C25.3: Malignant neoplasm of pancreatic duct

Risk adjustment

C25.3 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:

• HCC 20 Lung and Other Severe Cancers1.136 RAF

Coefficient shown for the Community Non-dual Aged segment. A higher HCC in the same hierarchy will suppress this one, so capturing it does not always add score. Look up the whole chart to see which of its HCCs the hierarchy would zero.

Medicare coverage

C25.3 is named in 68 Medicare coverage policies: 68 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.

• A52450Billing and Coding: Paclitaxel (e.g., Taxol®/Abraxane ™)
• A52479Oral Anticancer Drugs - Policy Article
• A52480Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics) - Policy Article
• A54338Billing and Coding: MolDX: Germline testing for use of PARP inhibitors