Question 1

What is ICD-10 code Q76.413?

Accepted Answer

Q76.413 is the ICD-10-CM diagnosis code for congenital kyphosis, cervicothoracic region. A birth defect causing abnormal backward curvature of the spine in the region where the neck meets the upper back (cervicothoracic junction). Q76.413 sits in the ICD-10-CM chapter for congenital malformations, deformations and chromosomal abnormalities (q00-qa0), within the section covering congenital malformations and deformations of the musculoskeletal system (q65-q79).

Q76.413 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.

This code applies specifically to the cervicothoracic region; verify documentation clearly identifies this location.

Question 2

Is Q76.413 an HCC code?

Accepted Answer

No. Q76.413 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 Q76.413 billable?

Accepted Answer

Yes. Q76.413 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. Q76.413 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

Which HCC does Q76.413 map to under V28?

Accepted Answer

Q76.413 does not map to a CMS-HCC V28 payment category. Check the current CMS-HCC V28 model file for payment year 2026 rather than an older V24 tip sheet.

Question 5

What does Q76.413 pay in RAF?

Accepted Answer

Q76.413 has no separately stated V28 community RAF weight. If it is not a V28 payment HCC, it adds nothing to a community RAF score.

Question 6

What is the V28 vs V24 difference for Q76.413?

Accepted Answer

Q76.413 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 community model rewards Q76.413 with a risk adjustment factor, it contributes zero to a Medicare Advantage beneficiary's V28/V24 community RAF score in either version. Coders should check whether provider documentation supports a more specific child code that does map to a community payment HCC.

Question 7

What documentation supports Q76.413?

Accepted Answer

This code applies specifically to the cervicothoracic region; verify documentation clearly identifies this location Document any associated pain, neurological deficits, or functional impairment for clinical completeness Q76.413 is not a CMS-HCC payment code, so MEAT is not the payment hook. Documentation still has to support the diagnosis if you report it.

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Q76.413

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Q76.413 ICD-10-CM Code: Congenital kyphosis, cervicothoracic region

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Q76.413

Is Q76.413 an HCC code?

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