E83.01
BillableWilson's disease
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is E83.01 an HCC code?
Yes. E83.01 maps to Glycogen/Amino-Acid/Other Metabolic Disorders under the CMS-HCC V28 risk adjustment model.
HCC Category Mapping
RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. 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.
MEAT Criteria for E83.01
For E83.01 to 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 E83.01 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
E83.01 is the ICD-10-CM diagnosis code for wilson's disease. A rare inherited disorder where copper accumulates in the liver, brain, and other organs, causing neurological problems, liver disease, and eye abnormalities. E83.01 sits in the ICD-10-CM chapter for endocrine, nutritional and metabolic diseases (e00-e89), within the section covering metabolic disorders (e70-e88).
Under the CMS-HCC V28 risk adjustment model, E83.01 maps to Glycogen/Amino-Acid/Other Metabolic Disorders (HCC 50) with a community, non-dual, aged base RAF weight of 0.289. E83.01 was not retained as a payment HCC under the older V24 model, so V28 introduced or recategorized it during the 2024–2026 phase-in. 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.
Wilson's disease is a serious condition requiring specific treatment; ensure accurate diagnosis documentation. Because E83.01 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 E83.01 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Wilson's disease is a serious condition requiring specific treatment; ensure accurate diagnosis documentation
- •Code any associated complications separately (cirrhosis, neurological manifestations, Kayser-Fleischer rings)
Clinical Significance
Wilson disease is an autosomal recessive disorder of copper metabolism caused by ATP7B gene mutations, leading to toxic copper accumulation in the liver, brain, and other organs. Without treatment, it is fatal, but early diagnosis and lifelong chelation therapy or zinc supplementation can be life-saving. Liver transplantation is curative for hepatic Wilson disease.
Documentation Requirements
- ✓Provider diagnosis of Wilson disease
- ✓Confirmatory diagnostic criteria: low serum ceruloplasmin, elevated 24-hour urine copper, hepatic copper on liver biopsy, Kayser-Fleischer rings on slit-lamp exam
- ✓ATP7B gene mutation analysis if performed
- ✓Hepatic manifestations: liver function tests, imaging, fibrosis staging
- ✓Neurological/psychiatric manifestations: tremor, dysarthria, dystonia, personality changes
- ✓Current treatment: D-penicillamine, trientine, zinc acetate, or liver transplant status
- ✓Treatment compliance monitoring: urine copper, serum copper levels
Code Also
- associated Kayser Fleischer ring (H18.04-)
Commonly Confused Codes
- •E83.00 — Disorder of copper metabolism, unspecified: use only when Wilson disease is not specifically confirmed
- •E83.09 — Other disorders of copper metabolism: for copper disorders that are NOT Wilson disease (e.g., Menkes disease in some classifications)
- •K74.69 — Other cirrhosis of liver: Wilson disease can present as cirrhosis, but the metabolic code is primary
- •G25.9 — Extrapyramidal and movement disorder, unspecified: neurological Wilson may mimic other movement disorders