There are drastic changes that will be implemented by the CMS that started for 2014 risk adjustment model. Now more than ever physicians and coders need to pay attention to capturing correct HCC codes and make sure they are addressed and billed correctly. Each IPA should anticipates a 5 to 10 % decline in scores throughout the upcoming years.

Here are the changes effective after 2014 :




Recalibration of scores (demographics & HCC)

-3% to -8%

First time in a few years

MA Coding Intensity Adjustments


Historically -3% or -4.41%

Fee for Service Normalization Factor


Risk scores divided by this factor to get numbers closer to FFS patients

Discontinued common HCCs

Est -6%

CKD 1-3, Old MI, Neuropathies , skin ulcers

CMS will use a blended model of 25% on 2013 model and 75% on 2014 model. There are now 79 HCC categories in comparison to 70 with 3166 HCC codes compared to 3519. Please make sure all your codes are coming through by checking with your biller. One suggestion is to capture all the HCC and 5 star codes in annual wellness visit.

2013 Hierarchical Condition Category Model            2014 Hierarchical Condition Category Model

                  17,555 ICD 9 Codes                                                       17,555 ICD 9 codes

     3,519 Risk Adjusted Codes in 79 categories                           3,166 Risk Adjusted Codes in 70 categories


 List of  already deleted HCC codes


ICD9Code ICD9_Description
040.2  Whipples Disease 
072.3  Mumps Pancreatitis 
078.6  Hemorrhagic Nephrosonephritis 
251.4  Abnormality Secretion Glucagon 
251.5  Abnormality Of Secretion Of Gastrin 
251.8  Oth D/O Pancreatic Intrl Secretion 
251.9  Uns D/O Pancreatic Intrl Secretion 
337.00  Idiopath Periph Auto Neurpathy Unsp 
337.09  Oth Idiopath Periph Auto Neuropathy 
337.1  Pripherl Autonomic Neuropthy D/O Ce 
337.20  Unspec Reflex Sympathetic Dystrophy 
337.21  Reflx Sympathet Dystrophy Up Limb 
337.22  Reflx Sympathet Dystrophy Low Limb 
337.29  Reflx Sympathet Dystrophy Oth Site 
337.3  Autonomic Dysreflexia 
337.9  Unspec Disorder Autonom Nerv System 
356.0  Hereditary Peripheral Neuropathy 
356.1  Peroneal Muscular Atrophy 
356.2  Hereditary Sensory Neuropathy 
356.3  Refsums Disease 
356.4  Idiopath Progressive Polyneuropathy 
356.8  Oth Spec Idiopath Periph Neuropathy 
356.9  Uns Hredtary&idiopath Priph Nurpthy 
359.22  Myotonia Congenita 
359.23  Myotonic Chondrodystrophy 
359.24  Drug-Induced Myotonia 
359.29  Other Specified Myotonic Disorder 
359.3  Periodic Paralysis 
359.4  Toxic Myopathy 
359.5  Myopathy Endocrine Dz Class Elsw 
359.6  Sx Inflam Myopathy Dz Class Elsw 
359.71  Inclusion Body Myositis 
359.79  Oth Inflam & Immune Myopathies Nec 
359.81  Critical Illness Myopathy 
359.89  Other Myopathies 
359.9  Unspecified Myopathy 
412  Old Myocardial Infarction 
577.0  Acute Pancreatitis 
577.2  Cyst And Pseudocyst Of Pancreas 
577.8  Other Specified Disease Of Pancreas 
577.9  Unspecified Disease Of Pancreas 
579.0  Celiac Disease 
579.1  Tropical Sprue 
579.2  Blind Loop Syndrome 
579.3  Oth&unspec Postsurgical Nonabsorb 
579.4  Pancreatic Steatorrhea 
579.8  Other Spec Intestinal Malabsorption 
579.9  Unspec Intestinal Malabsorption 
580.0  Acute Gln W/Lesion Proliferat Gln 
580.4  Acut Gln W/Lesion Rapidly Progs Gln 
580.81  Acut Gln W/Oth Spec Path Les Dz Ce 
580.89  Oth Ac Gln W/Oth Pathal Les Kidney 
580.9  Acut Gln W/Unspec Pathal Les Kidney 
581.0  Nephrotic Synd W/Les Proliferat Gln 
581.1  Nephrotic Synd W/Lesion Memb Gln 
581.2  Nephrotc Syn W/Les Membrnoprolf Gln 
581.3  Nephrotic Synd W/Les Mini Chg Gln 
581.81  Nephrotic Synd W/Oth Path Les Dz Ce 
581.89  Oth Nephrotic Syn-Spec Path Les 
581.9  Nephrotic Synd W/Uns Pathal Les 
582.0  Chronic Gln W/Lesion Proliferat Gln 
582.1  Chronic Gln W/Lesion Membranous Gln 
582.2  Chron Gln W/Les Membranoprolif Gln 
582.4  Chron Gln W/Les Rapidly Progs Gln 
582.81  Chrn Gln W/Oth Spec Path Les Dz Ce 
582.89  Oth Chrn Gln W/Spec Pathal Les 
582.9  Chron Gln W/Uns Pathal Les Kidney 
583.0  Nephritis&nephropathy W/Les Prolif 
583.1  Nephrit&nephropath-Les Memb Gln 
583.2  Nephrit&nephrop-Les Membrnprolf Gln 
583.4  Nephrit&nephrop-Les Rapid Prog Gln 
583.6  Nephrit&nephrop W/Les Crticl Necros 
583.7  Nephrit&nephrop W/Les Medulry Ncros 
583.81  Nephrit&nephrop-Oth Path Les Dz Ce 
583.89  Nephritis&nephropath W/Oth Path Les 
583.9  Nephritis&nephropath W/Uns Path Les 
585.1  Chronic Kidney Disease Stage I 
585.2  Chronic Kidney Dz Stage Ii (Mild) 
585.3  Chronic Kidney Dz Stage Iii (Mod) 
585.9  Chronic Kidney Disease Unspecified 
586  Unspecified Renal Failure 
707.00  Pressure Ulcer Unspecified Site 
707.01  Pressure Ulcer Elbow 
707.02  Pressure Ulcer Upper Back 
707.03  Pressure Ulcer Lower Back 
707.04  Pressure Ulcer Hip 
707.05  Pressure Ulcer Buttock 
707.06  Pressure Ulcer Ankle 
707.07  Pressure Ulcer Heel 
707.09  Pressure Ulcer Other Site 
707.20  Pressure Ulcer Unspecified Stage 
707.21  Pressure Ulcer Stage I 
707.22  Pressure Ulcer Stage Ii 
753.14  Congn Polycyst Kdney Autosom Recess 
799.01  Asphyxia 
799.02  Hypoxemia 
996.00  Mech Comp Uns Card Device Impl&gft 
996.01  Mech Comp Due Card Pacemaker 
996.02  Mech Comp Due Heart Valve Prosth 
996.03  Mech Comp Due Coronary Byps Graft 
996.04  Mech Comp Due Auto Impl Card Defib 
996.09  Mech Comp Card Device Impl&gft Oth 
996.32  Mech Comp-Intrautern Cntracpt Devc 
996.51  Mech Complication Due Corneal Graft 
996.52  Mech Comp Due Oth Tissue Graft Nec 
996.53  Mech Comp Due Oculr Lens Prosthesis 
996.54  Mech Comp Due Breast Prosthesis 
996.55  Mech Comp-Artificial Skin Graft 
996.57  Complication, Due To Insulin Pump 
996.59  Mech Comp-Oth Impl&intrl Devc Nec 
996.70  Oth Comps Due Uns Device Impl&gft 
996.71  Oth Comps Due Heart Valve Prosth 
996.72  Oth Comps-Oth Card Devc Impl&gft 
996.79  Oth Comp Oth Pros Dev Impl&gft 
997.00  Uns Nervous Sys Complication Nec 
997.01  Cns Complication Nec 
997.09  Oth Nervous Sys Complications Nec 
997.1  Cardiac Complications Nec 
997.2  Peripherl Vasculr Complication Nec 
997.32  Postprocedural Aspiration Pneumonia 
997.39  Other Respiratory Complications 
997.4  Digestive System Complication Nec 
997.49  Oth Digestive System Complications 
997.5  Urinary Complications Nec 
997.71  Vascular Comps Mesenteric Artery 
997.72  Vascular Complications Renal Artery 
997.79  Vascular Complications Oth Vessels 
998.0  Postoperative Shock 
998.00  Postoperative Shock Unspecified 
998.09  Postoperative Shock Other 
998.6  Persistent Postoperative Fist Nec