Condition guide
Amputation Status HCC Coding Guide
Amputation Status (e.g. Z89.511) maps to HCC 409 (Amputation Status, Lower Limb/Amputation Complications) under CMS-HCC V28. Its source-labeled community non-dual aged reference coefficient is 0.598. This is not a member total; full contribution depends on hierarchy, cleanup, interactions, member context, and model year. Z89.411, acquired absence of right great toe, is non-HCC under V28.
Quick Facts
HCC Categories
HCC 409, Amputation Status, Lower Limb/Amputation Complications
RAF Weight Range
0.598
Community, non-dual, aged (V28)
Model
CMS-HCC V28 (PY2026, 100% phase-in)
7 ICD-10 codes map to payment HCCs
What HCC category does Amputation Status map to under V28?
Amputation status affects risk adjustment whenever a patient has a documented acquired absence of a limb, captured with Z89 status codes (not the acute procedure). Under CMS-HCC V28, qualifying lower-limb amputations and amputation-stump complications map to HCC 409 (Amputation Status, Lower Limb/Amputation Complications), which carries a community non-dual aged RAF of 0.598. Level matters for which codes qualify: foot, ankle, below-knee, and above-knee absences map to HCC 409, while toe-only absences (Z89.41x, Z89.42x) do not map to an HCC in V28. Report the status at every encounter, document laterality and level precisely, and capture co-occurring conditions like diabetes or PVD separately, since those map to their own categories for complete risk adjustment.
ICD-10 to HCC Mapping
| ICD-10 Code | Description | Billable | HCC Mapping |
|---|---|---|---|
| Z89.411 | Acquired absence of right great toe | Yes | No HCC (not risk-adjusting under V28) |
| Z89.511 | Acquired absence of right leg below knee | Yes | HCC 409 |
| Z89.512 | Acquired absence of left leg below knee | Yes | HCC 409 |
| Z89.611 | Acquired absence of right leg above knee | Yes | HCC 409 |
| Z89.612 | Acquired absence of left leg above knee | Yes | HCC 409 |
| Z89.211 | Acquired absence of right upper limb below elbow | Yes | No HCC (not risk-adjusting under V28) |
| Z89.111 | Acquired absence of right hand | Yes | No HCC (not risk-adjusting under V28) |
| Z89.431 | Acquired absence of right foot | Yes | HCC 409 |
| Z89.432 | Acquired absence of left foot | Yes | HCC 409 |
| Z89.619 | Acquired absence of unspecified leg above knee | Yes | HCC 409 |
Displayed numbers are source-labeled community non-dual aged reference coefficients from CMS-HCC V28, not member totals.
Verify Amputation Status against the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coder workflow notes
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Documentation Tips
Document the specific level of amputation: toe, foot, below knee (transtibial), above knee (transfemoral), finger, hand, below elbow, above elbow.
Always specify laterality: right or left for all extremity amputations.
Report the amputation status code (Z89.x) at every encounter, it is a chronic status that must be recaptured annually.
Document the etiology of the amputation: diabetic complication, peripheral vascular disease, trauma, or malignancy.
Record the prosthetic status if applicable (Z97.1x) as a supporting code.
Document any complications of the amputation stump: phantom limb pain, wound healing issues, revision needs.
Common Coding Mistakes
Failing to code amputation status at annual encounters, Z89.x codes must be recaptured every year for risk adjustment.
Not specifying laterality, resulting in 'unspecified side' codes when the affected limb is clearly documented.
Confusing the acute amputation procedure code (surgical code) with the chronic amputation status code (Z89.x).
Missing the opportunity to code the underlying cause (diabetes E11.52, PVD I70.26x) alongside the amputation status.
V24 to V28 Changes
In V28, qualifying amputation status and amputation-stump complications resolve to HCC 409 (Amputation Status, Lower Limb/Amputation Complications). Compared with the prior V24 model, the category structure and identifiers were renumbered during recalibration, so coders mapping older crosswalks should re-verify each code against the current V28 tables rather than assume the legacy number carried over. A practical V28 detail: not every amputation Z89 code maps to an HCC. Foot, ankle, and leg (below-knee and above-knee) absences qualify for HCC 409, but toe-only absences carry no HCC weight. Amputation status remains a payment HCC in V28, reflecting the ongoing costs of prosthetic management, rehabilitation, and complication prevention. Always confirm laterality and level so the correct code, and its HCC status, is captured.
Related Conditions
Related references
Sources
Displayed numbers are source-labeled community non-dual aged reference coefficients from CMS-HCC V28, not member totals.
Verified current to CMS-HCC V28, payment year 2026 — last reviewed September 5, 2026.
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