ICD-10 Z79.4
Billable / Specific HCC v28: 19Long term (current) use of insulin
About ICD-10-CM Z79.4
ICD-10-CM code Z79.4 represents Long term (current) use of insulin. This is a billable/specific code in the Factors Influencing Health Status chapter (block Z79). The 2026 edition of ICD-10-CM Z79.4 became effective on October 1, 2025.
Coding Tips for Z79.4
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
Z79.4 is a CMS-HCC v28 risk-adjustment code (category 19). 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.
Type 2 Excludes
Not included here, the excluded code is not part of Z79.4, but a patient may have both conditions at the same time. Both codes may be coded together when applicable.
- long-term (current) use of injectable non-insulin antidiabetic drugs (Z79.85)
- long term (current) use of oral antidiabetic drugs (Z79.84)
- long term (current) use of oral hypoglycemic drugs (Z79.84)
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 Z79.4
Local Coverage Determinations (LCDs) from CMS MACs that list Z79.4 as a covered diagnosis.
Showing top 10 of 41 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing Z79.4.
5 Medicare
1 Aetna
CPT Codes Commonly Billed with Z79.4
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- 99211 Established patient minimal visit — BP check, medication refill, nurse visit, immunization admin, post-op follow-up, injury follow-up Primary Care
- 0003M CMS LCD: Billing and Coding: MolDX: Biomarker Testing for Risk Stratification in Metabolic Dysfunction-Associated Steatotic Liver Disease and Metabolic Dysfunction-Associated Steatohepatitis CMS LCD
- 0468U CMS LCD: Billing and Coding: MolDX: Biomarker Testing for Risk Stratification in Metabolic Dysfunction-Associated Steatotic Liver Disease and Metabolic Dysfunction-Associated Steatohepatitis CMS LCD
- 0166U CMS LCD: Billing and Coding: MolDX: Biomarker Testing for Risk Stratification in Metabolic Dysfunction-Associated Steatotic Liver Disease and Metabolic Dysfunction-Associated Steatohepatitis CMS LCD
- 81517 CMS LCD: Billing and Coding: MolDX: Biomarker Testing for Risk Stratification in Metabolic Dysfunction-Associated Steatotic Liver Disease and Metabolic Dysfunction-Associated Steatohepatitis CMS LCD
- 0344U CMS LCD: Billing and Coding: MolDX: Biomarker Testing for Risk Stratification in Metabolic Dysfunction-Associated Steatotic Liver Disease and Metabolic Dysfunction-Associated Steatohepatitis CMS LCD
Convert Z79.4 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 |
|---|---|---|
| Z79.4 | V5867 | 00000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To Z79.4
Other codes in section Z77-Z99 (Persons with potential health hazards related to family and personal history and certain conditions influencing health status).
ICD-10 Z79.4, Billing FAQ
Is ICD-10 code Z79.4 billable? +
Yes, Z79.4 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
What codes are Type 2 Excludes for Z79.4? +
Type 2 Excludes (may be coded together when both conditions exist): long-term (current) use of injectable non-insulin antidiabetic drugs (Z79.85); long term (current) use of oral antidiabetic drugs (Z79.84); long term (current) use of oral hypoglycemic drugs (Z79.84)
Does Z79.4 affect Medicare Advantage HCC risk adjustment? +
Yes. Z79.4 maps to CMS-HCC v28 category 19. Capture this diagnosis annually for accurate Medicare Advantage risk score.
What CPT codes are commonly billed with Z79.4? +
Procedures frequently paired with Z79.4 include: 99211, 0003M, 0468U, 0166U, 81517.
What ICD-9 codes does Z79.4 map to? +
Per CMS GEMs, Z79.4 maps to ICD-9 codes: V5867. 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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