T87.1X1
BillableComplications of reattached (part of) right lower extremity
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is T87.1X1 an HCC code?
Yes. T87.1X1 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 T87.1X1
For T87.1X1 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 T87.1X1 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
T87.1X1 is the ICD-10-CM diagnosis code for complications of reattached (part of) right lower extremity. Problems or complications that occur after a right leg or foot (or part of it) has been surgically reattached following amputation or traumatic loss. T87.1X1 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, T87.1X1 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, T87.1X1 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 T87.1X1 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 T87.1X1 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 the specific location of reattachment (foot, lower leg, thigh, or specific digits) when possible
Clinical Significance
Complications of reattached right lower extremity represent serious problems that can affect mobility and independence. These complications may include infection, vascular compromise, or functional failure requiring intensive rehabilitation or surgical intervention.
Documentation Requirements
- ✓Documentation of lower extremity amputation and reattachment
- ✓Specific complications affecting right lower extremity
- ✓Right lower extremity laterality clearly documented
- ✓Clinical examination and functional assessment
- ✓Mobility and weight-bearing status
- ✓Imaging or diagnostic studies supporting complications
- ✓Treatment and rehabilitation plans
- ✓Provider confirmation of reattachment-related etiology