth injury 248 No Yes P520 Intraventricular (nontraumatic) hemorrhage, grade 1, of newborn 248 No Yes P521 Intraventricular (nontraumatic) hemorrhage, grade 2, of newborn 248 No Yes P5221 Intraventricular (nontraumatic) hemorrhage, grade 3, of newborn 248 No Yes P5222 Intraventricular (nontraumatic) hemorrhage, grade 4, of newborn 248 No Yes P523 Unspecified intraventricular (nontraumatic) hemorrhage of newborn 248 No Yes P524 Intracerebral (nontraumatic) hemorrhage of newborn 248 No Yes P525 Subarachnoid (nontraumatic) hemorrhage of newborn 248 No Yes P526 Cerebellar (nontraumatic) and posterior fossa hemorrhage of newborn 248 No Yes P528 Other intracranial (nontraumatic) hemorrhages of newborn 248 No Yes P529 Intracranial (nontraumatic) hemorrhage of newborn, unspecified 248 No Yes T8630 Unspecified complication of heart-lung transplant 276 -- Yes T8631 Heart-lung transplant rejection 276 -- Yes T8632 Heart-lung transplant failure 276 -- Yes T8633 Heart-lung transplant infection 276 -- Yes T8639 Other complications of heart-lung transplant 276 -- Yes Z48280 Encounter for aftercare following heart-lung transplant 276 -- Yes Z943 Heart and lungs transplant status 276 -- Yes J4550 Severe persistent asthma, uncomplicated 279 No Yes J4551 Severe persistent asthma with (acute) exacerbation 279 No Yes J4552 Severe persistent asthma with status asthmaticus 279 No Yes E08311 Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy with macular edema 298 -- Yes E083211 Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, right eye 298 -- Yes E083212 Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, left eye 298 -- Yes E083213 Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, bilateral 298 -- Yes E083219 Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, unspecified eye 298 -- Yes E083311 Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, right eye 298 -- Yes E083312 Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, left eye 298 -- Yes E083313 Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, bilateral 298 -- Yes E083319 Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, unspecified eye 298 -- Yes E083411 Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy with macular edema, right eye 298 -- Yes E083412 Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy with macular edema, left eye 298 -- Yes E083413 Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy with macular edema, bilateral 298 -- Yes E083419 Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy with macular edema, unspecified eye 298 -- Yes E10311 Type 1 diabetes mellitus with unspecified diabetic retinopathy with macular edema 298 -- Yes E103211 Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, right eye 298 -- Yes E103212 Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, left eye 298 -- Yes E103213 Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, bilateral 298 -- Yes E103219 Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, unspecified eye 298 -- Yes E103311 Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, right eye 298 -- Yes E103312 Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, left eye 298 -- Yes E103313 Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, bilateral 298 -- Yes

 

[Lori]

E103319 Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, unspecified eye 298 -- Yes E103411 Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, right eye 298 -- Yes E103412 Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, left eye 298 -- Yes E103413 Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, bilateral 298 -- Yes E103419 Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, unspecified eye 298 -- Yes E11311 Type 2 diabetes mellitus with unspecified diabetic retinopathy with macular edema 298 -- Yes E113211 Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, right eye 298 -- Yes E113212 Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, left eye 298 -- Yes E113213 Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, bilateral 298 -- Yes E113219 Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, unspecified eye 298 -- Yes E113311 Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, right eye 298 -- Yes E113312 Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, left eye 298 -- Yes E113313 Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, bilateral 298 -- Yes E113319 Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, unspecified eye 298 -- Yes E113411 Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, right eye 298 -- Yes E113412 Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, left eye 298 -- Yes E113413 Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, bilateral 298 -- Yes E113419 Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, unspecified eye 298 -- Yes E13311 Other specified diabetes mellitus with unspecified diabetic retinopathy with macular edema 298 -- Yes E133211 Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, right eye 298 -- Yes E133212 Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, left eye 298 -- Yes E133213 Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, bilateral 298 -- Yes E133219 Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, unspecified eye 298 -- Yes E133311 Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, right eye 298 -- Yes E133312 Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, left eye 298 -- Yes E133313 Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, bilateral 298 -- Yes E133319 Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, unspecified eye 298 -- Yes E133411 Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, right eye 298 -- Yes E133412 Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, left eye 298 -- Yes E133413 Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, bilateral 298 -- Yes E133419 Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, unspecified eye 298 -- Yes

 

[Lori]

H348110 Central retinal vein occlusion, right eye, with macular edema 298 No Yes H348111 Central retinal vein occlusion, right eye, with retinal neovascularization 298 No Yes H348112 Central retinal vein occlusion, right eye, stable 298 No Yes H348120 Central retinal vein occlusion, left eye, with macular edema 298 No Yes H348121 Central retinal vein occlusion, left eye, with retinal neovascularization 298 No Yes H348122 Central retinal vein occlusion, left eye, stable 298 No Yes H348130 Central retinal vein occlusion, bilateral, with macular edema 298 No Yes H348131 Central retinal vein occlusion, bilateral, with retinal neovascularization 298 No Yes H348132 Central retinal vein occlusion, bilateral, stable 298 No Yes H348190 Central retinal vein occlusion, unspecified eye, with macular edema 298 No Yes H348191 Central retinal vein occlusion, unspecified eye, with retinal neovascularization 298 No Yes H348192 Central retinal vein occlusion, unspecified eye, stable 298 No Yes H348310 Tributary (branch) retinal vein occlusion, right eye, with macular edema 298 No Yes H348311 Tributary (branch) retinal vein occlusion, right eye, with retinal neovascularization 298 No Yes H348312 Tributary (branch) retinal vein occlusion, right eye, stable 298 No Yes H348320 Tributary (branch) retinal vein occlusion, left eye, with macular edema 298 No Yes H348321 Tributary (branch) retinal vein occlusion, left eye, with retinal neovascularization 298 No Yes H348322 Tributary (branch) retinal vein occlusion, left eye, stable 298 No Yes H348330 Tributary (branch) retinal vein occlusion, bilateral, with macular edema 298 No Yes H348331 Tributary (branch) retinal vein occlusion, bilateral, with retinal neovascularization 298 No Yes H348332 Tributary (branch) retinal vein occlusion, bilateral, stable 298 No Yes H348390 Tributary (branch) retinal vein occlusion, unspecified eye, with macular edema 298 No Yes H348391 Tributary (branch) retinal vein occlusion, unspecified eye, with retinal neovascularization 298 No Yes H348392 Tributary (branch) retinal vein occlusion, unspecified eye, stable 298 No Yes D863 Sarcoidosis of skin 387 No Yes L100 Pemphigus vulgaris 387 No Yes L101 Pemphigus vegetans 387 No Yes L102 Pemphigus foliaceous 387 No Yes L103 Brazilian pemphigus [fogo selvagem] 387 No Yes L104 Pemphigus erythematosus 387 No Yes L1081 Paraneoplastic pemphigus 387 No Yes L1089 Other pemphigus 387 No Yes L109 Pemphigus, unspecified 387 No Yes L120 Bullous pemphigoid 387 No Yes L121 Cicatricial pemphigoid 387 No Yes L128 Other pemphigoid 387 No Yes L129 Pemphigoid, unspecified 387 No Yes L88 Pyoderma gangrenosum 387 No Yes P122 Epicranial subaponeurotic hemorrhage due to birth injury 399 No Yes Z9713 Presence of artificial right leg (complete) (partial) 409 No Yes Z9714 Presence of artificial left leg (complete) (partial) 409 No Yes Z9716 Presence of artificial legs, bilateral (complete) (partial) 409 No Yes