D78.12
BillableAccidental puncture and laceration of the spleen during other procedure
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is D78.12 an HCC code?
No. D78.12 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).
What This Code Means
D78.12 is the ICD-10-CM diagnosis code for accidental puncture and laceration of the spleen during other procedure. Accidental puncture or cut to the spleen during surgery performed on another part of the body. D78.12 sits in the ICD-10-CM chapter for diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism (d50-d89), within the section covering intraoperative and postprocedural complications of the spleen (d78).
D78.12 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.
Use when spleen is inadvertently injured during non-splenic procedures.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for D78.12 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use when spleen is inadvertently injured during non-splenic procedures
- •Clarify in documentation whether injury occurred during approach or retraction