ICD-9 RISK ADJUSTED CODES
Codes revised as of 02/2011
ICD-9
413.9
441.9
441.4
440.24
Cardiology / Vascular
HCC
Value
0.244
0.316
0.316
0.316
402.91
411.1
410.90
410.92
412
427.0
427.2
443.9
Angina pectoris, NOS
Aortic aneurysm
Aortic aneurysm, abdominal (AAA)
Atherosclerosis, extremity w/ gangrene
Atherosclerosis, extremity w/ intermittent
claudication
Atherosclerosis, extremity w/ rest pain
Atherosclerosis, extremity w/ ulceration
Atrial fibrillation
Atrial flutter
AV block (complete)
Cardiomyopathy
Congestive heart failure (CHF)
DVT-lower extremity
Gangrene
Heart failure, chronic diastolic
Heart failure, chronic systolic
Heart failure, NOS
Hypertensive heart and chronic kidney dis.
(stage I-IV) w/ heart failure
Hypertensive heart dis. w/ heart failure
Intermediate coronary syndrome
MI, acute
MI, acute (subsequent episode)
MI, old
Parox. atrial tachycardia
Parox. tachycardia, NOS
Peripheral vascular disease (PVD)
415.11
Pulmonary embolism / infarction, Iatrogenic
0.610
427.81
Sinoatrial node dysfunction (SSS)
0.293
440.21
440.22
440.23
427.31
427.32
426.0
425.4
428.0
453.40
785.4
428.32
428.22
428.9
404.91
ICD-9
250.00
250.01
250.02
250.03
V58.67
250.4x
585.9
250.4x
585.6
250.4x
583.81
250.4x
Endocrinology
DM Type II controlled
DM Type I controlled
DM Type II uncontrolled
DM Type I uncontrolled
Long Term (current) Use of Insulin
Chronic kidney disease (CKD), stage unspec.,
due to DM
End stage renal disease (ESRD) due to DM
Diabetic nephropathy / nephritis
Diabetic nephrotic syndrome
0.316
0.316
0.316
0.293
0.293
0.293
0.410
0.410
0.316
0.610
0.410
0.410
0.410
0.410
0.410
0.284
0.284
0.284
0.244
0.293
0.293
0.316
HCC
Value
0.162
0.162
0.162
0.162
0.162
0.508
0.368
0.508
0.368
0.508
0.125
0.508
581.81
250.6x
357.2
250.7x
443.81
250.5x
362.02
250.8x
707.10
ICD-9
070.54
571.2
571.5
555.1
560.32
577.0
577.1
556.9
ICD-9
188.9
198.5
191.9
174.9
180.9
153.9
155.0
162.9
157.9
185
151.9
204.00
205.00
204.10
288.09
198.89
282.60
Diabetic nephrotic syndrome
Diabetic neuropathy
Diabetic peripheral angiopathy / PVD
Diabetic proliferative retinopathy
Ulcer of lower limb due to DM
Gastroenterology
Chronic hepatitis C w/o coma
Cirrhosis of liver, alcoholic
Cirrhosis of liver, NOS
Crohn's disease
Impaction, fecal
Pancreatitis, acute
Pancreatitis, chronic
Ulcerative colitis
Hematology / Oncology
CA, Bladder
CA, Bone (metastatic)
CA, Brain
CA, Breast
CA, Cervical
CA, Colon
CA, Liver (primary)
CA, Lung
CA, Pancreas
CA, Prostate
CA, Stomach
Leukemia, acute lymphoid (ALL)
Leukemia, acute myeloid (AML)
Leukemia, chronic lymphoid (CLL)
Neutropenia, other
Secondary malignant neoplasm, unspec.
Sickle cell anemia
0.125
0.408
0.327
0.508
0.316
0.259
0.252
0.408
0.449
HCC
Value
0.406
0.406
0.406
0.241
0.311
0.403
0.403
0.241
HCC
Value
0.208
2.276
0.794
0.208
0.208
0.208
1.053
1.053
1.053
0.208
1.053
2.276
2.276
0.794
0.912
2.276
1.015
* Only use if patient has active cancer and is on active treatment.
If cancer is "in remission" the ICD-9 would be a V-code.
ICD-9
042
038.42
038.12
038.9
ICD-9
725
714.0
710.0
730.20
733.1
733.13
ICD-9
434.11
780.39
438.20
438.50
340
344.1
332.0
356.9
344.0
345.90
345.91
Infectious Disease
AIDS / HIV
Septicemia, E. coli
Septicemia, MRSA
Septicemia, NEC
Musculoskeletal
Polymyalgia rheumatica
Rheumatoid arthritis (RA)
Systemic lupus erythematosus (SLE)
Osteomyelitis, unspec. site
Path. fracture-neck of femur
Path. fracture-vertebrae
Neurology
Acute embolic CVA w/ infarct
Convulsions, NEC
Late effect of CVA-hemiplegia, side NOS
Late effect of CVA-other paralytic syndrome
Multiple sclerosis
Paraplegia
Parkinson's disease
Peripheral neuropathy
Quadriplegia
Seizure disorder w/ intract epilepsy
Seizure disorder w/out intract epilepsy
HCC
Value
0.945
0.759
0.759
0.759
HCC
Value
0.346
0.346
0.346
0.535
0.443
0.443
HCC
Value
0.265
0.267
0.437
0.437
0.599
0.993
0.592
0.327
1.011
0.267
0.267
ICD-9
585.1
585.2
585.3
585.4
585.5
585.6
581.9
582.9
584.90
ICD-9
303.90
303.93
296.80
296.20
296.30
304.90
304.93
304.00
295.90
304.10
ICD-9
493.20
491.9
496
492.8
416.0
518.83
ICD-9
V49.76
V49.75
V49.73
V49.72
V44.3
V45.11
V44.1
V44.2
V44.0
ICD-9
799.4
263.0
263.1
263.90
Nephrology
Chronic kidney disease (CKD), stage I
Chronic kidney disease (CKD), stage II
Chronic kidney disease (CKD), stage III
Chronic kidney disease (CKD), stage IV
Chronic kidney disease (CKD), stage V
End stage renal disease (ESRD) / requiring
chronic dialysis
Nephrotic syndrome
Nephritis, chronic
Renal failure, acute
HCC
Value
0.368
0.368
0.368
0.368
0.368
0.368
0.125
0.125
0.368
Psychiatry
Alcohol dependence / alcoholism, NOS
Alcohol dependence, in remission
Bipolar disorder
Depression (major), single episode
Depression (major), recurrent
Drug dependence, NOS
Drug dependence, in remission
Opioid dependence
Schizophrenia, NOS
Sedative / anxiolytic dependence
Pulmonology
Asthma, chronic obstructive
Bronchitis, chronic
COPD
Emphysema
Primary pulmonary hypertension
Respiratory failure, chronic (CRF)
Status Codes
Amputation status, AKA
Amputation status, BKA
Amputation status, foot
Amputation status, toe(s)
Colostomy status
Dialysis status
Gastrostomy status
Ileostomy status
Tracheostomy status
Other
Cachexia
Malnutrition, moderate
Malnutrition, mild
Malnutrition, protein calorie (NOS)
HCC
Value
0.274
0.274
0.353
0.353
0.353
0.274
0.274
0.274
0.524
0.274
HCC
Value
0.399
0.399
0.399
0.399
0.410
0.578
HCC
Value
0.678
0.678
0.678
0.678
0.662
1.349
0.662
0.662
1.867
HCC
Value
0.856
0.856
0.856
0.856
This pocket coder provides you with those diagnoses most frequently encountered in the older
population with long-term or advanced illnesses. It is not intended to guide or replace your
independent clinical diagnostic decision making, but to help you quickly locate the codes for
common conditions. Additional resources may be required for accurate coding.
Codes are arranged by category. Five digit codes represent the highest level of specificity in
ICD-9 CM, but for some codes the highest specificity may be accomplished with four, or
rarely, three digits. Codes in this guide listed with "x" for example, 250.4x, indicate you must
utilize another resource to determine the most specific code.
Our expectation is that diagnosis documentation and coding be complete, accurate and specific.
For more information please contact Kim Kochan, RN (714) 443-4520 or kim.kochan@applecaremedical.com