T87.9
BillableUnspecified complications of amputation stump
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is T87.9 an HCC code?
Yes. T87.9 maps to Amputation Status, Lower Limb/Amputation Complications under the CMS-HCC V28 risk adjustment model (and Amputation Status, Lower Limb/Amputation 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 T87.9
For T87.9 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 T87.9 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
T87.9 is the ICD-10-CM diagnosis code for unspecified complications of amputation stump. A complication related to an amputation stump that is present but not specifically identified or documented. T87.9 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, T87.9 maps to Amputation Status, Lower Limb/Amputation Complications (HCC 409) with a community, non-dual, aged base RAF weight of 0.350. The V24 model used during the PY2024–PY2025 transition mapped T87.9 the same way and at the same RAF weight. 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.
Avoid using this unspecified code when the specific complication can be identified and coded more precisely. Because T87.9 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 T87.9 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Avoid using this unspecified code when the specific complication can be identified and coded more precisely
- •Query the provider if the specific type of stump complication can be determined from clinical documentation
Clinical Significance
Unspecified complications of amputation stump indicates presence of amputation-related problems without specific classification, suggesting need for further diagnostic clarification. This diagnosis captures ongoing care complexity while awaiting more definitive diagnosis.
Documentation Requirements
- ✓Documentation of complication related to amputation stump
- ✓Clinical evidence of problem affecting amputation site
- ✓Assessment indicating need for medical intervention
- ✓Treatment or evaluation plans in progress
- ✓Impact on patient's functional status
- ✓Plans for further diagnostic workup if needed
- ✓Healthcare resource utilization related to complication
- ✓Provider assessment indicating amputation-related issue