As we transition from CMS-HCC V24 to V28, many coding professionals and health plans are closely monitoring what’s in, what’s out, and what still carries weight in risk adjustment. One key takeaway? Infectious diseases like Tuberculosis (TB) and Hepatitis C (Hep C) still count—but the documentation has to be done right.
Yes, TB and Hep C Still Map to HCCs in V28
Even with the introduction of new categories and realigned hierarchies in V28, both Tuberculosis and Hepatitis C remain valid HCC-driving conditions—as long as they are clinically supported and actively managed.
Examples from the V28 model:
Pulmonary mycobacterial infection (A310) → Maps to HCC 6: Opportunistic Infections
Hepatitis C carrier state (Z22.51) → Still counts if there's PCR confirmation and a treatment or monitoring plan
Clinical Coding Tip:
Don’t code these infectious diseases as “history of” unless a current care plan is documented.
A history code without evidence of ongoing treatment, evaluation, or monitoring is insufficient for risk adjustment purposes.
What You Should Do:
Review infectious disease diagnoses carefully before dropping them from claims or EHR exports.
Ensure Z22.51 (Hep C carrier) is accompanied by:
A PCR lab result
A documented treatment plan (e.g., antivirals, specialist referral)
For TB, make sure active or latent infections are supported by:
Chest X-ray or sputum results
Ongoing treatment or surveillance documentation
Why This Matters:
In V28, CMS is more selective—but not dismissive—of conditions that signal chronic infection risk or impact on care complexity. Coding these correctly supports accurate risk scores, care coordination, and compliance.
Final Thought:
Just because a diagnosis is long-standing doesn’t mean it’s inactive. If your providers are still monitoring, treating, or counselling, then you can still code it. But remember: no care plan, no HCC.
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