Question 1

What is ICD-10 code Z87.738?

Accepted Answer

Z87.738 is the ICD-10-CM diagnosis code for Personal history of other specified (corrected) congenital malformations of digestive system. A person who previously had other types of birth defects affecting the digestive system that have been surgically corrected or treated. Z87.738 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. Z87.738 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Question 2

Is Z87.738 an HCC code?

Accepted Answer

No. Z87.738 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 Z87.738 billable?

Accepted Answer

Yes. Z87.738 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. Z87.738 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 Z87.738?

Accepted Answer

Z87.738 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 Z87.738 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 Z87.738?

Accepted Answer

Use this code for corrected digestive system malformations not specified in Z87.730, Z87.731, or Z87.732 Document the specific type of malformation in the medical record for reference and future care coordination

Z87.738

Is Z87.738 an HCC code?

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Open Z87.738 in the Interactive Encoder