Question 1

What is ICD-10 code D07.5?

Accepted Answer

D07.5 is the ICD-10-CM diagnosis code for carcinoma in situ of prostate. Abnormal cells in the prostate gland that have the potential to become cancer but have not yet invaded deeper tissues. D07.5 sits in the ICD-10-CM chapter for neoplasms (c00-d49), within the section covering in situ neoplasms (d00-d09).

D07.5 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.

Often discovered through PSA screening or biopsy; document whether this is associated with benign prostatic hyperplasia.

Question 2

Is D07.5 an HCC code?

Accepted Answer

No. D07.5 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 D07.5 billable?

Accepted Answer

Yes. D07.5 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. D07.5 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 D07.5?

Accepted Answer

D07.5 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 D07.5 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 D07.5?

Accepted Answer

Often discovered through PSA screening or biopsy; document whether this is associated with benign prostatic hyperplasia Distinguish from invasive prostate cancer (C61) and benign prostatic conditions

HCC Buddy Code Card

D07.5

Is D07.5 an HCC code?

What This Code Means

Coding Tips

Excludes 1, Do NOT code together

Child Codes

Code Hierarchy

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D07.5 ICD-10-CM Code: Carcinoma in situ of prostate

HCC Buddy Code Card

D07.5

Is D07.5 an HCC code?

What This Code Means

Coding Tips

Excludes 1, Do NOT code together

Child Codes

Code Hierarchy

Work D07.5 in HCC Buddy