In February, a patient is diagnosed with prostate cancer, which is classified as HCC 23.

In the CMS-HCC model, many related conditions are organized intohierarchiesso that only themost severemanifestation within a disease family contributes to the RAF. This prevents double counting when multiple codes describe progressive severity of the same underlying condition. Cancer categories are a common example: a diagnosis reflectingmetastatic diseaserepresents substantially higher expected resource utilization than a diagnosis of localized/primary malignancy. In this scenario, the February prostate cancer maps to a lower-severity HCC (HCC 23), while the October documentation of prostate cancerwith bone metastasesmaps to a higher-severity HCC (HCC 18). When both are captured within the applicable period, the hierarchy logic retains thehigher-weighted metastatic categoryand suppresses the lower category. The timing of which was coded first does not control the hierarchy outcome, and both HCCs are not counted together when they fall within the same hierarchical grouping. Therefore, the patient’s risk score calculation reflects HCC 18 rather than HCC 23.