HCC Evidence Finder · demo · CMS-HCC V28

Chart review

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Synthetic member M-70112, 72 F

E11.9 Type 2 diabetes without complications · HCC 38
I50.9 Heart failure, unspecified · HCC 226

Office visit, internal medicine

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enc-1 · 2026-03-12 · Face-to-face office visit · MD, internal medicine

Patient: Evelyn Marsh   DOB: 04/09/1954   MRN: 00551207
Phone: (555) 410-8823

Subjective: Follow-up of diabetes and kidney disease. Checks glucose twice daily, fasting readings 150 to 190.

Labs: A1c 8.2 today. eGFR 24, stable from 26 in December.

Assessment and plan:
1. Type 2 diabetes with diabetic chronic kidney disease. A1c 8.2, not at goal. Increase insulin glargine to 24 units nightly.
2. Chronic kidney disease stage 4. eGFR 24. Nephrology follow-up in 6 weeks. Avoid NSAIDs.
3. Hyperlipidemia. Continue atorvastatin.

Nurse telephone call

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enc-2 · 2026-04-02 · Telephone call, not face-to-face · RN

Patient: Evelyn Marsh   DOB: 04/09/1954   MRN: 00551207

Patient called about ankle swelling and says her heart failure is acting up. Advised to weigh herself daily and call back if she gains more than 3 pounds. Message routed to PCP.

Replay mode: live calls are off on this deployment.

Pick a chart.

Synthetic charts. A small demo subset. Checked against published coding guides, not the CMS mapping file itself. Verify against the CMS V28 mapping and hierarchy tables for the payment year before relying on it. I63.9 to HCC 249 could not be confirmed in those guides.