Question 1

What is ICD-10 code Z52.819?

Accepted Answer

Z52.819 is the ICD-10-CM diagnosis code for egg (oocyte) donor, unspecified. A woman donating eggs (oocytes) for fertility treatment when the donor's age category or recipient designation status is not specified or documented. Z52.819 sits in the ICD-10-CM chapter for factors influencing health status and contact with health services (z00-z99), within the section covering encounters for other specific health care (z40-z53).

Z52.819 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 age of donor or recipient designation cannot be determined from documentation.

Question 2

Is Z52.819 an HCC code?

Accepted Answer

No. Z52.819 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 Z52.819 billable?

Accepted Answer

Yes. Z52.819 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. Z52.819 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 Z52.819?

Accepted Answer

Z52.819 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 Z52.819 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 Z52.819?

Accepted Answer

Use this code only when age of donor or recipient designation cannot be determined from documentation Query the provider if age and recipient status are not documented, as more specific codes are preferred

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Z52.819

Is Z52.819 an HCC code?

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Z52.819 ICD-10-CM Code: Egg (Oocyte) donor, unspecified

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Z52.819

Is Z52.819 an HCC code?

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Open Z52.819 in the Interactive Encoder