ICD-10 E85.81
Billable / Specific HCC v28: 23 CCLight chain (AL) amyloidosis
About ICD-10-CM E85.81
ICD-10-CM code E85.81 represents Light chain (AL) amyloidosis. This is a billable/specific code in the Endocrine, Nutritional, and Metabolic chapter (block E85). The 2026 edition of ICD-10-CM E85.81 became effective on October 1, 2025.
Coding Tips for E85.81
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
E85.81 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.
E85.81 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 Light chain (AL) amyloidosis. As a Complication/Comorbidity (CC), this contributes to DRG severity adjustment when documented alongside the principal diagnosis.
Medicare LCD Coverage for E85.81
Local Coverage Determinations (LCDs) from CMS MACs that list E85.81 as a covered diagnosis.
Showing top 10 of 655 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing E85.81.
1 Cigna
5 Medicare
CPT Codes Commonly Billed with E85.81
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- 0077U CMS LCD: Billing and Coding: Mass Spectrometry (MS) Testing in Monoclonal Gammopathy (MG) CMS LCD
- 95923 CMS LCD: Billing and Coding: Autonomic Function Testing CMS LCD
- 95924 CMS LCD: Billing and Coding: Autonomic Function Testing CMS LCD
- 95921 CMS LCD: Billing and Coding: Autonomic Function Testing CMS LCD
- 95922 CMS LCD: Billing and Coding: Autonomic Function Testing CMS LCD
- 75635 CMS LCD: Billing and Coding: Cardiac Catheterization and Coronary Angiography CMS LCD
- 93503 CMS LCD: Billing and Coding: Cardiac Catheterization and Coronary Angiography CMS LCD
- 36221 CMS LCD: Billing and Coding: Cardiac Catheterization and Coronary Angiography CMS LCD
Codes Adjacent To E85.81
Other codes in section E70-E88 (Metabolic disorders).
ICD-10 E85.81, Billing FAQ
Is ICD-10 code E85.81 billable? +
Yes, E85.81 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
Does E85.81 affect Medicare Advantage HCC risk adjustment? +
Yes. E85.81 maps to CMS-HCC v28 category 23. Capture this diagnosis annually for accurate Medicare Advantage risk score.
Is E85.81 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.
What CPT codes are commonly billed with E85.81? +
Procedures frequently paired with E85.81 include: 0077U, 95923, 95924, 95921, 95922.
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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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