Z89.612
BillableAcquired absence of left leg above knee
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is Z89.612 an HCC code?
Yes. Z89.612 maps to Amputation Status, Lower Limb/Amputation Complications under the CMS-HCC V28 risk adjustment model (and Amputation Status, Lower Limb/Amputation Complications under V24).
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 Z89.612
For Z89.612 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 Z89.612 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
Z89.612 is the ICD-10-CM diagnosis code for acquired absence of left leg above knee. A person who has lost their left leg above the knee (above-knee amputation). This is a permanent condition significantly affecting mobility and typically requires prosthetic devices. Z89.612 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 CMS-HCC V28 risk adjustment model, Z89.612 maps to Amputation Status, Lower Limb/Amputation Complications (HCC 409) with a community, non-dual, aged base RAF weight of 0.350. The V24 model used during the PY2024–PY2025 transition mapped Z89.612 the same way and at the same RAF weight. 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.
This code indicates amputation above the knee joint; verify documentation specifies above-knee level. Because Z89.612 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 Z89.612 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This code indicates amputation above the knee joint; verify documentation specifies above-knee level
- •Often paired with prosthetic fitting codes and rehabilitation services
Clinical Significance
This code represents a major physical impairment that significantly impacts patient mobility, independence, and quality of life. The amputation status requires ongoing medical management including prosthetic care, physical therapy, and monitoring for complications such as phantom pain or stump issues.
Documentation Requirements
- ✓Documentation of acquired absence (not congenital)
- ✓Specific laterality (left leg)
- ✓Level of amputation clearly stated as above knee
- ✓Confirmation this is a permanent status
- ✓Method of amputation if relevant (surgical vs traumatic)
- ✓Current functional status with/without prosthetic
- ✓Any ongoing complications or care needs
- ✓Date of original amputation if available