I30-I5A — Other forms of heart disease

Risk adjustment in I30-I5A

0 codes in this block map to a CMS-HCC, which means the diagnosis carries a risk-adjustment payment when it is documented and coded. Under-coding here is money left on the table; over-coding here is what audits are for.

• HCC 238 Specified Heart Arrhythmias
• HCC 226 Heart Failure, Except End Stage and Acute
• HCC 227 Cardiomyopathy/Myocarditis
• HCC 225 Acute Heart Failure (Excludes Acute on Chronic)
• HCC 213 Cardio-Respiratory Failure and Shock
• HCC 224 Acute on Chronic Heart Failure

What else to watch in I30-I5A

• 15 codes are laterality-specific. They come in left and right pairs, and the pair is mutually exclusive on a single site: coding both without a bilateral code is a contradiction a scrubber should catch before the payer does.
• 140 codes are named in Medicare coverage policies. An LCD or NCD lists them as supporting medical necessity, or explicitly as not supporting it. Which applies depends on the MAC for your state.