Z87.74
BillablePersonal history of (corrected) congenital malformations of heart and circulatory system
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is Z87.74 an HCC code?
No. Z87.74 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).
What This Code Means
Z87.74 is the ICD-10-CM diagnosis code for personal history of (corrected) congenital malformations of heart and circulatory system. A person who previously had a birth defect of the heart or blood vessels that has been surgically corrected or treated. Z87.74 sits in the ICD-10-CM chapter for factors influencing health status and contact with health services (z00-z99), within the section covering persons with potential health hazards related to family and personal history and certain conditions influencing health status (z77-z99).
Z87.74 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.
Include documentation of the specific congenital heart defect (e.g., ventricular septal defect, tetralogy of Fallot) for comprehensive medical history.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for Z87.74 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Include documentation of the specific congenital heart defect (e.g., ventricular septal defect, tetralogy of Fallot) for comprehensive medical history
- •This code applies to all corrected congenital heart and circulatory malformations