E03.5: Myxedema coma

Risk adjustment

E03.5 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:

• HCC 202 Coma, Brain Compression/Anoxic Damage0.543 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

E03.5 is named in 11 Medicare coverage policies: 11 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.

• A56612Billing and Coding: CT of the Head
• A56645Billing and Coding: Controlled Substance Monitoring and Drugs of Abuse Testing
• A56773Billing and Coding: Neurophysiology Evoked Potentials (NEPs)
• A56781Billing and Coding: Transthoracic Echocardiography (TTE)