ICD-10 E75.249
Billable / Specific HCC v28: 23Niemann-Pick disease, unspecified
About ICD-10-CM E75.249
ICD-10-CM code E75.249 represents Niemann-Pick disease, unspecified. This is a billable/specific code in the Endocrine, Nutritional, and Metabolic chapter (block E75). The 2026 edition of ICD-10-CM E75.249 became effective on October 1, 2025.
Coding Tips for E75.249
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
E75.249 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 E75.249. Per CMS ICD-10-CM Tabular 2026.
- Acid sphingomyelinase deficiency (ASMD) NOS
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 E75.249
Local Coverage Determinations (LCDs) from CMS MACs that list E75.249 as a covered diagnosis.
Showing top 10 of 66 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing E75.249.
5 Medicare
3 Aetna
CPT Codes Commonly Billed with E75.249
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- 83090 CMS LCD: Billing and Coding: MolDX: Biomarkers in Cardiovascular Risk Assessment CMS LCD
- 83700 CMS LCD: Billing and Coding: MolDX: Biomarkers in Cardiovascular Risk Assessment CMS LCD
- 82172 CMS LCD: Billing and Coding: MolDX: Biomarkers in Cardiovascular Risk Assessment CMS LCD
- 86141 CMS LCD: Billing and Coding: MolDX: Biomarkers in Cardiovascular Risk Assessment CMS LCD
- 83701 CMS LCD: Billing and Coding: MolDX: Biomarkers in Cardiovascular Risk Assessment CMS LCD
- 83719 CMS LCD: Billing and Coding: MolDX: Biomarkers in Cardiovascular Risk Assessment CMS LCD
- 83721 CMS LCD: Billing and Coding: MolDX: Biomarkers in Cardiovascular Risk Assessment CMS LCD
- 83698 CMS LCD: Billing and Coding: MolDX: Biomarkers in Cardiovascular Risk Assessment CMS LCD
- 83695 CMS LCD: Billing and Coding: MolDX: Biomarkers in Cardiovascular Risk Assessment CMS LCD
- 83704 CMS LCD: Billing and Coding: MolDX: Biomarkers in Cardiovascular Risk Assessment CMS LCD
Convert E75.249 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 |
|---|---|---|
| E75.249 | 2727 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To E75.249
Other codes in section E70-E88 (Metabolic disorders).
ICD-10 E75.249, Billing FAQ
Is ICD-10 code E75.249 billable? +
Yes, E75.249 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
What other names or terms map to E75.249? +
ICD-10 E75.249 includes: Acid sphingomyelinase deficiency (ASMD) NOS.
Does E75.249 affect Medicare Advantage HCC risk adjustment? +
Yes. E75.249 maps to CMS-HCC v28 category 23. Capture this diagnosis annually for accurate Medicare Advantage risk score.
What CPT codes are commonly billed with E75.249? +
Procedures frequently paired with E75.249 include: 83090, 83700, 82172, 86141, 83701.
What ICD-9 codes does E75.249 map to? +
Per CMS GEMs, E75.249 maps to ICD-9 codes: 2727. 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 July 16, 2026.
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