Z89.619
BillableAcquired absence of unspecified leg above knee
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is Z89.619 an HCC code?
Yes. Z89.619 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 Z89.619
For Z89.619 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 Z89.619 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
Z89.619 is the ICD-10-CM diagnosis code for acquired absence of unspecified leg above knee. A person who has lost a leg above the knee (side not specified). This is a permanent condition significantly affecting mobility and typically requires prosthetic devices. Z89.619 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, Z89.619 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 Z89.619 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.
Use only when the specific side (right or left) cannot be determined from documentation. Because Z89.619 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 Z89.619 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
Clinical Significance
This represents a major physical impairment with significant impact on mobility and independence, but lacks specific laterality documentation. The unspecified nature may limit care coordination and prosthetic fitting accuracy, making proper documentation crucial for optimal patient management.
Documentation Requirements
- ✓Documentation of acquired absence (not congenital)
- ✓Level of amputation clearly stated as above knee
- ✓Confirmation this is a permanent status
- ✓Reason for unspecified laterality if known
- ✓Method of amputation if relevant
- ✓Current functional status with/without prosthetic
- ✓Any ongoing complications or care needs
- ✓Attempts to clarify laterality in documentation