Question 1

What is ICD-10 code Q76.415?

Accepted Answer

Q76.415 is the ICD-10-CM diagnosis code for congenital kyphosis, thoracolumbar region. A birth defect where the spine curves abnormally forward (kyphosis) in the middle-to-lower back region (thoracolumbar area). Q76.415 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).

Q76.415 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 specifies the thoracolumbar region; use Q76.419 if the region is unspecified or unknown.

Question 2

Is Q76.415 an HCC code?

Accepted Answer

No. Q76.415 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 Q76.415 billable?

Accepted Answer

Yes. Q76.415 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. Q76.415 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 Q76.415 map to under V28?

Accepted Answer

Q76.415 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 Q76.415 pay in RAF?

Accepted Answer

Q76.415 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 Q76.415?

Accepted Answer

Q76.415 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 Q76.415 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 Q76.415?

Accepted Answer

This code specifies the thoracolumbar region; use Q76.419 if the region is unspecified or unknown Congenital kyphosis may be associated with other spinal abnormalities; review documentation for additional conditions Q76.415 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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Q76.415

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Q76.415 ICD-10-CM Code: Congenital kyphosis, thoracolumbar region

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Q76.415

Is Q76.415 an HCC code?

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