13
V. Algorithm to produce output
This section describes the process by which the outputs identified in Section IV are created. The
algorithm to produce risk scores can be segmented into five parts—HHS-CC and HHS-HCC
creation, model variable creation, access factors table, unadjusted score calculation, and CSR-
adjusted score calculation.
Step 1: HHS-CC and HHS-HCC creation. This first step should use Table 3 for HHS-CC
creation and Table 4 for HHS-HCC creation.
Table 3 crosswalks ICD-10 codes to the HHS-Condition Categories (CCs) in the risk
adjustment models. This table incorporates the ICD-10 Medicare Code Edits (MCEs) for age
and sex, the further specified CC age and sex splits, and the creation of CCs and additional
CCs.
7
Explanations of the fields in Table 3 are provided below:
• OBS (column A): Observations, numeric count from 1 to 8,283 of the code list.
• ICD10 (column B): Only ICD-10 codes assigned to HCCs in the risk adjustment
models are included in this crosswalk. All other ICD-10 codes correspond to HCCs
not included in the risk adjustment models and are not used to calculate risk scores.
• ICD10 Label (column C): Full ICD-10 code labels.
• Code Valid columns (columns D and E): Identifies the fiscal year(s) (column D
FY2017; column E FY2018) in which the ICD-10 codes are valid. There are two
possible values in columns D and E:
o Y = Yes, code is valid ICD-10 code in that fiscal year
o N = No, code is not valid ICD-10 code in that fiscal year; code may not yet be
in existence or code was deleted in that fiscal year
• FY2017 MCE Age Condition [use AGE_AT_DIAGNOSIS] (column F), FY2018
MCE Age Condition [use AGE_AT_DIAGNOSIS] (column H), and CY2017
(FY17/FY18) MCE Age Condition [use AGE_AT_DIAGNOSIS] (column J): Checks
that a person with a diagnosis code has the appropriate age for the diagnosis. The
specific fiscal year versions are presented for informational purposes. The user
should use the CY2017 version which covers both fiscal years (column J) to match
the MCE Age Condition version being used in Operations. Conditions listed in this
column are required for the CC to be assigned.
o Newborn diagnosis: Age of 0 years
o Pediatric diagnosis: Age range is 0-17 years inclusive
o Maternity diagnosis: Age range is 12-55 years inclusive
o Adult diagnosis: Age range is 15 years or older
• FY2017 MCE Sex Condition (column G), FY2018 MCE Sex Condition (column I),
and CY2017 (FY17/FY18) MCE Sex Condition (column K): Checks that a person
with a diagnosis code has the appropriate sex for the diagnosis. The specific fiscal
year versions are presented for informational purposes. The user should use the
CY2017 version which covers both fiscal years (column K) to match the MCE Sex
Condition version being used in Operations. Conditions listed in this column are
required for the CC to be assigned.
7
The CC age and sex splits relate to how specific conditions are reclassified by age or sex within the full HHS-HCC
classification. These reassignments are not related to age or sex coding guidelines.