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R75 ICD-10-CM Code: Inconclusive laboratory evidence of human immunodeficiency virus [HIV]

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FY 2026 Apr update / Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99) / Abnormal findings on examination of blood, without diagnosis (R70-R79)

R75

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Inconclusive laboratory evidence of human immunodeficiency virus [HIV]

HIV test results are unclear or inconclusive, meaning the test cannot definitively confirm or rule out HIV infection at this time.

CMS-HCC V28

0

0

RAF 0

CMS-HCC V24

0

0

RAF 0

ACA/HHS

0

0

RAF 0

ESRD/PACE

0

0

RAF 0

RXHCC

0

0

RAF 0

Code Trumping

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Code Book Path

Official
R7Abnormal findings on examination of blood, without diagnosis (R70-R79)
R75Inconclusive laboratory evidence of human immunodeficiency virus [HIV]

Inclusion Terms

Official
  • Nonconclusive HIV-test finding in infants

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for R75 in this effective period.

Related Child Codes

Official

ICD-10-CM does not list child codes under R75 for this display context.

Includes

Official

ICD-10-CM does not list Includes notes for R75 in this effective period.

Excludes 1

Official
  • asymptomatic human immunodeficiency virus [HIV] infection status (Z21)
  • human immunodeficiency virus [HIV] disease (B20)

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for R75 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for R75 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for R75 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance
This code indicates indeterminate or inconclusive results - follow-up testing is typically required
Do not use this code if HIV infection has been confirmed; use B20 or Z21 instead

Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.

Is R75 an HCC code?

No. R75 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.

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

R75 is the ICD-10-CM diagnosis code for inconclusive laboratory evidence of human immunodeficiency virus [hiv]. HIV test results are unclear or inconclusive, meaning the test cannot definitively confirm or rule out HIV infection at this time. R75 sits in the ICD-10-CM chapter for symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (r00-r99), within the section covering abnormal findings on examination of blood, without diagnosis (r70-r79).

R75 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 indicates indeterminate or inconclusive results - follow-up testing is typically required.

HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for R75 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

  • This code indicates indeterminate or inconclusive results - follow-up testing is typically required
  • Do not use this code if HIV infection has been confirmed; use B20 or Z21 instead

Excludes 1, Do NOT code together

  • asymptomatic human immunodeficiency virus [HIV] infection status (Z21)
  • human immunodeficiency virus [HIV] disease (B20)

Code Hierarchy

R75Inconclusive laboratory evidence of human immunodeficiency virus [HIV]
R75Inconclusive laboratory evidence of human immunodeficiency virus [HIV]

Work R75 in HCC Buddy

Open R75 in the Code Book for the full Index-to-Tabular path, MEAT checklist, and V28 HCC mapping, or in the Encoder to code from a keyword search. Pro includes 14 days to try everything.