Wiki DM complication HCC 18 and PVD HCC 108

[HCC12345]

I need clarification please! When I was trained I was told PVD as a DM complication RAF score is reduced compared to if PVD wasn't a DM complication. Is this true? If patient only has one diabetic complication, E11.51, do we only receive .288 or do we get HCC 18 (.302) and HCC 108 (.288) RAF value?

 

[terribrown]

You will notice two entries (rows) on the CMS HCC crosswalk for E11.51: one for HCC 18 and one for HCC 108. Yes, the combined RAF is .590.
If the provider states these two conditions are not related, and therefore requiring you to report separately, the combined RAF is .393 for FY2020.

 

[andie.zurbrick]

You would get credit for HCC 18 and HCC 108. If you look at the CMS mapping tool, you will also see that you get credit for both.