What is the difference between ICD-10 and HCC codes?
What is the difference between ICD-10 and HCC codes?
ICD-10 and HCC codes serve different purposes in clinical documentation:ICD-10 (International Classification of Diseases, 10th Revision)
See Ambient Session Structured Data and Supported Diagnosis Codes for endpoint details.
- A standardized system of codes used to classify and record diagnoses, symptoms, and procedures.
- Used for billing, clinical documentation, and interoperability across healthcare systems.
- Example:
I10= Essential hypertension. - ICD-10 is the primary identifier Suki uses internally to match, deduplicate, and process diagnoses.
- A risk-adjustment coding model used primarily in value-based care and Medicare Advantage programs.
- HCC codes are derived from ICD-10 codes: CMS groups related ICD-10 codes into HCC categories to estimate a patient’s expected healthcare costs.
- Not every ICD-10 code maps to an HCC category: only those that significantly affect patient risk scores do.
- Example: ICD-10
I10(Essential hypertension) maps to HCC 136.
- Suki processes and stores diagnoses using ICD-10 as the source of truth.
- In API structured data, HCC categories appear in the diagnosis
codesarray withtype: "HCC". - In the Web SDK, the
hccCodefield in the Diagnosis type surfaces the HCC category that corresponds to the ICD-10 code, when one exists. - You can use HCC output to support risk-adjustment workflows or value-based care reporting in your integration.
| ICD-10 | HCC | |
|---|---|---|
| Purpose | Clinical diagnosis coding | Risk adjustment and cost prediction |
| Scope | All diagnoses | Subset of high-impact diagnoses |
| Used by | All payers, EHRs | Medicare Advantage, value-based care |
| In Suki | Primary identifier | Supplemental output field |
Can I send HCC codes in session context?
Can I send HCC codes in session context?
No. HCC codes are returned in structured data output only. Send ICD10 or IMO codes in session context. Suki derives HCC categories from the ICD-10-CM code when you retrieve structured data.See Ambient Session Structured Data.