T87.0X1
BillableComplications of reattached (part of) right upper extremity
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is T87.0X1 an HCC code?
Yes. T87.0X1 maps to Traumatic Amputations and Complications under the CMS-HCC V28 risk adjustment model (and Traumatic Amputations and Complications under V24).
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 T87.0X1
For T87.0X1 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 T87.0X1 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
T87.0X1 is the ICD-10-CM diagnosis code for complications of reattached (part of) right upper extremity. Problems or complications that occur after a right arm or hand (or part of it) has been surgically reattached following amputation or traumatic loss. T87.0X1 sits in the ICD-10-CM chapter for injury, poisoning and certain other consequences of external causes (s00-t88), within the section covering complications of surgical and medical care, not elsewhere classified (t80-t88).
Under the CMS-HCC V28 risk adjustment model, T87.0X1 maps to Traumatic Amputations and Complications (HCC 405) with a community, non-dual, aged base RAF weight of 0.000. Under the older V24 model, T87.0X1 mapped to the same category but with a base RAF weight of 0.350 — V28 recalibrated weights across the entire model. 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.
The 'X' in the code structure allows for additional characters; verify the complete code with the fifth character for specific complication type. Because T87.0X1 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 T87.0X1 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •The 'X' in the code structure allows for additional characters; verify the complete code with the fifth character for specific complication type
- •Document whether the complication involves the entire extremity or just a part (finger, hand, etc.) for accurate coding
Clinical Significance
Complications of reattached right upper extremity indicate problems with a surgically reattached arm or hand, potentially including infection, necrosis, or failure of reattachment. These complications can result in functional impairment or need for re-amputation.
Documentation Requirements
- ✓Documentation of traumatic amputation and reattachment procedure
- ✓Specific complications present (infection, necrosis, vascular compromise)
- ✓Right upper extremity laterality clearly specified
- ✓Clinical examination findings supporting complications
- ✓Functional assessment of the reattached limb
- ✓Treatment plans for complication management
- ✓Provider assessment confirming reattachment-related etiology
- ✓Timeline relationship between reattachment and complication