ICD-10 E72.53
Non-Billable Header HCC v28: 23Primary hyperoxaluria
About ICD-10-CM E72.53
ICD-10-CM code E72.53 represents Primary hyperoxaluria. This is a non-billable header code in the Endocrine, Nutritional, and Metabolic chapter (block E72). The 2026 edition of ICD-10-CM E72.53 became effective on October 1, 2025. Non-billable codes cannot be used as a primary or secondary diagnosis on a claim, use a more specific child code instead.
Coding Tips for E72.53
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
E72.53 is a CMS-HCC v28 risk-adjustment code (category 23). To count for the patient Risk Adjustment Factor (RAF), document the diagnosis with MEAT language each calendar year: Monitored, Evaluated, Assessed, Treated. A diagnosis on the problem list alone does not satisfy CMS RADV audit standards. Include the diagnosis in the assessment with current status and current treatment plan.
Inclusion Terms / Approximate Synonyms
Clinical terms and conditions classified under E72.53. Per CMS ICD-10-CM Tabular 2026.
- Oxalosis
- Oxaluria
Type 1 Excludes
Pure excludes, these codes can never be coded together with E72.53. The conditions are mutually exclusive (e.g., congenital vs acquired forms).
- secondary hyperoxaluria (E72.54-)
Medicare Advantage HCC Impact
Capture this diagnosis annually for accurate risk adjustment. Missed HCC captures are the #1 revenue leak in Medicare Advantage risk programs.
Medicare LCD Coverage for E72.53
Local Coverage Determinations (LCDs) from CMS MACs that list E72.53 as a covered diagnosis.
This doesn't mean the code isn't covered, it means no MAC has issued a Local Coverage Determination naming this specific code. Coverage may still apply under National Coverage Determinations or general medical-necessity rules.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing E72.53.
Our payer policy database covers Aetna, Cigna, Anthem, BCBS, Humana, and Medicare Advantage plans, but E72.53 doesn't currently appear in any indexed policy. The code may still be covered under standard plan benefits.
CPT Codes Commonly Billed with E72.53
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
We don't have CPT pairings indexed for this specific code yet. Use the CPT search above to find common procedures, or check your payer's published medical policy for code-specific guidance.
Convert E72.53 to ICD-9-CM
Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.
| ICD-10 | ICD-9 | Mapping Flags |
|---|---|---|
| E72.53 | 2718 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To E72.53
Other codes in section E70-E88 (Metabolic disorders).
ICD-10 E72.53, Billing FAQ
Is ICD-10 code E72.53 billable? +
No, E72.53 is a non-billable header code. Use a more specific child code from block E72 when submitting claims.
What other names or terms map to E72.53? +
ICD-10 E72.53 includes: Oxalosis; Oxaluria.
What codes are Type 1 Excludes for E72.53? +
Type 1 Excludes (never code together with E72.53): secondary hyperoxaluria (E72.54-)
Does E72.53 affect Medicare Advantage HCC risk adjustment? +
Yes. E72.53 maps to CMS-HCC v28 category 23. Capture this diagnosis annually for accurate Medicare Advantage risk score.
What ICD-9 codes does E72.53 map to? +
Per CMS GEMs, E72.53 maps to ICD-9 codes: 2718. Useful for legacy data review and historical claim analysis.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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