Difference between revisions of "CMS-HCC Disease Coefficients"

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These are the disease coefficients component of the [[CMS-HCC Risk Adjustments]]
 
These are the disease coefficients component of the [[CMS-HCC Risk Adjustments]]
  
−
The relative risk scores in this table were calculated by dividing the parameter estimates by the Part C national average predicted expenditures (CMS Part C Denominator). The Part C Denominator value used is $8,034.71.
+
The relative risk scores in this table were calculated by dividing the parameter estimates by the Part C national average predicted expenditures of $9,276.26.
 
{| class="wikitable sortable"
 
{| class="wikitable sortable"
 
!style="background: #e3e3e3;"|Disease Coefficients
 
!style="background: #e3e3e3;"|Disease Coefficients
Line 11: Line 11:
 
|HCC1
 
|HCC1
 
|style="background-color: #FFCCCC" |HIV/AIDS
 
|style="background-color: #FFCCCC" |HIV/AIDS
−
|align="center"|0.492
+
|align="center"|0.470
−
|align="center"|1.374
+
|align="center"|1.904
 
|-
 
|-
 
|HCC2
 
|HCC2
 
|style="background-color: #FFCCCC" |Septicemia, Sepsis, Systemic Inflammatory Response Syndrome/Shock
 
|style="background-color: #FFCCCC" |Septicemia, Sepsis, Systemic Inflammatory Response Syndrome/Shock
−
|align="center"|0.520
+
|align="center"|0.535
−
|align="center"|0.471
+
|align="center"|0.575
 
|-
 
|-
 
|HCC6
 
|HCC6
 
|style="background-color: #FFCCCC" |Opportunistic Infections
 
|style="background-color: #FFCCCC" |Opportunistic Infections
−
|align="center"|0.557
+
|align="center"|0.440
−
|align="center"|0.541
+
|align="center"|0.344
 
|-
 
|-
 
|HCC8
 
|HCC8
 
|style="background-color: #FFCCCC" |Metastatic Cancer and Acute Leukemia
 
|style="background-color: #FFCCCC" |Metastatic Cancer and Acute Leukemia
−
|align="center"|2.425
+
|align="center"|2.484
−
|align="center"|0.928
+
|align="center"|1.203
 
|-
 
|-
 
|HCC9
 
|HCC9
 
|style="background-color: #FFCCCC" |Lung and Other Severe Cancers
 
|style="background-color: #FFCCCC" |Lung and Other Severe Cancers
−
|align="center"|1.006
+
|align="center"|0.973
−
|align="center"|0.610
+
|align="center"|0.674
 
|-
 
|-
 
|HCC10
 
|HCC10
 
|style="background-color: #FFCCCC" |Lymphoma and Other Cancers
 
|style="background-color: #FFCCCC" |Lymphoma and Other Cancers
−
|align="center"|0.695
+
|align="center"|0.672
−
|align="center"|0.363
+
|align="center"|0.412
 
|-
 
|-
 
|HCC11
 
|HCC11
 
|style="background-color: #FFCCCC" |Colorectal, Bladder, and Other Cancers
 
|style="background-color: #FFCCCC" |Colorectal, Bladder, and Other Cancers
−
|align="center"|0.330
+
|align="center"|0.317
−
|align="center"|0.255
+
|align="center"|0.296
 
|-
 
|-
 
|HCC12
 
|HCC12
 
|style="background-color: #FFCCCC" |Breast, Prostate, and Other Cancers and Tumors
 
|style="background-color: #FFCCCC" |Breast, Prostate, and Other Cancers and Tumors
−
|align="center"|0.180
+
|align="center"|0.154
−
|align="center"|0.165
+
|align="center"|0.198
 
|-
 
|-
 
|HCC17
 
|HCC17
 
|style="background-color: #FFCCCC" |Diabetes with Acute Complications
 
|style="background-color: #FFCCCC" |Diabetes with Acute Complications
−
|align="center"|0.344
+
|align="center"|0.368
−
|align="center"|0.434
+
|align="center"|0.474
 
|-
 
|-
 
|HCC18
 
|HCC18
 
|style="background-color: #FFCCCC" |Diabetes with Chronic Complications
 
|style="background-color: #FFCCCC" |Diabetes with Chronic Complications
−
|align="center"|0.344
+
|align="center"|0.368
−
|align="center"|0.434
+
|align="center"|0.474
 
|-
 
|-
 
|HCC19
 
|HCC19
 
|style="background-color: #FFCCCC" |Diabetes without Complications
 
|style="background-color: #FFCCCC" |Diabetes without Complications
−
|align="center"|0.124
+
|align="center"|0.118
−
|align="center"|0.187
+
|align="center"|0.182
 
|-
 
|-
 
|HCC21
 
|HCC21
 
|style="background-color: #FFCCCC" |Protein-Calorie Malnutrition
 
|style="background-color: #FFCCCC" |Protein-Calorie Malnutrition
−
|align="center"|0.653
+
|align="center"|0.713
−
|align="center"|0.343
+
|align="center"|0.399
 
|-
 
|-
 
|HCC22
 
|HCC22
 
|style="background-color: #FFCCCC" |Morbid Obesity
 
|style="background-color: #FFCCCC" |Morbid Obesity
−
|align="center"|0.342
+
|align="center"|0.365
−
|align="center"|0.353
+
|align="center"|0.579
 
|-
 
|-
 
|HCC23
 
|HCC23
 
|style="background-color: #FFCCCC" |Other Significant Endocrine and Metabolic Disorders
 
|style="background-color: #FFCCCC" |Other Significant Endocrine and Metabolic Disorders
−
|align="center"|0.240
+
|align="center"|0.245
−
|align="center"|0.248
+
|align="center"|0.282
 
|-
 
|-
 
|HCC27
 
|HCC27
 
|style="background-color: #FFCCCC" |End-Stage Liver Disease
 
|style="background-color: #FFCCCC" |End-Stage Liver Disease
−
|align="center"|1.003
+
|align="center"|0.923
−
|align="center"|0.637
+
|align="center"|1.083
 
|-
 
|-
 
|HCC28
 
|HCC28
 
|style="background-color: #FFCCCC" |Cirrhosis of Liver
 
|style="background-color: #FFCCCC" |Cirrhosis of Liver
−
|align="center"|0.425
+
|align="center"|0.399
−
|align="center"|0.343
+
|align="center"|0.351
 
|-
 
|-
 
|HCC29
 
|HCC29
 
|style="background-color: #FFCCCC" |Chronic Hepatitis
 
|style="background-color: #FFCCCC" |Chronic Hepatitis
−
|align="center"|0.313
+
|align="center"|0.251
−
|align="center"|0.343
+
|align="center"|0.351
 
|-
 
|-
 
|HCC33
 
|HCC33
 
|style="background-color: #FFCCCC" |Intestinal Obstruction/Perforation
 
|style="background-color: #FFCCCC" |Intestinal Obstruction/Perforation
−
|align="center"|0.337
+
|align="center"|0.310
−
|align="center"|0.302
+
|align="center"|0.384
 
|-
 
|-
 
|HCC34
 
|HCC34
 
|style="background-color: #FFCCCC" |Chronic Pancreatitis
 
|style="background-color: #FFCCCC" |Chronic Pancreatitis
−
|align="center"|0.257
+
|align="center"|0.286
−
|align="center"|0.175
+
|align="center"|0.095
 
|-
 
|-
 
|HCC35
 
|HCC35
 
|style="background-color: #FFCCCC" |Inflammatory Bowel Disease
 
|style="background-color: #FFCCCC" |Inflammatory Bowel Disease
−
|align="center"|0.279
+
|align="center"|0.302
−
|align="center"|0.250
+
|align="center"|0.318
 
|-
 
|-
 
|HCC39
 
|HCC39
 
|style="background-color: #FFCCCC" |Bone/Joint/Muscle Infections/Necrosis
 
|style="background-color: #FFCCCC" |Bone/Joint/Muscle Infections/Necrosis
−
|align="center"|0.423
+
|align="center"|0.498
−
|align="center"|0.386
+
|align="center"|0.340
 
|-
 
|-
 
|HCC40
 
|HCC40
 
|style="background-color: #FFCCCC" |Rheumatoid Arthritis and Inflammatory Connective Tissue Disease
 
|style="background-color: #FFCCCC" |Rheumatoid Arthritis and Inflammatory Connective Tissue Disease
−
|align="center"|0.376
+
|align="center"|0.374
−
|align="center"|0.222
+
|align="center"|0.351
 
|-
 
|-
 
|HCC46
 
|HCC46
 
|style="background-color: #FFCCCC" |Severe Hematological Disorders
 
|style="background-color: #FFCCCC" |Severe Hematological Disorders
−
|align="center"|1.078
+
|align="center"|1.136
−
|align="center"|0.638
+
|align="center"|0.794
 
|-
 
|-
 
|HCC47
 
|HCC47
 
|style="background-color: #FFCCCC" |Disorders of Immunity
 
|style="background-color: #FFCCCC" |Disorders of Immunity
−
|align="center"|0.306
+
|align="center"|0.521
−
|align="center"|0.436
+
|align="center"|0.519
 
|-
 
|-
 
|HCC48
 
|HCC48
 
|style="background-color: #FFCCCC" |Coagulation Defects and Other Specific Hematological Disorders
 
|style="background-color: #FFCCCC" |Coagulation Defects and Other Specific Hematological Disorders
−
|align="center"|0.258
+
|align="center"|0.252
−
|align="center"|0.197
+
|align="center"|0.164
−
|-
+
−
|HCC51
+
−
|style="background-color: #FFCCCC" |Dementia With Complications
+
−
|align="center"|0.616
+
−
|align="center"|-
+
−
|-
+
−
|HCC52
+
−
|style="background-color: #FFCCCC" |Dementia Without Complications
+
−
|align="center"|0.343
+
−
|align="center"|-
+
 
|-
 
|-
 
|HCC54
 
|HCC54
 
|style="background-color: #FFCCCC" |Drug/Alcohol Psychosis
 
|style="background-color: #FFCCCC" |Drug/Alcohol Psychosis
−
|align="center"|0.358
+
|align="center"|0.420
−
|align="center"|0.051
+
|align="center"|0.053
 
|-
 
|-
 
|HCC55
 
|HCC55
 
|style="background-color: #FFCCCC" |Drug/Alcohol Dependence
 
|style="background-color: #FFCCCC" |Drug/Alcohol Dependence
−
|align="center"|0.358
+
|align="center"|0.420
−
|align="center"|0.051
+
|align="center"|0.053
 
|-
 
|-
 
|HCC57
 
|HCC57
 
|style="background-color: #FFCCCC" |Schizophrenia
 
|style="background-color: #FFCCCC" |Schizophrenia
−
|align="center"|0.471
+
|align="center"|0.490
−
|align="center"|0.274
+
|align="center"|0.311
 
|-
 
|-
 
|HCC58
 
|HCC58
 
|style="background-color: #FFCCCC" |Major Depressive, Bipolar, and Paranoid Disorders
 
|style="background-color: #FFCCCC" |Major Depressive, Bipolar, and Paranoid Disorders
−
|align="center"|0.318
+
|align="center"|0.330
−
|align="center"|0.274
+
|align="center"|0.311
 
|-
 
|-
 
|HCC70
 
|HCC70
 
|style="background-color: #FFCCCC" |Quadriplegia
 
|style="background-color: #FFCCCC" |Quadriplegia
−
|align="center"|1.075
+
|align="center"|1.234
−
|align="center"|0.497
+
|align="center"|0.650
 
|-
 
|-
 
|HCC71
 
|HCC71
 
|style="background-color: #FFCCCC" |Paraplegia
 
|style="background-color: #FFCCCC" |Paraplegia
−
|align="center"|0.868
+
|align="center"|1.052
−
|align="center"|0.497
+
|align="center"|0.539
 
|-
 
|-
 
|HCC72
 
|HCC72
 
|style="background-color: #FFCCCC" |Spinal Cord Disorders/Injuries
 
|style="background-color: #FFCCCC" |Spinal Cord Disorders/Injuries
−
|align="center"|0.441
+
|align="center"|0.509
−
|align="center"|0.191
+
|align="center"|0.280
 
|-
 
|-
 
|HCC73
 
|HCC73
 
|style="background-color: #FFCCCC" |Amyotrophic Lateral Sclerosis and Other Motor Neuron Disease
 
|style="background-color: #FFCCCC" |Amyotrophic Lateral Sclerosis and Other Motor Neuron Disease
−
|align="center"|1.016
+
|align="center"|0.958
−
|align="center"|0.294
+
|align="center"|0.367
 
|-
 
|-
 
|HCC74
 
|HCC74
 
|style="background-color: #FFCCCC" |Cerebral Palsy
 
|style="background-color: #FFCCCC" |Cerebral Palsy
−
|align="center"|0.036
+
|align="center"|0.045
 
|align="center"|-
 
|align="center"|-
 
|-
 
|-
 
|HCC75
 
|HCC75
 
|style="background-color: #FFCCCC" |Polyneuropathy
 
|style="background-color: #FFCCCC" |Polyneuropathy
−
|align="center"|0.281
+
|align="center"|0.408
−
|align="center"|0.256
+
|align="center"|0.300
 
|-
 
|-
 
|HCC76
 
|HCC76
 
|style="background-color: #FFCCCC" |Muscular Dystrophy
 
|style="background-color: #FFCCCC" |Muscular Dystrophy
−
|align="center"|0.460
+
|align="center"|0.565
−
|align="center"|0.247
+
|align="center"|0.215
 
|-
 
|-
 
|HCC77
 
|HCC77
 
|style="background-color: #FFCCCC" |Multiple Sclerosis
 
|style="background-color: #FFCCCC" |Multiple Sclerosis
−
|align="center"|0.482
+
|align="center"|0.556
 
|align="center"|-
 
|align="center"|-
 
|-
 
|-
 
|HCC78
 
|HCC78
 
|style="background-color: #FFCCCC" |Parkinson's and Huntington's Diseases
 
|style="background-color: #FFCCCC" |Parkinson's and Huntington's Diseases
−
|align="center"|0.555
+
|align="center"|0.691
−
|align="center"|0.110
+
|align="center"|0.173
 
|-
 
|-
 
|HCC79
 
|HCC79
 
|style="background-color: #FFCCCC" |Seizure Disorders and Convulsions
 
|style="background-color: #FFCCCC" |Seizure Disorders and Convulsions
−
|align="center"|0.252
+
|align="center"|0.284
−
|align="center"|0.173
+
|align="center"|0.144
 
|-
 
|-
 
|HCC80
 
|HCC80
 
|style="background-color: #FFCCCC" |Coma, Brain Compression/Anoxic Damage
 
|style="background-color: #FFCCCC" |Coma, Brain Compression/Anoxic Damage
−
|align="center"|0.533
+
|align="center"|0.570
−
|align="center"|0.103
+
|align="center"|0.104
 
|-
 
|-
 
|HCC82
 
|HCC82
 
|style="background-color: #FFCCCC" |Respirator Dependence/Tracheostomy Status
 
|style="background-color: #FFCCCC" |Respirator Dependence/Tracheostomy Status
−
|align="center"|1.732
+
|align="center"|1.520
−
|align="center"|1.567
+
|align="center"|1.769
 
|-
 
|-
 
|HCC83
 
|HCC83
 
|style="background-color: #FFCCCC" |Respiratory Arrest
 
|style="background-color: #FFCCCC" |Respiratory Arrest
−
|align="center"|0.769
+
|align="center"|0.802
−
|align="center"|0.611
+
|align="center"|1.169
 
|-
 
|-
 
|HCC84
 
|HCC84
 
|style="background-color: #FFCCCC" |Cardio-Respiratory Failure and Shock
 
|style="background-color: #FFCCCC" |Cardio-Respiratory Failure and Shock
−
|align="center"|0.326
+
|align="center"|0.329
−
|align="center"|0.346
+
|align="center"|0.442
 
|-
 
|-
 
|HCC85
 
|HCC85
 
|style="background-color: #FFCCCC" |Congestive Heart Failure
 
|style="background-color: #FFCCCC" |Congestive Heart Failure
−
|align="center"|0.361
+
|align="center"|0.368
−
|align="center"|0.226
+
|align="center"|0.229
 
|-
 
|-
 
|HCC86
 
|HCC86
 
|style="background-color: #FFCCCC" |Acute Myocardial Infarction
 
|style="background-color: #FFCCCC" |Acute Myocardial Infarction
−
|align="center"|0.283
+
|align="center"|0.275
−
|align="center"|0.394
+
|align="center"|0.515
 
|-
 
|-
 
|HCC87
 
|HCC87
 
|style="background-color: #FFCCCC" |Unstable Angina and Other Acute Ischemic Heart Disease
 
|style="background-color: #FFCCCC" |Unstable Angina and Other Acute Ischemic Heart Disease
−
|align="center"|0.283
+
|align="center"|0.258
−
|align="center"|0.394
+
|align="center"|0.515
 
|-
 
|-
 
|HCC88
 
|HCC88
 
|style="background-color: #FFCCCC" |Angina Pectoris
 
|style="background-color: #FFCCCC" |Angina Pectoris
−
|align="center"|0.210
+
|align="center"|0.141
−
|align="center"|0.366
+
|align="center"|0.474
 
|-
 
|-
 
|HCC96
 
|HCC96
 
|style="background-color: #FFCCCC" |Specified Heart Arrhythmias
 
|style="background-color: #FFCCCC" |Specified Heart Arrhythmias
−
|align="center"|0.276
+
|align="center"|0.295
−
|align="center"|0.227
+
|align="center"|0.262
 
|-
 
|-
 
|HCC99
 
|HCC99
 
|style="background-color: #FFCCCC" |Cerebral Hemorrhage
 
|style="background-color: #FFCCCC" |Cerebral Hemorrhage
−
|align="center"|0.371
+
|align="center"|0.339
−
|align="center"|0.175
+
|align="center"|0.216
 
|-
 
|-
 
|HCC100
 
|HCC100
 
|style="background-color: #FFCCCC" |Ischemic or Unspecified Stroke
 
|style="background-color: #FFCCCC" |Ischemic or Unspecified Stroke
−
|align="center"|0.333
+
|align="center"|0.317
−
|align="center"|0.175
+
|align="center"|0.216
 
|-
 
|-
 
|HCC103
 
|HCC103
 
|style="background-color: #FFCCCC" |Hemiplegia/Hemiparesis
 
|style="background-color: #FFCCCC" |Hemiplegia/Hemiparesis
−
|align="center"|0.481
+
|align="center"|0.581
−
|align="center"|0.063
+
|align="center"|0.061
 
|-
 
|-
 
|HCC104
 
|HCC104
 
|style="background-color: #FFCCCC" |Monoplegia, Other Paralytic Syndromes
 
|style="background-color: #FFCCCC" |Monoplegia, Other Paralytic Syndromes
−
|align="center"|0.212
+
|align="center"|0.396
−
|align="center"|0.063
+
|align="center"|0.061
 
|-
 
|-
 
|HCC106
 
|HCC106
 
|style="background-color: #FFCCCC" |Atherosclerosis of the Extremities with Ulceration or Gangrene
 
|style="background-color: #FFCCCC" |Atherosclerosis of the Extremities with Ulceration or Gangrene
−
|align="center"|1.313
+
|align="center"|1.413
−
|align="center"|0.773
+
|align="center"|0.886
 
|-
 
|-
 
|HCC107
 
|HCC107
 
|style="background-color: #FFCCCC" |Vascular Disease with Complications
 
|style="background-color: #FFCCCC" |Vascular Disease with Complications
−
|align="center"|0.417
+
|align="center"|0.410
−
|align="center"|0.257
+
|align="center"|0.301
 
|-
 
|-
 
|HCC108
 
|HCC108
 
|style="background-color: #FFCCCC" |Vascular Disease
 
|style="background-color: #FFCCCC" |Vascular Disease
−
|align="center"|0.288
+
|align="center"|0.299
−
|align="center"|0.146
+
|align="center"|0.107
 
|-
 
|-
 
|HCC110
 
|HCC110
 
|style="background-color: #FFCCCC" |Cystic Fibrosis
 
|style="background-color: #FFCCCC" |Cystic Fibrosis
−
|align="center"|0.388
+
|align="center"|0.417
−
|align="center"|0.323
+
|align="center"|0.364
 
|-
 
|-
 
|HCC111
 
|HCC111
 
|style="background-color: #FFCCCC" |Chronic Obstructive Pulmonary Disease
 
|style="background-color: #FFCCCC" |Chronic Obstructive Pulmonary Disease
−
|align="center"|0.388
+
|align="center"|0.346
−
|align="center"|0.323
+
|align="center"|0.364
 
|-
 
|-
 
|HCC112
 
|HCC112
 
|style="background-color: #FFCCCC" |Fibrosis of Lung and Other Chronic Lung Disorders
 
|style="background-color: #FFCCCC" |Fibrosis of Lung and Other Chronic Lung Disorders
−
|align="center"|0.294
+
|align="center"|0.274
−
|align="center"|0.252
+
|align="center"|0.260
 
|-
 
|-
 
|HCC114
 
|HCC114
 
|style="background-color: #FFCCCC" |Aspiration and Specified Bacterial Pneumonias
 
|style="background-color: #FFCCCC" |Aspiration and Specified Bacterial Pneumonias
−
|align="center"|0.006
+
|align="center"|0.672
−
|align="center"|0.610
+
|align="center"|0.285
 
|-
 
|-
 
|HCC115
 
|HCC115
 
|style="background-color: #FFCCCC" |Pneumococcal Pneumonia, Emphysema, Lung Abscess
 
|style="background-color: #FFCCCC" |Pneumococcal Pneumonia, Emphysema, Lung Abscess
−
|align="center"|0.212
+
|align="center"|0.200
−
|align="center"|0.194
+
|align="center"|0.285
 
|-
 
|-
 
|HCC122
 
|HCC122
 
|style="background-color: #FFCCCC" |Proliferative Diabetic Retinopathy and Vitreous Hemorrhage
 
|style="background-color: #FFCCCC" |Proliferative Diabetic Retinopathy and Vitreous Hemorrhage
−
|align="center"|0.223
+
|align="center"|0.203
−
|align="center"|0.366
+
|align="center"|0.433
 
|-
 
|-
 
|HCC124
 
|HCC124
 
|style="background-color: #FFCCCC" |Exudative Macular Degeneration
 
|style="background-color: #FFCCCC" |Exudative Macular Degeneration
−
|align="center"|0.248
+
|align="center"|0.335
−
|align="center"|0.178
+
|align="center"|0.166
 
|-
 
|-
 
|HCC134
 
|HCC134
 
|style="background-color: #FFCCCC" |Dialysis Status
 
|style="background-color: #FFCCCC" |Dialysis Status
−
|align="center"|0.617
+
|align="center"|0.476
−
|align="center"|0.538
+
|align="center"|0.509
 
|-
 
|-
 
|HCC135
 
|HCC135
 
|style="background-color: #FFCCCC" |Acute Renal Failure
 
|style="background-color: #FFCCCC" |Acute Renal Failure
−
|align="center"|0.617
+
|align="center"|0.476
−
|align="center"|0.538
+
|align="center"|0.509
 
|-
 
|-
 
|HCC136
 
|HCC136
 
|style="background-color: #FFCCCC" |Chronic Kidney Disease, Stage 5
 
|style="background-color: #FFCCCC" |Chronic Kidney Disease, Stage 5
−
|align="center"|0.227
+
|align="center"|0.224
−
|align="center"|0.304
+
|align="center"|0.509
 
|-
 
|-
 
|HCC137
 
|HCC137
 
|style="background-color: #FFCCCC" |Chronic Kidney Disease, Severe (Stage 4)
 
|style="background-color: #FFCCCC" |Chronic Kidney Disease, Severe (Stage 4)
−
|align="center"|0.227
+
|align="center"|0.224
−
|align="center"|0.304
+
|align="center"|0.294
−
|-
+
−
|HCC138
+
−
|style="background-color: #FFCCCC" |Chronic Kidney Disease, Moderate (Stage 3)
+
−
|align="center"|0.227
+
−
|align="center"|0.304
+
−
|-
+
−
|HCC139
+
−
|style="background-color: #FFCCCC" |Chronic Kidney Disease, Mild or Unspecified (Stage 1-2 or Unspecified)
+
−
|align="center"|0.227
+
−
|align="center"|0.304
+
−
|-
+
−
|HCC140
+
−
|style="background-color: #FFCCCC" |Unspecified Renal Failure
+
−
|align="center"|0.227
+
−
|align="center"|0.304
+
−
|-
+
−
|HCC141
+
−
|style="background-color: #FFCCCC" |Nephritis
+
−
|align="center"|0.075
+
−
|align="center"|0.235
+
 
|-
 
|-
 
|HCC157
 
|HCC157
 
|style="background-color: #FFCCCC" |Pressure Ulcer of Skin with Necrosis Through to Muscle, Tendon, or Bone
 
|style="background-color: #FFCCCC" |Pressure Ulcer of Skin with Necrosis Through to Muscle, Tendon, or Bone
−
|align="center"|1.071
+
|align="center"|2.488
−
|align="center"|0.284
+
|align="center"|1.050
 
|-
 
|-
 
|HCC158
 
|HCC158
 
|style="background-color: #FFCCCC" |Pressure Ulcer of Skin with Full Thickness Skin Loss
 
|style="background-color: #FFCCCC" |Pressure Ulcer of Skin with Full Thickness Skin Loss
−
|align="center"|1.071
+
|align="center"|1.338
−
|align="center"|0.284
+
|align="center"|0.435
−
|-
+
−
|HCC159
+
−
|style="background-color: #FFCCCC" |Pressure Ulcer of Skin with Partial Thickness Skin Loss
+
−
|align="center"|1.071
+
−
|align="center"|0.284
+
−
|-
+
−
|HCC160
+
−
|style="background-color: #FFCCCC" |Pressure Pre-Ulcer Skin Changes or Unspecified Stage
+
−
|align="center"|1.071`
+
−
|align="center"|0.610
+
 
|-
 
|-
 
|HCC161
 
|HCC161
 
|style="background-color: #FFCCCC" |Chronic Ulcer of Skin, Except Pressure
 
|style="background-color: #FFCCCC" |Chronic Ulcer of Skin, Except Pressure
−
|align="center"|0.473
+
|align="center"|0.536
−
|align="center"|0.226
+
|align="center"|0.311
 
|-
 
|-
 
|HCC162
 
|HCC162
 
|style="background-color: #FFCCCC" |Severe Skin Burn or Condition
 
|style="background-color: #FFCCCC" |Severe Skin Burn or Condition
−
|align="center"|0.458
+
|align="center"|0.411
−
|align="center"|-
+
|align="center"|0.327
 
|-
 
|-
 
|HCC166
 
|HCC166
 
|style="background-color: #FFCCCC" |Severe Head Injury
 
|style="background-color: #FFCCCC" |Severe Head Injury
−
|align="center"|0.533
+
|align="center"|0.570
−
|align="center"|0.103
+
|align="center"|0.104
 
|-
 
|-
 
|HCC167
 
|HCC167
 
|style="background-color: #FFCCCC" |Major Head Injury
 
|style="background-color: #FFCCCC" |Major Head Injury
−
|align="center"|0.141
+
|align="center"|0.163
 
|align="center"|-
 
|align="center"|-
 
|-
 
|-
 
|HCC169
 
|HCC169
 
|style="background-color: #FFCCCC" |Vertebral Fractures without Spinal Cord Injury
 
|style="background-color: #FFCCCC" |Vertebral Fractures without Spinal Cord Injury
−
|align="center"|0.441
+
|align="center"|0.497
−
|align="center"|0.179
+
|align="center"|0.228
 
|-
 
|-
 
|HCC170
 
|HCC170
 
|style="background-color: #FFCCCC" |Hip Fracture/Dislocation
 
|style="background-color: #FFCCCC" |Hip Fracture/Dislocation
−
|align="center"|0.363
+
|align="center"|0.446
 
|align="center"|-
 
|align="center"|-
 
|-
 
|-
 
|HCC173
 
|HCC173
 
|style="background-color: #FFCCCC" |Traumatic Amputation and Complications
 
|style="background-color: #FFCCCC" |Traumatic Amputation and Complications
−
|align="center"|0.379
+
|align="center"|0.265
−
|align="center"|0.067
+
|align="center"|0.122
 
|-
 
|-
 
|HCC176
 
|HCC176
 
|style="background-color: #FFCCCC" |Complications of Specified Implanted Device or Graft
 
|style="background-color: #FFCCCC" |Complications of Specified Implanted Device or Graft
−
|align="center"|0.555
+
|align="center"|0.556
−
|align="center"|0.369
+
|align="center"|0.522
 
|-
 
|-
 
|HCC186
 
|HCC186
 
|style="background-color: #FFCCCC" |Major Organ Transplant or Replacement Status
 
|style="background-color: #FFCCCC" |Major Organ Transplant or Replacement Status
−
|align="center"|1.032
+
|align="center"|0.891
−
|align="center"|1.120
+
|align="center"|0.515
 
|-
 
|-
 
|HCC188
 
|HCC188
 
|style="background-color: #FFCCCC" |Artificial Openings for Feeding or Elimination
 
|style="background-color: #FFCCCC" |Artificial Openings for Feeding or Elimination
−
|align="center"|0.609
+
|align="center"|0.651
−
|align="center"|0.658
+
|align="center"|0.594
 
|-
 
|-
 
|HCC189
 
|HCC189
 
|style="background-color: #FFCCCC" |Amputation Status, Lower Limb / Amputation Complications
 
|style="background-color: #FFCCCC" |Amputation Status, Lower Limb / Amputation Complications
−
|align="center"|0.804
+
|align="center"|0.779
−
|align="center"|0.384
+
|align="center"|0.468
 
|-
 
|-
 
|}
 
|}

Latest revision as of 14:15, 23 April 2014

These are the disease coefficients component of the CMS-HCC Risk Adjustments

The relative risk scores in this table were calculated by dividing the parameter estimates by the Part C national average predicted expenditures of $9,276.26.

Disease Coefficients Description Label Community Factor Institutional Factor
HCC1 HIV/AIDS 0.470 1.904
HCC2 Septicemia, Sepsis, Systemic Inflammatory Response Syndrome/Shock 0.535 0.575
HCC6 Opportunistic Infections 0.440 0.344
HCC8 Metastatic Cancer and Acute Leukemia 2.484 1.203
HCC9 Lung and Other Severe Cancers 0.973 0.674
HCC10 Lymphoma and Other Cancers 0.672 0.412
HCC11 Colorectal, Bladder, and Other Cancers 0.317 0.296
HCC12 Breast, Prostate, and Other Cancers and Tumors 0.154 0.198
HCC17 Diabetes with Acute Complications 0.368 0.474
HCC18 Diabetes with Chronic Complications 0.368 0.474
HCC19 Diabetes without Complications 0.118 0.182
HCC21 Protein-Calorie Malnutrition 0.713 0.399
HCC22 Morbid Obesity 0.365 0.579
HCC23 Other Significant Endocrine and Metabolic Disorders 0.245 0.282
HCC27 End-Stage Liver Disease 0.923 1.083
HCC28 Cirrhosis of Liver 0.399 0.351
HCC29 Chronic Hepatitis 0.251 0.351
HCC33 Intestinal Obstruction/Perforation 0.310 0.384
HCC34 Chronic Pancreatitis 0.286 0.095
HCC35 Inflammatory Bowel Disease 0.302 0.318
HCC39 Bone/Joint/Muscle Infections/Necrosis 0.498 0.340
HCC40 Rheumatoid Arthritis and Inflammatory Connective Tissue Disease 0.374 0.351
HCC46 Severe Hematological Disorders 1.136 0.794
HCC47 Disorders of Immunity 0.521 0.519
HCC48 Coagulation Defects and Other Specific Hematological Disorders 0.252 0.164
HCC54 Drug/Alcohol Psychosis 0.420 0.053
HCC55 Drug/Alcohol Dependence 0.420 0.053
HCC57 Schizophrenia 0.490 0.311
HCC58 Major Depressive, Bipolar, and Paranoid Disorders 0.330 0.311
HCC70 Quadriplegia 1.234 0.650
HCC71 Paraplegia 1.052 0.539
HCC72 Spinal Cord Disorders/Injuries 0.509 0.280
HCC73 Amyotrophic Lateral Sclerosis and Other Motor Neuron Disease 0.958 0.367
HCC74 Cerebral Palsy 0.045 -
HCC75 Polyneuropathy 0.408 0.300
HCC76 Muscular Dystrophy 0.565 0.215
HCC77 Multiple Sclerosis 0.556 -
HCC78 Parkinson's and Huntington's Diseases 0.691 0.173
HCC79 Seizure Disorders and Convulsions 0.284 0.144
HCC80 Coma, Brain Compression/Anoxic Damage 0.570 0.104
HCC82 Respirator Dependence/Tracheostomy Status 1.520 1.769
HCC83 Respiratory Arrest 0.802 1.169
HCC84 Cardio-Respiratory Failure and Shock 0.329 0.442
HCC85 Congestive Heart Failure 0.368 0.229
HCC86 Acute Myocardial Infarction 0.275 0.515
HCC87 Unstable Angina and Other Acute Ischemic Heart Disease 0.258 0.515
HCC88 Angina Pectoris 0.141 0.474
HCC96 Specified Heart Arrhythmias 0.295 0.262
HCC99 Cerebral Hemorrhage 0.339 0.216
HCC100 Ischemic or Unspecified Stroke 0.317 0.216
HCC103 Hemiplegia/Hemiparesis 0.581 0.061
HCC104 Monoplegia, Other Paralytic Syndromes 0.396 0.061
HCC106 Atherosclerosis of the Extremities with Ulceration or Gangrene 1.413 0.886
HCC107 Vascular Disease with Complications 0.410 0.301
HCC108 Vascular Disease 0.299 0.107
HCC110 Cystic Fibrosis 0.417 0.364
HCC111 Chronic Obstructive Pulmonary Disease 0.346 0.364
HCC112 Fibrosis of Lung and Other Chronic Lung Disorders 0.274 0.260
HCC114 Aspiration and Specified Bacterial Pneumonias 0.672 0.285
HCC115 Pneumococcal Pneumonia, Emphysema, Lung Abscess 0.200 0.285
HCC122 Proliferative Diabetic Retinopathy and Vitreous Hemorrhage 0.203 0.433
HCC124 Exudative Macular Degeneration 0.335 0.166
HCC134 Dialysis Status 0.476 0.509
HCC135 Acute Renal Failure 0.476 0.509
HCC136 Chronic Kidney Disease, Stage 5 0.224 0.509
HCC137 Chronic Kidney Disease, Severe (Stage 4) 0.224 0.294
HCC157 Pressure Ulcer of Skin with Necrosis Through to Muscle, Tendon, or Bone 2.488 1.050
HCC158 Pressure Ulcer of Skin with Full Thickness Skin Loss 1.338 0.435
HCC161 Chronic Ulcer of Skin, Except Pressure 0.536 0.311
HCC162 Severe Skin Burn or Condition 0.411 0.327
HCC166 Severe Head Injury 0.570 0.104
HCC167 Major Head Injury 0.163 -
HCC169 Vertebral Fractures without Spinal Cord Injury 0.497 0.228
HCC170 Hip Fracture/Dislocation 0.446 -
HCC173 Traumatic Amputation and Complications 0.265 0.122
HCC176 Complications of Specified Implanted Device or Graft 0.556 0.522
HCC186 Major Organ Transplant or Replacement Status 0.891 0.515
HCC188 Artificial Openings for Feeding or Elimination 0.651 0.594
HCC189 Amputation Status, Lower Limb / Amputation Complications 0.779 0.468
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