Z89.411
BillableAcquired absence of right great toe
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is Z89.411 an HCC code?
Yes. Z89.411 maps to Amputation Status, Lower Limb/Amputation Complications under the V24 model but is not retained in V28.
HCC Category Mapping
RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.
MEAT Criteria for Z89.411
For Z89.411 to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically — it has to be re-documented and supported each calendar year.
- MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
- EEvaluate: test results, medication response, or physical findings reviewed by the provider
- AAssess: explicit mention in the assessment or plan with acknowledgment of status
- TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis
Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed Z89.411 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
Z89.411 is the ICD-10-CM diagnosis code for acquired absence of right great toe. A person who has lost their right big toe due to amputation or other acquired cause. Z89.411 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).
Under the older CMS-HCC V24 model, Z89.411 maps to Amputation Status, Lower Limb/Amputation Complications (HCC 189) with a community, non-dual, aged base RAF weight of 0.350. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition.
The great toe is the first toe; distinguish from loss of other toes using codes Z89.421-Z89.422. Because Z89.411 maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. When documentation is ambiguous, coders should issue a provider query rather than assume the highest-specificity variant.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for Z89.411 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
Clinical Significance
Acquired absence of right great toe represents a significant lower extremity amputation that impacts balance, gait, and mobility. This condition often results from diabetic complications, peripheral vascular disease, or trauma, indicating substantial underlying pathology and increased fall risk.
Documentation Requirements
- ✓Acquired nature of the absence (not congenital)
- ✓Specific identification of right great toe
- ✓Cause of amputation or absence documented
- ✓Level of amputation if partial toe removal
- ✓Functional impact on mobility and balance
- ✓Prosthetic device use if applicable
- ✓Rehabilitation needs and services
- ✓Associated complications or sequelae
Commonly Confused Codes
- •Q72.3 — Congenital absence of foot and toe, for birth defects
- •Z89.419 — Unspecified great toe, when laterality is documented
- •Z89.421 — Other right toes, for non-great toe amputations
- •S98.111A — Traumatic amputation codes for acute injuries
- •Z47.81 — Encounter for orthotic fitting, not amputation status