Z97.13 ICD-10-CM Code: Presence of artificial right leg (complete) (partial)
Z97.13 maps to CMS-HCC V28 409. A source-labeled RAF reference is available. Documentation must support MEAT. 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)
Z97.13
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidancePresence of artificial right leg (complete) (partial)
A patient has an artificial right leg prosthetic, which may be a complete leg replacement or a partial prosthetic.
Buddy Insight
This code indicates the presence of a right leg prosthetic device, representing adaptation to major limb loss that significantly impacts mobility and independence.
CMS-HCC V28
MappedHCC 409
Code-level coefficient reference
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
MappedHCC 254
Code-level coefficient reference
ESRD/PACE
N/A—
Not mapped
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for Z97.13 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for Z97.13 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for Z97.13 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for Z97.13 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for Z97.13 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for Z97.13 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for Z97.13 in this effective period.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
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 Z97.13 an HCC code?
Yes. Z97.13 (Presence of artificial right leg (complete) (partial)) maps to HCC 409, Amputation Status, Lower Limb/Amputation Complications under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.598. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes. It is billable for payment year 2026.
Coder answer: Z97.13 is billable and maps to V28 HCC 409, Amputation Status, Lower Limb/Amputation Complications. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.
- Code
- Z97.13
- Description
- Presence of artificial right leg (complete) (partial)
- HCC (V28)
- HCC 409 — Amputation Status, Lower Limb/Amputation Complications
- RAF reference coefficient
- 0.598
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. 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 context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.
Work Z97.13 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT Criteria for Z97.13
For Z97.13 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 Z97.13 during that encounter, not just copy-forwarded from a problem list.
Coder workflow notes
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What This Code Means
Z97.13 is the ICD-10-CM diagnosis code for presence of artificial right leg (complete) (partial). A patient has an artificial right leg prosthetic, which may be a complete leg replacement or a partial prosthetic. Z97.13 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, Z97.13 maps to Amputation Status, Lower Limb/Amputation Complications (HCC 409) with a source-labeled community, non-dual, aged reference coefficient of 0.598. No V24 mapping is shown for Z97.13; use the applicable model and payment year when reviewing the V28 mapping. 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. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes.
Specify in documentation whether the prosthetic is complete (entire leg) or partial (below-knee, foot, etc.) for clarity. Because Z97.13 maps to an HCC category, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) before the diagnosis is used for risk adjustment. 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, source-labeled coefficient references, and MEAT documentation criteria for Z97.13 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Specify in documentation whether the prosthetic is complete (entire leg) or partial (below-knee, foot, etc.) for clarity
- •Use this code for status documentation; pair with other codes if there are complications or fitting issues
Clinical Significance
This code indicates the presence of a right leg prosthetic device, representing adaptation to major limb loss that significantly impacts mobility and independence. These patients require ongoing prosthetic care, physical therapy, and monitoring for complications such as skin breakdown or prosthetic malfunction.
Documentation Requirements
- ✓Confirmation of artificial right leg prosthetic presence
- ✓Level of amputation (above knee, below knee, etc.)
- ✓Type of prosthetic device
- ✓Functional status with prosthetic
- ✓Fit and comfort issues
- ✓Maintenance and adjustment needs
- ✓Physical therapy requirements
- ✓Integration with mobility aids