Q85.09: Other neurofibromatosis

Risk adjustment

Q85.09 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

Q85.09 is named in 32 Medicare coverage policies: 32 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.

• A52480Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics) - Policy Article
• A53060Billing and Coding: Ophthalmology: Extended Ophthalmoscopy and Fundus Photography
• A54969Billing and Coding: Nerve Conduction Studies and Electromyography
• A56462Billing and Coding: Erythropoiesis Stimulating Agents (ESA)