N85.A ICD-10-CM Code: Isthmocele
HCC Buddy Code Card
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FY 2026 Apr update / Diseases of the genitourinary system (N00-N99) / Noninflammatory disorders of female genital tract (N80-N98)
N85.A
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceIsthmocele
A defect or weakness in the lower uterine segment (isthmus) that typically develops after cesarean section, potentially causing abnormal bleeding or pregnancy complications.
CMS-HCC V28
N/A—
Not mapped
CMS-HCC V24
N/A—
Not mapped
ACA/HHS
N/A—
Not mapped
ESRD/PACE
N/A—
Not mapped
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
Official- Isthmocele (non-pregnant state)
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for N85.A in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for N85.A in this effective period.
Excludes 1
Official- maternal care for cesarean scar defect (isthmocele) (O34.22)
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for N85.A in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for N85.A in this effective period.
Code Also
Official- any associated conditions such as:
- abnormal uterine and vaginal bleeding, unspecified (N93.9)
- female infertility of uterine origin (N97.2)
- pelvic and perineal pain (R10.2-)
Buddy Documentation Tip
Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →
Is N85.A an HCC code?
No. N85.A is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
- Code
- N85.A
- Description
- Isthmocele
- HCC (V28)
- No CMS-HCC V28 mapping
- RAF
- —
- Billable
- Yes
- Payment year
- 2026
Coder workflow notes
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This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).
What This Code Means
N85.A is the ICD-10-CM diagnosis code for isthmocele. A defect or weakness in the lower uterine segment (isthmus) that typically develops after cesarean section, potentially causing abnormal bleeding or pregnancy complications. N85.A sits in the ICD-10-CM chapter for diseases of the genitourinary system (n00-n99), within the section covering noninflammatory disorders of female genital tract (n80-n98).
N85.A 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 relationship to prior cesarean delivery, as this is the primary risk factor and relevant for clinical management.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for N85.A sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Document the relationship to prior cesarean delivery, as this is the primary risk factor and relevant for clinical management
- •Verify if the patient is symptomatic or if this is an incidental finding, as this affects treatment decisions
Excludes 1, Do NOT code together
- maternal care for cesarean scar defect (isthmocele) (O34.22)