What is ICD-10 code E25.0?

E25.0 is the ICD-10-CM diagnosis code for Congenital adrenogenital disorders associated with enzyme deficiency. A group of inherited disorders where the adrenal glands produce abnormal hormone levels due to missing or defective enzymes, often causing virilization or salt-wasting problems. E25.0 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. E25.0 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Yes. E25.0 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. E25.0 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.

What is the V28 vs V24 difference for E25.0?

CMS phased in the V28 risk adjustment model over payment years 2024 (33%), 2025 (67%), and 2026 (100%), replacing V24. V28 consolidates HCC categories, removes some lower-acuity conditions, and recalibrates RAF weights across the entire model. E25.0 was a payment HCC under V24 (Other Significant Endocrine and Metabolic Disorders) but the V28 recalibration removed it from the risk adjustment model. Both models can still appear in legacy data and in payer-specific lookback periods.

What should coders know when reporting E25.0?

Specify the type of enzyme deficiency (21-hydroxylase, 11-beta-hydroxylase, etc.) if documented Note whether the presentation is salt-wasting, simple virilizing, or non-classic form Because E25.0 maps to a payment HCC, the documentation must also satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's risk adjustment score.

2026 ICD-10-CM E25.0: Congenital adrenogenital

ICD-10-CM Code View

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Code lookupE25.0Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Endocrine, nutritional and metabolic diseases (E00-E89) / Disorders of other endocrine glands (E20-E35)

E25.0

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Congenital adrenogenital disorders associated with enzyme deficiency

A group of inherited disorders where the adrenal glands produce abnormal hormone levels due to missing or defective enzymes, often causing virilization or salt-wasting problems.

Buddy Insight

CMS-HCC V28

N/A

—

Not risk-adjusted for this model/period.

Not mapped

CMS-HCC V24

Mapped

HCC 23

Other Significant Endocrine a...

RAF 0.194

ACA/HHS

Mapped

HCC 30

HHS-HCC 30

Varies by metal level

ESRD/PACE

Mapped

HCC 23

Other Significant Endocrine a...

RAF 0.036

RXHCC

Mapped

HCC 43

Other Significant Endocrine a...

RAF 0.063

Code Book Path

Official

E25Adrenogenital disorders

E25.0Congenital adrenogenital disorders associated with enzyme deficiency

Inclusion Terms

Official

Congenital adrenal hyperplasia
21-Hydroxylase deficiency
Salt-losing congenital adrenal hyperplasia

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for E25.0 in this effective period.

Related Child Codes

Official

E25.8Other adrenogenital disorders

E25.9Adrenogenital disorder, unspecified

Includes

Official

adrenogenital syndromes, virilizing or feminizing, whether acquired or due to adrenal hyperplasia consequent on inborn enzyme defects in hormone synthesis
Female adrenal pseudohermaphroditism
Female heterosexual precocious pseudopuberty
Male isosexual precocious pseudopuberty
Male macrogenitosomia praecox

Excludes 1

Official

indeterminate sex and pseudohermaphroditism (Q56)
chromosomal abnormalities (Q90-Q99)

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for E25.0 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for E25.0 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for E25.0 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

Document the specific enzyme deficiency (21-hydroxylase, 11-beta-hydroxylase, 17-alpha-hydroxylase), clinical form (classic salt-wasting, simple virilizing, or non-classic/late-onset), 17-hydroxyprogesterone levels, adrenocorticotropic hormone stimulation test results, and hormone replacement regimen.

MEAT Support

HCC Buddy guidance

Audit Caution

HCC Buddy guidance

This code is specifically for congenital enzyme deficiency forms. Acquired adrenogenital disorders should use E25.

Do not assign this code for adrenal insufficiency without the androgenic component. Late-onset or non-classic forms still qualify for E25.0 if enzyme deficiency is confirmed.

Common Mistakes

HCC Buddy guidance

E25.8 (other adrenogenital disorders for acquired forms), E25.9 (adrenogenital disorder unspecified), E27.1 (primary adrenocortical insufficiency without the adrenogenital component), Q56.x (indeterminate sex codes for ambiguous genitalia presentation).

Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.

Is E25.0 an HCC code?

Yes. E25.0 maps to Other Significant Endocrine and Metabolic Disorders under the V24 model but is not retained in V28.

Code: E25.0
Description: Congenital adrenogenital disorders associated with enzyme deficiency
HCC (V28): No CMS-HCC V28 mapping
RAF: —
Billable: Yes
Payment year: 2026

HCC Category Mapping

V24HCC 23, Other Significant Endocrine and Metabolic Disorders

0.194

ESRDHCC 23, Other Significant Endocrine and Metabolic Disorders

0.036

RxHCCHCC 43, Other Significant Endocrine and Metabolic Disorders

0.063

Each model's RAF is its CMS base weight for that model's standard population, so weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.

Work E25.0 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

MEAT Criteria for E25.0

For E25.0to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically, it has to be re-documented and supported each calendar year.

MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
EEvaluate: test results, medication response, or physical findings reviewed by the provider
AAssess: explicit mention in the assessment or plan with acknowledgment of status
TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis

Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed E25.0 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

E25.0 is the ICD-10-CM diagnosis code for congenital adrenogenital disorders associated with enzyme deficiency. A group of inherited disorders where the adrenal glands produce abnormal hormone levels due to missing or defective enzymes, often causing virilization or salt-wasting problems. E25.0 sits in the ICD-10-CM chapter for endocrine, nutritional and metabolic diseases (e00-e89), within the section covering disorders of other endocrine glands (e20-e35).

Under the older CMS-HCC V24 model, E25.0 maps to Other Significant Endocrine and Metabolic Disorders (HCC 23) with a community, non-dual, aged base RAF weight of 0.194. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition.

Specify the type of enzyme deficiency (21-hydroxylase, 11-beta-hydroxylase, etc.) if documented. Because E25.0 maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. When documentation is ambiguous, coders should issue a provider query rather than assume the highest-specificity variant.

HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for E25.0 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Specify the type of enzyme deficiency (21-hydroxylase, 11-beta-hydroxylase, etc.) if documented
•Note whether the presentation is salt-wasting, simple virilizing, or non-classic form

Clinical Significance

Congenital adrenogenital disorders associated with enzyme deficiency, primarily congenital adrenal hyperplasia, are autosomal recessive conditions causing impaired cortisol synthesis with compensatory adrenocorticotropic hormone elevation and adrenal androgen excess. The most common form, 21-hydroxylase deficiency, can present with life-threatening salt-wasting crisis in neonates or virilization in females.

Documentation Requirements

✓Document the specific enzyme deficiency (21-hydroxylase, 11-beta-hydroxylase, 17-alpha-hydroxylase), clinical form (classic salt-wasting, simple virilizing, or non-classic/late-onset), 17-hydroxyprogesterone levels, adrenocorticotropic hormone stimulation test results, and hormone replacement regimen.

Commonly Confused Codes

•E25.8 (other adrenogenital disorders for acquired forms), E25.9 (adrenogenital disorder unspecified), E27.1 (primary adrenocortical insufficiency without the adrenogenital component), Q56.x (indeterminate sex codes for ambiguous genitalia presentation).