Question 1

What is ICD-10 code D48.117?

Accepted Answer

D48.117 is the ICD-10-CM diagnosis code for desmoid tumor of back. A desmoid tumor located in the back or spine area that can affect the muscles, bones, or spinal cord. D48.117 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).

D48.117 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.

Clarify whether the tumor is in the paraspinal muscles, vertebrae, or spinal canal.

Question 2

Is D48.117 an HCC code?

Accepted Answer

No. D48.117 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 D48.117 billable?

Accepted Answer

Yes. D48.117 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. D48.117 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 D48.117?

Accepted Answer

D48.117 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 D48.117 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 D48.117?

Accepted Answer

Clarify whether the tumor is in the paraspinal muscles, vertebrae, or spinal canal Document any neurological symptoms or spinal cord compression

HCC Buddy Code Card

D48.117

Is D48.117 an HCC code?

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D48.117 ICD-10-CM Code: Desmoid tumor of back

HCC Buddy Code Card

D48.117

Is D48.117 an HCC code?

What This Code Means

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Work D48.117 in HCC Buddy