Question 1

What is ICD-10 code Z16.342?

Accepted Answer

Z16.342 is the ICD-10-CM diagnosis code for resistance to multiple antimycobacterial drugs. A condition where tuberculosis or other mycobacterial infections are resistant to multiple tuberculosis medications, significantly limiting treatment options. Z16.342 sits in the ICD-10-CM chapter for factors influencing health status and contact with health services (z00-z99), within the section covering resistance to antimicrobial drugs (z16).

Z16.342 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.

Multi-drug resistant tuberculosis (MDR-TB) is a serious public health concern; ensure accurate documentation of which drugs show resistance.

Question 2

Is Z16.342 an HCC code?

Accepted Answer

No. Z16.342 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 Z16.342 billable?

Accepted Answer

Yes. Z16.342 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. Z16.342 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 Z16.342?

Accepted Answer

Z16.342 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 Z16.342 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 Z16.342?

Accepted Answer

Multi-drug resistant tuberculosis (MDR-TB) is a serious public health concern; ensure accurate documentation of which drugs show resistance This code indicates a more severe resistance pattern than single-drug resistance and requires specialized treatment protocols

HCC Buddy Code Card

Z16.342

Is Z16.342 an HCC code?

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Z16.342 ICD-10-CM Code: Resistance to multiple antimycobacterial drugs

HCC Buddy Code Card

Z16.342

Is Z16.342 an HCC code?

What This Code Means

Coding Tips

Child Codes

Code Hierarchy

Open Z16.342 in the Interactive Encoder