Table IV-5.  List Of Disease Groups (HCCs) in Hierarchies,,
If the Disease Group is Listed in This Column...,,...Then Drop the Associated Disease Group(s) Listed in This Column
Disease Group (HCC),Disease Group Label,Disease Group (HCC)
5,Opportunistic Infections,112
7,Metastatic Cancer and Acute Leukemia,"8,9,10"
8,"Lung, Upper Digestive Tract, and Other Severe Cancers","9,10"
9,"Lymphatic, Head and Neck, Brain and Other Major Cancers",10
15,Diabetes with Renal Manifestations,"16,17,18,19"
16,Diabetes with Neurologic or Other Specified Manifestation,"17,18,19"
17,Diabetes with Acute Complications,"18,19"
18,Diabetes with Ophthalmologic Manifestations,19
25,End-Stage Liver Disease,"26,27"
26,Cirrhosis of Liver,27
51,Drug/Alcohol Psychosis,52
54,Schizophrenia,55
67,"Quadriplegia, Other Extensive Paralysis","68,69,100,101,157"
68,Paraplegia,"69, 100, 101, 157"
69,Spinal Cord Disorders/Injuries,157
77,Respirator Dependence/ Tracheostomy Status,"78,79"
78,Respiratory Arrest,79
81,Acute Myocardial Infarction,"82,83"
82,Unstable Angina and Other Acute Ischemic Heart Disease,83
95,Cerebral Hemorrhage,96
100,Hemiplegia/Hemiparesis,101
104,Vascular Disease with Complications,"105, 149"
111,Aspiration and Specified Bacterial Pneumonias,112
130,Dialysis Status,"131, 132"
131,Renal Failure,132
148,Decubitus Ulcer of the Skin,149
154,"Severe Head Injury, Coma, Brain Compression/Anoxic Damage","75, 155"
161,Traumatic Amputation,177
How Payments are Made with a Disease Hierarchy.  ,,
"EXAMPLE:      If a beneficiary triggers Disease Groups 148 (Decubitus Ulcer of the Skin) and 149 (Chronic Ulcer of Skin, Except Decubitus), then DG 149 will be dropped.  In other words, payment will always be associated with the DG in column 1, if a DG in column 3 also occurs during the same collection period.  Therefore, the M+C organization’s payment will be based on DG 148 rather than DG 149."