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Major Complications and Comorbid Conditions (MCC) & Complications and Comorbid Conditions (CC)

Abbreviated CMS List of MCCs and CCs

Major Complications/Comorbid Conditions Complications/Comorbid Conditions Complications/Comorbid Conditions

Cardiovascular/Cerebrovascular Cardiovascular & Vascular Gastrointestinal

❑Congestive Heart Failure, Acute ❑Myocardial Ischemia, Acute, Without MI ❑Ascites
Acute on Chronic ❑Angina, Unstable ❑Attention to Gastrostomy
Systolic or Diastolic ❑Complete Block ❑C. Difficile Enteritis
❑Cor Pulmonale, Acute AV or Mobitz Type II ❑Cholelithiasis with Cholecystitis
❑CVA, Stroke, Cerebral Infarct or Hemorrhage Trifascicular or BBB ❑Colitis, Enteritis or Gastroenteritis
❑Cerebral Edema ❑Atrial Flutter of Presumed Infectious Origin
❑Coma ❑CAD of Bypass Graft ❑Colitis, Ischemic or Ulcerative
❑Endocarditis or Myocarditis, Acute ❑Congestive Heart Failure ❑Colostomy or Enterostomy, Complications
❑MI, Acute Chronic or Unspecified ❑Crohn’s Disease
❑Pulmonary Embolism, Acute Systolic or Diastolic ❑Diverticulitis
❑Cardiomyopathy EXCEPT Ischemic ❑Esophagitis, Acute
Respiratory & Infectious Disease ❑Demand Ischemia ❑Gastroenteritis, Toxic or due to Radiation
❑Aspiration Bronchitis, Aspiration Pneumonia ❑Heart Failure, Left ❑GI Bleed, Melena, Hematemesis, Hemoptysis
❑HIV Disease ❑Hypertension, Accelerated or Malignant ❑Hernia with Obstruction
❑Peritonitis ❑Hypertensive Heart Disease with CHF ❑Ileus
❑Pneumonia, Including viral ❑Hypertensive Encephalopathy ❑Intestinal Infections, Viral or Bacterial
❑Pulmonary Edema, Acute, Non-cardiogenic ❑In-Stent Stenosis, Cardiac ❑Intestinal Malabsorption
❑Respiratory Failure, Acute ❑Pleural Effusion ❑Jaundice
❑Respiratory Insufficiency ❑Post-MI Syndrome ❑Pancreatitis, Chronic
Acute Post-Operative ❑Tachycardia, Sustained PSVT ❑Ulcer, Acute Gastric, Duodenal or Peptic
❑Sepsis, Severe Sepsis, Septic Shock ❑Thrombophlebitis & Venous Thrombosis
Acute or Chronic Nephrology & Genitourinary
Other MCCs ❑Acute Renal Failure
❑Acute Renal Failure with Behavioral, Nervous & Cerebrovascular ❑Calculus of Ureter or Kidney
Acute Tubular Necrosis (ATN) ❑Alzheimer’s Dementia with Behavioral ❑Chronic Kidney Disease, Stage IV or V
❑Aplastic, Anemia due to Disturbance ❑Hydronephrosis or Hydroureter
Drugs, Chemo, Infection, or ❑Aphasia, NOT Post-Stroke ❑Nephrotic Syndrome
Radiation ❑Delirium, Drug Induced ❑Polycystic Kidney
❑Diabetic Ketoacidosis or Diabetes with ❑Dementia with ❑Pyelonephritis, UTI
Hyperosmolarity or Other Coma Delirium, Depression or Delusion
❑Encephalopathy Presenile, Senile or Vascular Orthopedic & Skin
Metabolic or Toxic ❑Depression, Major, Acute ❑Cellulits, EXCEPT Fingers or Toes
Other or Unspecified ❑Encephalopathy, Alcoholic ❑Compartment Syndrome, Non-Traumatic
❑End Stage Renal Disease ❑Hallucinations ❑Complications of Prosthetic Joint
❑GI Disorder With Auditory OR Drug/Alcohol-Induced ❑Fractures, Pathologic
Hemorrhage, Gastritis, Duodenitis ❑Hemiplegia, Hemiparesis ❑Fractures, Traumatic, Closed/Many Sites
Or Diverticular Disease ❑Normal Pressure Hydrocephalus ❑Osteomyelitis, Acute, Chronic or Unspecified
❑GI Ulcer With Perforation, Hemorrhage or ❑Paraplegia ❑Stasis Ulcer, Inflamed or Infected
Obstruction ❑Post-Traumatic Seizures ❑Ulcer of Skin, Lower Extremity
❑Ischemic Colitis, Acute ❑Schizophrenia EXCEPT Unspecified
❑Major Injuries ❑Suicidal Ideation Respiratory
❑Malnutrition, Severe ❑TIA ❑Asthma Exacerbation
❑Pancreatitis, Acute ❑Vertebrobasilar Insufficiency ❑Atelectasis
❑Peritonitis ❑Withdrawal, Drug or Alcohol ❑COPD with Acute Exacerbation
❑Pressure Ulcer Stage III OR IV ❑Emphysema
❑Quadriplegia or Functional Quadriplegia Hematology & Oncology with Exacerbation of Chronic Bronchitis
❑SIRS due to Noninfectious Process with ❑Anemia due to Acute or Post-Op Blood Loss ❑Hemoptysis
Acute Organ Dysfunction ❑Aplastic Anemia ❑Pulmonary Edema, Non-Cardiogenic
❑Volvulus ❑Lymphoma, Leukemia Also In Remission ❑Respiratory Distress, Acute
❑Malignant Neoplasm, Most Sites ❑Respiratory Failure, Chronic
MCC IF Discharged Alive NOT Breast or Prostate ❑Respirator Weaning or Dependence
❑Cardiac Arrest ❑Pancytopenia
❑Cardiogenic Shock ❑Secondary Neuroendocrine Tumor Other
❑Respiratory Arrest ❑Bacteremia
❑Ventricular Fibrillation Metabolic ❑Complications of Device, Implant or Graft
❑Other Shock without Trauma ❑Acidosis/Alkalosis ❑SIRS due to Non-Infectious Process
❑Adult BMI <19 OR ≥40 ❑Thrush
❑Cachexia ❑Transplant Status, Most Organs
❑Hypernatremia OR Hyponatremia
❑Malnutrition, Unspecified
❑Obesity Hypoventilation Syndrome