Draft Fiscal Year 2016 ICD-10 Crosswalk Information Regarding Hierarchical Condition Categories

HHS-HCC risk adjustment model uses diagnosis codes in the current year to predict medical and drug spending in the same year. The diagnostic classification system underlying the HHS-operated risk adjustment model begins by mapping all ICD-9-CM diagnosis codes to diagnostic groups, or DXGs, and then maps the DXGs to hierarchical condition categories (HCCs). This article discusses how the HCC codes will transition from ICD-9 to ICD-10.

The International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) has been developed as a replacement for ICD-9-CM and is scheduled to be implemented in the United States beginning on October 1, 2015, in the last quarter of the 2015 benefit year of HHS-operated risk adjustment. All data reporting for the HHS-operated risk adjustment program must include ICD-10-CM codes for claims with dates of service on or after October 1, 2015. In an effort to prepare issuers for this implementation, CCIIO has prepared this document to describe our approach to mapping ICD-10 codes in the HHS-operated risk adjustment model. Additionally, we are providing a draft crosswalk mapping of the ICD-10 diagnosis codes to HHS-operated risk adjustment hierarchical condition categories (HCCs) for stakeholder feedback. The ICD-10 crosswalk is posted on the CCIIO webpage under the section labeled “Premium Stabilization Programs,” under “Regulations & Guidance” in Excel format for your review (https://www.cms.gov/CCIIO/Programs-and-Initiatives/Premium-StabilizationPrograms/index.html).

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