Question 1

What is ICD-10 code A48.52?

Accepted Answer

A48.52 is the ICD-10-CM diagnosis code for wound botulism. Wound botulism is a serious infection caused by bacteria that enter through a cut or wound and produce a toxin that paralyzes muscles. This condition requires immediate medical attention as it can affect breathing and other vital functions. A48.52 sits in the ICD-10-CM chapter for certain infectious and parasitic diseases (a00-b99), within the section covering other bacterial diseases (a30-a49).

A48.52 is a billable ICD-10-CM code but does not map to a payment HCC under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can be reported on Medicare Advantage encounter data submissions but it does not contribute to a beneficiary's RAF score and therefore does not affect risk-adjusted payments to the plan.

Ensure the wound location and type are documented in the medical record, as this information may be needed for complete coding of the injury itself.

Question 2

Is A48.52 an HCC code?

Accepted Answer

No. A48.52 is a billable ICD-10-CM code but does not map to any payment HCC category under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can still be reported on Medicare Advantage encounter data submissions, but it does not contribute to the beneficiary's Risk Adjustment Factor (RAF) score and therefore does not affect the risk-adjusted capitation payment to the plan. V28 reached 100% phase-in for payment year 2026.

Question 3

Is A48.52 billable?

Accepted Answer

Yes. A48.52 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. A48.52 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

Question 4

What is the V28 vs V24 difference for A48.52?

Accepted Answer

A48.52 does not map to a payment HCC under either the CMS-HCC V28 risk adjustment model or the older V24 model. V28 reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition. Because neither model rewards A48.52 with a risk adjustment factor, it contributes zero to a Medicare Advantage beneficiary's RAF score in either version. Coders should check whether provider documentation supports a more specific child code that does map to a payment HCC.

Question 5

What should coders know when reporting A48.52?

Accepted Answer

Ensure the wound location and type are documented in the medical record, as this information may be needed for complete coding of the injury itself Verify that botulism antitoxin administration or other specific treatments are documented separately, as these may have their own procedure codes

HCC Buddy Code Card

A48.52

Is A48.52 an HCC code?

Get the V28 RAF + MEAT cheat sheet

What This Code Means

Coding Tips

Use Additional Code

Child Codes

Code Hierarchy

Work A48.52 in HCC Buddy

A48.52 ICD-10-CM Code: Wound botulism

HCC Buddy Code Card

A48.52

Is A48.52 an HCC code?

Get the V28 RAF + MEAT cheat sheet

What This Code Means

Coding Tips

Use Additional Code

Child Codes

Code Hierarchy

Work A48.52 in HCC Buddy