Two ICD-10 codes change HCC on the patient's sex, and the swing is 10×

Reproduce this

Every figure above comes from two public CMS files. Put them in an empty directory and run these — each command prints exactly the numbers published here. Outputs below are pasted verbatim from a real run.

1. 0Confirm which ICD-10-CM edition you have. Run this first.

   python3 -c "
   import xml.etree.ElementTree as ET
   r = ET.parse('icd10cm_index_2026.xml').getroot()
   for mt in r.iter('mainTerm'):
       if (mt.findtext('title','') or '').strip().lower() == 'tumor':
           for t in mt.iter('term'):
               if (t.findtext('title','') or '').strip().lower() == 'neuroendocrine':
                   code = t.findtext('code')
                   print('Tumor > neuroendocrine =', code)
                   print('edition =', 'April 1 2026' if code.startswith('C7A')
                                      else 'October 1 2025' if code.startswith('D3A')
                                      else 'unrecognised')
   "

   Output

   Tumor > neuroendocrine = C7A.-
   edition = April 1 2026

2. 1The two sex-conditional codes

   python3 -c "
   import csv
   for row in csv.DictReader(open('ICD10_CC_mappings_CMS_HCC_2027_v28_initial.csv')):
       if row['ICD10'] in ('D66','D67'):
           print(row['ICD10'], '-> HCC', row['CC'],
                 '| age:', row['AGE_EDIT_CONDITION'] or '-',
                 '| sex:', row['SEX_EDIT_CONDITION'] or '-')
   "

   Output

   D66 -> HCC 111.0 | age: age < 65 | sex: 1.0
   D66 -> HCC 111.0 | age: age >= 65 | sex: 1.0
   D66 -> HCC 112.0 | age: - | sex: 2.0
   D67 -> HCC 111.0 | age: age < 65 | sex: 1.0
   D67 -> HCC 111.0 | age: age >= 65 | sex: 1.0
   D67 -> HCC 112.0 | age: - | sex: 2.0

3. 2The coefficients

   python3 -c "
   import csv
   for row in csv.reader(open('V28_CE_Relative_Factors.csv', encoding='utf-8-sig')):
       if row and row[0].strip() in ('HCC111','HCC112','HCC22','HCC23'):
           print(f'{row[0].strip():8s} community_NA={row[2]:6s} {row[1].strip()[:52]}')
   "

   Output

   HCC22    community_NA=0.363  Bladder, Colorectal, and Other Cancers
   HCC23    community_NA=0.186  Prostate, Breast, and Other Cancers and Tumors
   HCC111   community_NA=4.639  Hemophilia, Male
   HCC112   community_NA=0.45   Immune Thrombocytopenia and Specified Coagulation De

4. 3The 339, split into conditional and simultaneous

   python3 -c "
   import csv, collections
   rows = list(csv.DictReader(open('ICD10_CC_mappings_CMS_HCC_2027_v28_initial.csv')))
   by = collections.defaultdict(list)
   for r in rows: by[r['ICD10']].append(r)
   multi = {k: v for k, v in by.items() if len({r['CC'] for r in v}) > 1}
   sex  = [k for k, v in multi.items() if any(r['SEX_EDIT_CONDITION'] for r in v)]
   cond = [k for k, v in multi.items() if any(r['SEX_EDIT_CONDITION'] or r['AGE_EDIT_CONDITION'] or r['MCE_AGE_CONDITION'] for r in v)]
   print('codes mapping to more than one HCC:', len(multi))
   print('  ...conditional on age or sex:', len(cond))
   print('  ...conditional on SEX:', len(sex), sorted(sex))
   print('  ...unconditional (both HCCs apply at once):', len(multi) - len(cond))
   "

   Output

   codes mapping to more than one HCC: 339
     ...conditional on age or sex: 189
     ...conditional on SEX: 2 ['D66', 'D67']
     ...unconditional (both HCCs apply at once): 150

If you write your own parser, traverse the whole tree. root.iter('term') misses the cells under <mainTerm>— the table's head row — and comes up exactly one cell short in every column. And normalise cells with .replace(".","").rstrip("-"): a lone -means “no code”, while a trailing hyphen on a real stem means “more characters required”. Those are different things.

Sources and method

ICD-10-CM

ICD-10-CM FY2026, April 1 2026 release. The Neoplasm Table is unchanged from the October 1 2025 release — both statements are true, and either download reproduces every figure. april-1-2026-code-tables-tabular-index.zip

CMS-HCC model

CMS-HCC V28, Payment Year 2027 initial model software (Python package). 2027-initial-model-software-python.zip

Segment

All coefficients are COMMUNITY_NA — community, non-dual, aged. Other segments carry different values and some invert; a coefficient without its segment is meaningless.

Published by Eviora Health Tech LLC on 17 August 2026. These pages describe how the CMS-HCC payment model behaves. They are not coding advice — code selection follows the ICD-10-CM Official Guidelines and the provider's documentation.