Question 1

What is ICD-10 code E72.541?

Accepted Answer

E72.541 is the ICD-10-CM diagnosis code for enteric hyperoxaluria. Elevated oxalate levels caused by intestinal absorption problems, often related to inflammatory bowel disease or other gastrointestinal conditions. E72.541 sits in the ICD-10-CM chapter for endocrine, nutritional and metabolic diseases (e00-e89), within the section covering metabolic disorders (e70-e88).

E72.541 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.

Document the underlying gastrointestinal condition causing the enteric hyperoxaluria.

Question 2

Is E72.541 an HCC code?

Accepted Answer

No. E72.541 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 E72.541 billable?

Accepted Answer

Yes. E72.541 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. E72.541 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 E72.541?

Accepted Answer

E72.541 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 E72.541 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 E72.541?

Accepted Answer

Document the underlying gastrointestinal condition causing the enteric hyperoxaluria Link this code to the primary GI diagnosis such as Crohn's disease or short bowel syndrome

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E72.541

Is E72.541 an HCC code?

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E72.541 ICD-10-CM Code: Enteric hyperoxaluria

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E72.541

Is E72.541 an HCC code?

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