Acute Comorbidity Categories
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1 ESRD PPS Comorbidity Categories and Diagnosis Codes Crosswalk Gastrointestinal Bleeding Ulcer of esophagus with bleeding Acute gastric ulcer with, without mention of Acute Comorbidity Categories K22.11 Ulcer of esophagus with bleeding K25.0 Acute gastric ulcer with Acute gastric ulcer with, with K25.0 Acute gastric ulcer with Acute gastric ulcer with, without mention of K25.2 Acute gastric ulcer with both and Acute gastric ulcer with, with Chronic or unspecified gastric ulcer with, without mention of Chronic or unspecified gastric ulcer with, with Chronic or unspecified gastric ulcer with and, without mention of Chronic or unspecified gastric ulcer with and, with K25.2 Acute gastric ulcer with both and K25.4 Chronic or unspecified gastric ulcer with K25.4 Chronic or unspecified gastric ulcer with K25.6 Chronic or unspecified gastric ulcer with both K25.6 Chronic or unspecified gastric ulcer with both Acute duodenal ulcer with, without mention of K26.0 Acute duodenal ulcer with Acute duodenal ulcer with, with K26.0 Acute duodenal ulcer with Acute duodenal ulcer with, without mention of Acute duodenal ulcer with, with Chronic or unspecified duodenal ulcer with, without mention of K26.2 Acute duodenal ulcer with both and K26.2 Acute duodenal ulcer with both and K26.4 Chronic or unspecified duodenal ulcer with Page 1 of 7
2 Chronic or unspecified duodenal ulcer with, with Chronic or unspecified duodenal ulcer with and, without mention of K26.4 Chronic or unspecified duodenal ulcer with K26.6 Chronic or unspecified duodenal ulcer with both Chronic or unspecified duodenal ulcer with and, with Acute peptic ulcer of unspecified site with, without mention of Acute peptic ulcer of unspecified site with, with Acute peptic ulcer of unspecified site with and, without mention of K26.6 Chronic or unspecified duodenal ulcer with both K27.0 Acute peptic ulcer, site unspecified, with K27.0 Acute peptic ulcer, site unspecified, with K27.2 Acute peptic ulcer, site unspecified, with both Acute peptic ulcer of unspecified site with and, with Chronic or unspecified peptic ulcer of unspecified site with, without mention of Chronic or unspecified peptic ulcer of unspecified site with, with Chronic or unspecified peptic ulcer of unspecified site with, without mention of K27.2 Acute peptic ulcer, site unspecified, with both K27.4 Chronic or unspecified peptic ulcer, site unspecified, with K27.4 Chronic or unspecified peptic ulcer, site unspecified, with K27.6 Chronic or unspecified peptic ulcer, site unspecified, with both Chronic or unspecified peptic ulcer of unspecified site with, with K27.6 Chronic or unspecified peptic ulcer, site unspecified, with both Acute gastrojejunal ulcer with, without mention of K28.0 Acute gastrojejunal ulcer with Acute gastrojejunal ulcer, with, with K28.0 Acute gastrojejunal ulcer with Acute gastrojejunal ulcer with, without mention of K28.2 Acute gastrojejunal ulcer with both and Page 2 of 7
3 Acute gastrojejunal ulcer with, with Chronic or unspecified gastrojejunal ulcer with, without mention of Chronic or unspecified gastrojejunal ulcer, with, with Chronic or unspecified gastrojejunal ulcer with and, without mention of Chronic or unspecified gastrojejunal ulcer with and, with K28.2 Acute gastrojejunal ulcer with both and K28.4 Chronic or unspecified gastrojejunal ulcer with K28.4 Chronic or unspecified gastrojejunal ulcer with K28.6 Chronic or unspecified gastrojejunal ulcer with both K28.6 Chronic or unspecified gastrojejunal ulcer with both Eosinophilic gastritis, with K Eosinophilic gastritis or gastroenteritis Angiodysplasia of stomach and duodenum with K Angiodysplasia of stomach and duodenum with bleeding Diverticulosis of small intestine with K57.11 Diverticulosis of small intestine without Diverticulosis of small intestine with K57.51 Diverticulosis of both small and large intestine without Diverticulitis of small intestine with K57.01 Diverticulitis of small intestine with and abscess with bleeding Diverticulitis of small intestine with K57.13 Diverticulitis of small intestine without Diverticulitis of small intestine with K57.41 Diverticulitis of both small and large intestine with and abscess with bleeding Diverticulitis of small intestine with K57.53 Diverticulitis of both small and large intestine without Diverticulosis of colon with K57.31 Diverticulosis of large intestine without Diverticulosis of colon with K57.51 Diverticulosis of both small and large intestine without Page 3 of 7
4 Diverticulosis of colon with K57.91 Diverticulosis of intestine, part unspecified, without Diverticulitis of colon with K57.21 Diverticulitis of large intestine with and abscess with bleeding Diverticulitis of colon with K57.33 Diverticulitis of large intestine without Diverticulitis of colon with K57.41 Diverticulitis of both small and large intestine with and abscess with bleeding Diverticulitis of colon with K57.53 Diverticulitis of both small and large intestine without Diverticulitis of colon with K57.81 Diverticulitis of intestine, part unspecified, with and abscess with bleeding Diverticulitis of colon with K57.93 Diverticulitis of intestine, part unspecified, without Angiodysplasia of intestine with K55.21 Angiodysplasia of colon with Bacterial Pneumonia Salmonella pneumonia A02.22 Salmonella pneumonia Pneumonia due to Klebsiella pneumoniae J15.0 Pneumonia due to Klebsiella pneumoniae Pneumonia due to Pseudomonas J15.1 Pneumonia due to Pseudomonas Pneumonia due to Hemophilus influenzae [H. influenzae] J14 Pneumonia due to Hemophilus influenzae Pneumonia due to Streptococcus, unspecified J15.4 Pneumonia due to other streptococci Pneumonia due to Streptococcus, group A J15.4 Pneumonia due to other streptococci Pneumonia due to Streptococcus, group B J15.3 Pneumonia due to streptococcus, group B Pneumonia due to other Streptococcus J15.4 Pneumonia due to other streptococci Pneumonia due to Staphylococcus, unspecified J15.20 Pneumonia due to staphylococcus, unspecified Methicillin susceptible pneumonia due to Staphylococcus aureus J Pneumonia due to Methicillin susceptible Staphylococcus aureus Methicillin resistant pneumonia due to Staphylococcus aureus J Pneumonia due to Methicillin resistant Staphylococcus aureus Page 4 of 7
5 Other Staphylococcus pneumonia J15.29 Pneumonia due to other staphylococcus Pneumonia due to anaerobes J15.8 Pneumonia due to other specified bacteria Pneumonia due to escherichia coli [E. coli] J15.5 Pneumonia due to Escherichia coli Pneumonia due to other gram-negative bacteria J15.6 Pneumonia due to other aerobic Gram-negative bacteria Pneumonia due to Legionnaires' disease A48.1 Legionnaires' disease Pneumonia due to other specified bacteria J15.8 Pneumonia due to other specified bacteria Pneumonitis due to inhalation of food or vomitus J69.0 Pneumonitis due to inhalation of food and vomit Pneumonitis due to other solids and liquids J69.8 Pneumonitis due to inhalation of other solids and liquids Empyema with fistula J86.0 Pyothorax with fistula Empyema without mention of fistula J86.9 Pyothorax without fistula Abscess of lung J85.0 Gangrene and necrosis of lung Abscess of lung J85.1 Abscess of lung with pneumonia Abscess of lung J85.2 Abscess of lung without pneumonia Pericarditis Acute pericarditis in diseases classified elsewhere A18.84 Tuberculosis of heart Acute pericarditis in diseases classified elsewhere I32 Pericarditis in diseases classified elsewhere Acute pericarditis in diseases classified elsewhere M32.12 Pericarditis in systemic lupus erythematosus Acute pericarditis, unspecified I30.1 Infective pericarditis Acute pericarditis, unspecified I30.9 Acute pericarditis, unspecified Acute idiopathic pericarditis I30.0 Acute nonspecific idiopathic pericarditis Other acute pericarditis I30.8 Other forms of acute pericarditis Other acute pericarditis I30.9 Acute pericarditis, unspecified Page 5 of 7
6 Hereditary Hemolytic and Sickle Cell Anemia Hereditary spherocytosis Chronic Comorbidity Categories D58.0 Hereditary spherocytosis Hereditary elliptocytosis D58.1 Hereditary elliptocytosis Anemias due to disorders of glutathione metabolism D55.0 Anemia due to glucose-6-phosphate dehydrogenase [G6PD] deficiency Anemias due to disorders of glutathione metabolism D55.1 Anemia due to other disorders of glutathione metabolism Other hemolytic anemias due to enzyme deficiency D55.2 Anemia due to disorders of glycolytic enzymes Other hemolytic anemias due to enzyme deficiency D55.3 Anemia due to disorders of nucleotide metabolism Other hemolytic anemias due to enzyme deficiency D55.8 Other anemias due to enzyme disorders Other hemolytic anemias due to enzyme deficiency D55.9 Anemia due to enzyme disorder, unspecified Sickle-cell thalassemia without crisis D57.40 Sickle-cell thalassemia without crisis Sickle-cell thalassemia with crisis D Sickle-cell thalassemia with acute chest syndrome Sickle-cell thalassemia with crisis D Sickle-cell thalassemia with splenic sequestration Sickle-cell thalassemia with crisis D Sickle-cell thalassemia with crisis, unspecified Alpha thalassemia D56.0 Alpha thalassemia Beta thalassemia D56.1 Beta thalassemia Delta-beta thalassemia D56.2 Delta-beta thalassemia Thalassemia minor D56.3 Thalassemia minor Hemoglobin E-beta thalassemia D56.5 Hemoglobin E-beta thalassemia Other thalassemia D56.8 Other thalassemias Hb-SS disease without crisis D57.1 Sickle-cell disease without crisis Hb-SS disease with crisis D57.00 Hb-SS disease with crisis, unspecified Hb-SS disease with crisis D57.01 Hb-SS disease with acute chest syndrome Hb-SS disease with crisis D57.02 Hb-SS disease with splenic sequestration Sickle-cell/Hb-C disease without crisis D57.20 Sickle-cell/Hb-C disease without crisis Sickle-cell/Hb-C disease with crisis D Sickle-cell/Hb-C disease with acute chest syndrome Sickle-cell/Hb-C disease with crisis D Sickle-cell/Hb-C disease with splenic sequestration Page 6 of 7
7 Sickle-cell/Hb-C disease with crisis D Sickle-cell/Hb-C disease with crisis, unspecified Other sickle-cell disease without crisis D57.80 Other sickle-cell disorders without crisis Other sickle-cell disease with crisis D Other sickle-cell disorders with acute chest syndrome Other sickle-cell disease with crisis D Other sickle-cell disorders with splenic sequestration Other sickle-cell disease with crisis D Other sickle-cell disorders with crisis, unspecified Monoclonal Gammopathy Monoclonal paraproteinemia D47.2 Monoclonal gammopathy Monoclonal paraproteinemia D Hypergammaglobulinemia, unspecified Myelodysplastic Syndrome Essential thrombocythemia D47.3 Essential (hemorrhagic) thrombocythemia Low grade myelodysplastic syndrome lesions D46.0 Refractory anemia without ring sideroblasts, so stated Low grade myelodysplastic syndrome lesions D46.1 Refractory anemia with ring sideroblasts Low grade myelodysplastic syndrome lesions D46.20 Refractory anemia with excess of blasts, unspecified Low grade myelodysplastic syndrome lesions D46.21 Refractory anemia with excess of blasts Low grade myelodysplastic syndrome lesions D46.4 Refractory anemia, unspecified Low grade myelodysplastic syndrome lesions D46.A Refractory cytopenia with multilineage dysplasia Low grade myelodysplastic syndrome lesions D46.B Refractory cytopenia with multilineage dysplasia and ring sideroblasts High grade myelodysplastic syndrome lesions D46.22 Refractory anemia with excess of blasts Myelodysplastic syndrome with 5q deletion D46.C Myelodysplastic syndrome with isolated del(5q) chromosomal abnormality Myelodysplastic syndrome, unspecified D46.9 Myelodysplastic syndrome, unspecified Myelodysplastic syndrome, unspecified D46.Z Other myelodysplastic syndromes Myelofibrosis with myeloid metaplasia D47.1 Chronic myeloproliferative disease 1 Effective October 1, 2015, the code does not qualify as a comorbidity eligible for the comorbidity payment adjustment under the ESRD PPS (78 FR 72179, December 2, Source: Page 7 of 7
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