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Z89.411 ICD-10-CM Code: Acquired absence of right great toe

Z89.411 is not a CMS-HCC payment code. MEAT criteria · RAF calculator · HCC Buddy coding tools

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FY 2026 Apr update / Factors influencing health status and contact with health services (Z00-Z99) / Persons with potential health hazards related to family and personal history and certain conditions influencing health status (Z77-Z99)

Z89.411

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Acquired absence of right great toe

A person who has lost their right big toe due to amputation or other acquired cause.

Buddy the Bee presenting code insight

Buddy Insight

Acquired absence of right great toe represents a significant lower extremity amputation that impacts balance, gait, and mobility.

CMS-HCC V28

N/A

—

Not mapped

CMS-HCC V24

HCC 189

RAF 0.519

ACA/HHS

N/A

—

Not mapped

ESRD/PACE

HCC 189

RAF 0.081

RXHCC

N/A

—

Not mapped

Code Book Path

Official
Z89.4Acquired absence of toe(s), foot, and ankle
Z89.41Acquired absence of great toe
Z89.411Acquired absence of right great toe

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for Z89.411 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for Z89.411 in this effective period.

Related Child Codes

Official
Z89.412Acquired absence of left great toe
Z89.419Acquired absence of unspecified great toe

Includes

Official

ICD-10-CM does not list Includes notes for Z89.411 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for Z89.411 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for Z89.411 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for Z89.411 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for Z89.411 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance
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

MEAT Support

HCC Buddy guidance
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

Audit Caution

HCC Buddy guidance
Using traumatic amputation codes for healed amputation status
Failing to specify laterality when documented in the record
Confusing great toe with other toe amputations
Using congenital absence codes for acquired conditions

Common Mistakes

HCC Buddy guidance
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

Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →

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.

Code
Z89.411
Description
Acquired absence of right great toe
HCC (V28)
No CMS-HCC V28 mapping
RAF
—
Billable
Yes
Payment year
2026

HCC Category Mapping

V24HCC 189, Amputation Status, Lower Limb/Amputation Complications
0.519
ESRDHCC 189, Amputation Status, Lower Limb/Amputation Complications
0.081

Each model's RAF is its CMS base weight for that model's standard population, so weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. 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.

Work Z89.411 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

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.

Coder workflow notes

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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 0.519. 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.

Acquired absence of right great toe, toe amputation status, right side. 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

  • •Acquired absence of right great toe, toe amputation status, right side.
  • •Toe amputations are common in diabetic ischemia and should be captured for chart accuracy. Chart should support the prior amputation event (usually a Z87 or surgical history note).
  • •Z89.411 does NOT map to a V28 payment HCC. A single great-toe amputation carries no V28 coefficient; the lower-limb amputation HCC 409 begins at foot-level amputations (Z89.43x) and above.

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

Child Codes

Z89.411Acquired absence of right great toe
Z89.412Acquired absence of left great toe
Z89.419Acquired absence of unspecified great toe

Code Hierarchy

└Z89Acquired absence of limb└Z89.4Acquired absence of toe(s), foot, and ankle└Z89.41Acquired absence of great toe└Z89.411Acquired absence of right great toe
└Z89.411Acquired absence of right great toe

Because Z89.411 maps to a payment HCC, the documentation must also satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's risk adjustment score.

More on Z89.411

Related condition guides

Referenced in blog posts

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