D35.4: Benign neoplasm of pineal gland

Risk adjustment

D35.4 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:

• HCC 23 Prostate, Breast, and Other Cancers and Tumors0.186 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

D35.4 is named in 17 Medicare coverage policies: 17 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.

• A55315Billing and Coding: Proton Beam Therapy
• A56464Billing and Coding: Flow Cytometry
• A56537Billing and Coding: Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)
• A56551Billing and Coding: Visual Fields Testing