ICD-10 T87.54
Billable / Specific HCC v28: 189Necrosis of amputation stump, left lower extremity
About ICD-10-CM T87.54
ICD-10-CM code T87.54 represents Necrosis of amputation stump, left lower extremity. This is a billable/specific code in the Injury, Poisoning, and External Causes chapter (block T87). The 2026 edition of ICD-10-CM T87.54 became effective on October 1, 2025.
Coding Tips for T87.54
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
T87.54 is a CMS-HCC v28 risk-adjustment code (category 189). 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.
Injury codes require a 7th character: A (initial encounter, active treatment), D (subsequent, healing/recovery), S (sequela, late effect of original injury). Codes with fewer than 6 characters need the placeholder X to bring them to 6 characters before adding the 7th. Wrong or missing 7th character is the #1 cause of injury claim denials.
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 T87.54
Local Coverage Determinations (LCDs) from CMS MACs that list T87.54 as a covered diagnosis.
Showing top 10 of 203 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing T87.54.
5 Medicare
CPT Codes Commonly Billed with T87.54
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 T87.54 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 |
|---|---|---|
| T87.54 | 99769 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To T87.54
Other codes in section T80-T88 (Complications of surgical and medical care, not elsewhere classified).
ICD-10 T87.54, Billing FAQ
Is ICD-10 code T87.54 billable? +
Yes, T87.54 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
Does T87.54 affect Medicare Advantage HCC risk adjustment? +
Yes. T87.54 maps to CMS-HCC v28 category 189. Capture this diagnosis annually for accurate Medicare Advantage risk score.
What ICD-9 codes does T87.54 map to? +
Per CMS GEMs, T87.54 maps to ICD-9 codes: 99769. 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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