Amputation Status HCC Coding Guide
Complete HCC coding guide for Amputation Status (Z89.x) including ICD-10 to HCC mapping, V28 RAF weights, level documentation, and traumatic vs. surgical coding.
Quick Facts
HCC Categories
HCC 253 — Amputation Status, Lower Limb/Amputation Complications
RAF Weight Range
0.488
Community, non-dual, aged (V28)
Model
CMS-HCC V28 (PY2026 — 100% phase-in)
10 ICD-10 codes map to payment HCCs
Overview
Amputation status affects risk adjustment coding whenever a patient has undergone limb amputation at any level, from toe to above-knee. Under CMS-HCC V28, major amputation status maps to HCC 253 (Amputation Status, Upper Limb or Lower Limb, Foot Only) or higher categories depending on the level. The Z89 code category captures the current amputation status (not the acute procedure), and these codes should be reported at every encounter. Coding requires documenting the specific level of amputation, laterality, and whether it is traumatic or surgical. Diabetic and PVD-related amputations are particularly common and often co-occur with other HCC conditions, making it important to capture all related diagnoses 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 | HCC 253 |
| Z89.511 | Acquired absence of right leg below knee | Yes | HCC 253 |
| Z89.512 | Acquired absence of left leg below knee | Yes | HCC 253 |
| Z89.611 | Acquired absence of right leg above knee | Yes | HCC 253 |
| Z89.612 | Acquired absence of left leg above knee | Yes | HCC 253 |
| Z89.211 | Acquired absence of right hand | Yes | HCC 253 |
| Z89.111 | Acquired absence of right thumb | Yes | HCC 253 |
| Z89.431 | Acquired absence of right foot | Yes | HCC 253 |
| Z89.432 | Acquired absence of left foot | Yes | HCC 253 |
| Z89.619 | Acquired absence of unspecified leg above knee | Yes | HCC 253 |
RAF weights are community, non-dual, aged base coefficients from the CMS-HCC V28 model (PY2026). Verify against the latest CMS rate announcement for payment calculations.
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
V28 consolidated amputation status into HCC 253, replacing the V24 hierarchy that included HCC 189 (Amputation Status, Lower Limb/Amputation Complications) and separate upper limb categories. The V28 recalibration combined upper and lower limb amputations with foot-only amputations into a broader category. RAF weights were adjusted to reflect the merged cost prediction. Importantly, V28 maintained amputation status as a payment HCC, recognizing the ongoing healthcare costs associated with prosthetic management, rehabilitation, and complication prevention.
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