Cardiovascular-Kidney-Metabolic Syndrome: Development of an ICD-10-CM Coding Framework

Cardiovascular-Kidney-Metabolic (CKM) syndrome is a multisystem construct describing the intertwined progression of cardiometabolic risk factors, chronic kidney disease (CKD), and cardiovascular disease (CVD). The American Heart Association (AHA) proposed CKM stages (0-4) for risk stratification and prevention. However, CKM lacks a single ICD-10-CM code, which hinders standardized stage identification in EHRs and claims data.

To develop an AHA-aligned ICD-10-CM coding framework as an implementation template that operationalizes CKM stages 0-4 for reproducible cohort identification and stage-based analyses in real-world data.

We mapped American Heart Association CKM stages (0-4) to ICD-10-CM diagnosis code sets using FY2026 conventions, code-set engineering best practices, and clinician review. To improve reproducibility, we defined a hierarchical staging algorithm, co-occurrence rules, and recommended lookback and encounter-confirmation thresholds. Stage 3 includes guidance for EHR-enhanced ascertainment and claims-only proxies.

We provide stage-specific ICD-10-CM code sets for CKM stages 0-4. Stage 1 captures excess or dysfunctional adiposity or prediabetes. Stage 2 captures established metabolic disease and earlier-stage CKD. Stage 3 captures subclinical cardiovascular injury or very high-risk CKD. Stage 4 captures overt clinical CVD events, with or without kidney failure.

This implementation framework enables transparent, reproducible CKM staging in real-world datasets and supports stage-based epidemiologic and health-system applications. Empirical validation and local implementation testing are needed prior to clinical deployment.