Medical Coding

Overview

Medical code mapping and classification: ICD-10-CM/PCS, CPT, SNOMED CT, HCPCS, LOINC, RxNorm. Covers code validation, cross-terminology mapping, HCC risk adjustment, and reimbursement modeling used in healthcare billing and clinical research.

ICD-10 to HCC Mapping

hcc_map = {
    "E11.9": "HCC 19",   # Diabetes without complications
    "I10": "HCC 134",    # Essential hypertension
    "N18.3": "HCC 138",  # CKD stage 3
}

def calc_hcc(codes):
    hccs = set()
    for c in codes:
        if c in hcc_map:
            hccs.add(hcc_map[c])
    return list(hccs)

print(calc_hcc(["E11.9", "I10"]))

Code Validation

valid_icd10 = set()  # from official CMS file or lookup

def validate_code(code):
    if code in valid_icd10:
        return True, "Valid"
    if code[:3] in valid_icd10:
        return True, "Valid (category)"
    return False, "Unknown code"

References

• CMS ICD-10
• SNOMED CT
• HCC coding