2027 ICD-10-CM Diagnosis Code E72.538Other specified primary hyperoxaluria
ICD-10-CM Codes›E00–E89›E70-E88›E72
- Billable — Valid for Submission
- CC — Complication or Comorbidity
- Risk Adjusts — HCC 50
- Chronic Condition
E72.538 is a billable ICD-10-CM diagnosis code for other specified primary hyperoxaluria. It is valid on HIPAA claims for fiscal year 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 642. As a secondary diagnosis, it counts as a complication or comorbidity (CC) and moves an inpatient stay to a higher severity level within its MS-DRG family. It does not count, however, when the principal diagnosis is one of 144 closely related codes. Coders also document this condition as hyperoxaluria. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Other specified and unspecified nutritional and metabolic disorders.
For Medicare Advantage risk adjustment, E72.538 maps to CMS-HCC Category 50 (Amyloidosis, Porphyria, and Other Specified Metabolic Disorders) under the V28 model, adding a risk factor of about 0.648 for a community, non-dual, aged beneficiary in payment year 2027.
Code Identity
Code Classification
Medicare Risk Adjustment (HCC)Billing
E72.538 maps to a payment category in the CMS-HCC model used to risk-adjust Medicare Advantage payments. Weights are the published community factors for payment year 2027.
Source: CMS Payment Year 2027 risk adjustment mappings and model software. Weights are relative factors, not dollar amounts; a beneficiary's total RAF also includes demographics and interactions. Browse all CMS-HCC categories.
Approximate SynonymsGuidance
Alternate terms and clinical phrases that map to this code.
- Hyperoxaluria
- Primary hyperoxaluria
- Primary hyperoxaluria type III
- Primary hyperoxaluria, type II
Instructional NotesGuidance
Instructions from the official ICD-10-CM Tabular List that apply to E72.538: its own notes plus those printed at E72.53, E72, block E70-E88, and Chapter 4. A note printed at a category, block or chapter applies to every code under it.
Applicable To
Conditions this code is used for: synonyms of the title or, for "other specified" codes, the conditions assigned to it. The list is not exhaustive.
- Primary hyperoxaluria, type 2
- Primary hyperoxaluria, type 3
Excludes1
Not coded here: the excluded code is never reported together with this one, unless the two conditions are unrelated.
Excludes2
Not included here: the excluded condition is not part of this code, but a patient may have both, so both codes may be reported.
- Ehlers-Danlos syndromes (Q79.6-)
Notes
General instructions on how these codes are used.
- All neoplasms, whether functionally active or not, are classified in Chapter 2. Appropriate codes in this chapter (i.e. E05.8, E07.0, E16-E31, E34.-) may be used as additional codes to indicate either functional activity by neoplasms and ectopic endocrine tissue or hyperfunction and hypofunction of endocrine glands associated with neoplasms and other conditions classified elsewhere.
Source: CMS ICD-10-CM Tabular List. How to read instructional notes.
Referenced in Other NotesGuidance
Instructional notes printed at other codes that name E72.538, its category, or a range that includes it.
Excludes1 5
These codes carry an Excludes1 note naming E72.538: they are not reported together with it, unless the two conditions are unrelated.
- E72.54 Secondary hyperoxaluriaprimary hyperoxaluria (E72.53-) names E72.53-, which includes this code
- R82.992 Hyperoxaluriaprimary hyperoxaluria (E72.53-) names E72.53-, which includes this code
- R79 Other abnormal findings of blood chemistry
- R79.83 Abnormal findings of blood amino-acid level
- Block R80-R82 Abnormal findings on examination of urine, without diagnosis
Index to Diseases and InjuriesGuidance
Alphabetical index entries that point to this code.
Disorder (of) See Also: Disease;
specified type NEC E72.538
type 2 E72.538
type 3 E72.538
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
Clinical InformationClinical
Hyperoxaluria, Primary
a genetic disorder characterized by excretion of large amounts of oxalates in urine; nephrolithiasis; nephrocalcinosis; early onset of renal failure; and often a generalized deposit of calcium oxalate. there are subtypes classified by the enzyme defects in glyoxylate metabolism.
Patient EducationClinical
Primary hyperoxaluria
Primary hyperoxaluria is a rare condition characterized by recurrent kidney and bladder stones. The condition often results in end stage renal disease (ESRD), which is a life-threatening condition that prevents the kidneys from filtering fluids and waste products from the body effectively.
Read the full article at MedlinePlus
Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.
Code History & ChangesHistory
Replacement E72.538 replaces the following previously assigned code(s):
- E72.53 - Hyperoxaluria
- E72.53 - Primary hyperoxaluria
Questions About E72.538Overview
What is the ICD-10 code for other specified primary hyperoxaluria?
The ICD-10-CM code for other specified primary hyperoxaluria is E72.538 (sometimes written as E72538). It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
Is E72.538 (Primary hyperoxaluria) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report other specified primary hyperoxaluria on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
What MS-DRG does E72.538 group to?
When other specified primary hyperoxaluria is the principal diagnosis on an inpatient stay, it groups to MS-DRG 642 (inborn and Other Disorders of Metabolism), which carries a relative weight of 1.3226. Higher weights mean higher Medicare reimbursement.
Is E72.538 a CC or MCC?
CMS lists E72.538 as a CC (complication or comorbidity) for FY 2027. Reported as a secondary diagnosis, it moves the inpatient stay to a higher-weighted DRG within its severity family. It does not count when the principal diagnosis is one of the 144 closely related codes in its exclusion list.
Can E72.538 be reported with a code from E72.54?
Not as a rule. The Excludes1 note at E72.53, which applies to E72.538, lists "secondary hyperoxaluria (E72.54-)". An Excludes1 note means the excluded code is never reported together with this one; the only exception is when the two conditions are unrelated to each other (Official Guidelines, Section I.A.12.a).
What HCC is E72.538?
E72.538 (other specified primary hyperoxaluria) maps to CMS-HCC Category 50 (Amyloidosis, Porphyria, and Other Specified Metabolic Disorders), commonly written as HCC 50, in the CMS-HCC V28 model used for Medicare Advantage risk adjustment in payment year 2027. It also maps in the PACE (CMS-HCC V22), ESRD (V21), and ESRD (V24) models. In the Part D prescription drug model it maps to RxHCC 43.
Does E72.538 risk-adjust for Medicare Advantage payment?
Yes. When documented and reported on a Medicare Advantage encounter, E72.538 adds a risk adjustment factor of about 0.648 to the beneficiary's RAF score for a community, non-dual, aged enrollee (published V28 weights range from 0.362 to 0.883 depending on the payment segment). HCC 50 sits at the top of its hierarchy, so no other condition category supersedes it. See the full factor table on the HCC 50 category page.
