L40.53: Psoriatic spondylitis

Risk adjustment

L40.53 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:

• HCC 93 Rheumatoid Arthritis and Other Specified Inflammatory Rheumatic Disorders0.617 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

L40.53 is named in 11 Medicare coverage policies: 11 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.

• A52423Billing and Coding: Infliximab and biosimilars
• A55639Billing and Coding: Chemotherapy Agents for Non-Oncologic Conditions
• A56416Billing and Coding: Assays for Vitamins and Metabolic Function
• A56432Billing and Coding: Infliximab