Question 1

What is ICD-10 code D48.115?

Accepted Answer

D48.115 is the ICD-10-CM diagnosis code for desmoid tumor of upper extremity and shoulder girdle. A desmoid tumor in the upper arm, forearm, hand, or shoulder area that can affect muscles and surrounding tissues. D48.115 sits in the ICD-10-CM chapter for neoplasms (c00-d49), within the section covering neoplasms of uncertain behavior, polycythemia vera and myelodysplastic syndromes (d37-d48).

D48.115 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.

Specify which part of the upper extremity is affected (arm, forearm, hand) and which shoulder structure if applicable.

Question 2

Is D48.115 an HCC code?

Accepted Answer

No. D48.115 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 D48.115 billable?

Accepted Answer

Yes. D48.115 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. D48.115 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 D48.115?

Accepted Answer

D48.115 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 D48.115 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 D48.115?

Accepted Answer

Specify which part of the upper extremity is affected (arm, forearm, hand) and which shoulder structure if applicable Document whether the tumor affects function or nerve/blood vessel involvement

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D48.115

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D48.115 ICD-10-CM Code: Desmoid tumor of upper extremity and shoulder girdle

HCC Buddy Code Card

D48.115

Is D48.115 an HCC code?

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Work D48.115 in HCC Buddy