Z93.52
BillableAppendico-vesicostomy status
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is Z93.52 an HCC code?
Yes. Z93.52 maps to Artificial Openings for Feeding or Elimination under the CMS-HCC V28 risk adjustment model (and Artificial Openings for Feeding or Elimination 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 Z93.52
For Z93.52 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 Z93.52 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
Z93.52 is the ICD-10-CM diagnosis code for appendico-vesicostomy status. A surgically created opening between the appendix and bladder that allows urine to drain into a pouch made from the appendix. Z93.52 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, Z93.52 maps to Artificial Openings for Feeding or Elimination (HCC 463) with a community, non-dual, aged base RAF weight of 0.233. Under the older V24 model, Z93.52 mapped to the same category but with a base RAF weight of 0.570 — V28 recalibrated weights across the entire model. 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 a specific type of continent urinary diversion procedure; document the functional status of the appendico-vesicostomy. Because Z93.52 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 Z93.52 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This code indicates a specific type of continent urinary diversion procedure; document the functional status of the appendico-vesicostomy
- •Verify if this is the primary reason for the encounter or a secondary condition affecting current treatment
Clinical Significance
This code represents a sophisticated urological reconstruction using the appendix to create a continent urinary diversion from the bladder. This complex procedure requires specialized knowledge for ongoing care and represents significant urological pathology necessitating major surgical intervention.
Documentation Requirements
- ✓Confirmation of appendico-vesicostomy presence
- ✓Documentation of appendix utilization
- ✓Indication for this complex procedure
- ✓Current functionality and continence status
- ✓Catheterization requirements and technique
- ✓Specialized care protocols
- ✓Any complications or dysfunction
- ✓Underlying condition requiring reconstruction