Question 1

What is ICD-10 code Y92.049?

Accepted Answer

Y92.049 is the ICD-10-CM diagnosis code for unspecified place in boarding-house as the place of occurrence of the external cause. An injury or accident occurred in a boarding house, but the specific room or area is not specified. Y92.049 sits in the ICD-10-CM chapter for external causes of morbidity (v00-y99), within the section covering supplementary factors related to causes of morbidity classified elsewhere (y90-y99).

Y92.049 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.

Use this code only when the exact location within the boarding house cannot be determined from documentation.

Question 2

Is Y92.049 an HCC code?

Accepted Answer

No. Y92.049 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 Y92.049 billable?

Accepted Answer

Yes. Y92.049 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. Y92.049 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 Y92.049 map to under V28?

Accepted Answer

Y92.049 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 Y92.049 pay in RAF?

Accepted Answer

Y92.049 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 Y92.049?

Accepted Answer

Y92.049 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 Y92.049 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 Y92.049?

Accepted Answer

Use this code only when the exact location within the boarding house cannot be determined from documentation If a specific room (kitchen, bedroom, bathroom) is documented, use the more specific code instead Y92.049 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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Y92.049

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Y92.049 ICD-10-CM Code: Unspecified place in boarding-house as the place of occurrence of the external cause

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Y92.049

Is Y92.049 an HCC code?

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