Question 1

What is ICD-10 code Z01.419?

Accepted Answer

Z01.419 is the ICD-10-CM diagnosis code for encounter for gynecological examination (general) (routine) without abnormal findings. A routine gynecological examination performed for preventive health screening that shows no abnormal findings. Z01.419 sits in the ICD-10-CM chapter for factors influencing health status and contact with health services (z00-z99), within the section covering persons encountering health services for examinations (z00-z13).

Z01.419 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 examination is routine/preventive and results are completely normal with no abnormalities detected.

Question 2

Is Z01.419 an HCC code?

Accepted Answer

No. Z01.419 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 Z01.419 billable?

Accepted Answer

Yes. Z01.419 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. Z01.419 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

What is the V28 vs V24 difference for Z01.419?

Accepted Answer

Z01.419 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 model rewards Z01.419 with a risk adjustment factor, it contributes zero to a Medicare Advantage beneficiary's RAF score in either version. Coders should check whether provider documentation supports a more specific child code that does map to a payment HCC.

Question 5

What should coders know when reporting Z01.419?

Accepted Answer

Use this code only when the examination is routine/preventive and results are completely normal with no abnormalities detected Do not use this code if any abnormal findings are discovered; instead use the appropriate code indicating the abnormality

Z01.419

Is Z01.419 an HCC code?

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