ICD-10 E72.530
Billable / Specific HCC v28: 23 CCPrimary hyperoxaluria, type 1
About ICD-10-CM E72.530
ICD-10-CM code E72.530 represents Primary hyperoxaluria, type 1. This is a billable/specific code in the Endocrine, Nutritional, and Metabolic chapter (block E72). The 2026 edition of ICD-10-CM E72.530 became effective on October 1, 2025.
Coding Tips for E72.530
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
E72.530 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.
E72.530 is designated CC for MS-DRG grouping. On inpatient claims, this code can shift the DRG to the with-CC variant when documented as a present-on-admission secondary diagnosis. Hospital CDI programs flag CC opportunities during chart review. Failure to capture this code may leave 30 to 80 percent of the inpatient stay revenue unrealized.
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.
Inpatient DRG Impact, CC
codes Primary hyperoxaluria, type 1. As a Complication/Comorbidity (CC), this contributes to DRG severity adjustment when documented alongside the principal diagnosis.
Medicare LCD Coverage for E72.530
Local Coverage Determinations (LCDs) from CMS MACs that list E72.530 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 E72.530.
2 Cigna
CPT Codes Commonly Billed with E72.530
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.
Codes Adjacent To E72.530
Other codes in section E70-E88 (Metabolic disorders).
ICD-10 E72.530, Billing FAQ
Is ICD-10 code E72.530 billable? +
Yes, E72.530 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
Does E72.530 affect Medicare Advantage HCC risk adjustment? +
Yes. E72.530 maps to CMS-HCC v28 category 23. Capture this diagnosis annually for accurate Medicare Advantage risk score.
Is E72.530 a CC or MCC for inpatient DRG? +
Yes, this code is designated as CC. Documenting as a secondary diagnosis on inpatient claims can shift the DRG to a higher-weighted category.
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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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