2027 ICD-10-CM Diagnosis Code Z68.43Body mass index [BMI] 50.0-59.9, adult
ICD-10-CM Codes›Z00–Z99›BMI›Z68
- Billable — Valid for Submission
- CC — Complication or Comorbidity
- Risk Adjusts — HCC 48
- POA Exempt
- Not a Principal Diagnosis
Z68.43 is a billable ICD-10-CM diagnosis code for body mass index [BMI] 50.0-59.9, adult. It is valid on HIPAA claims for fiscal year 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 640 through 641. 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 9 closely related codes. The code is restricted by the Medicare Code Editor to adult patients (age 15 through 124), not accepted as a principal diagnosis, and exempt from POA reporting. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Obesity.
For Medicare Advantage risk adjustment, Z68.43 maps to CMS-HCC Category 48 (Morbid Obesity) under the V28 model, adding a risk factor of about 0.186 for a community, non-dual, aged beneficiary in payment year 2027.
Code Identity
Code Classification
Code EditsBilling
Medicare Code Editor checks that affect claim validity for Z68.43.
Present on Admission (POA)Billing
Z68.43 is exempt from POA reporting on inpatient claims to general acute care hospitals. Review the other POA exempt codes in Body mass index (BMI) (Z68).
Medicare Risk Adjustment (HCC)Billing
Z68.43 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.
Instructional NotesGuidance
Instructions from the official ICD-10-CM Tabular List that apply to Z68.43: its own notes plus those printed at Z68 and Chapter 21. A note printed at a category, block or chapter applies to every code under it.
Notes
General instructions on how these codes are used.
- BMI adult codes are for use for persons 20 years of age or older
- BMI pediatric codes are for use for persons 2-19 years of age.
- These percentiles are based on the growth charts published by the Centers for Disease Control and Prevention (CDC)
- Z codes represent reasons for encounters. A corresponding procedure code must accompany a Z code if a procedure is performed. Categories Z00-Z99 are provided for occasions when circumstances other than a disease, injury or external cause classifiable to categories A00-Y89 are recorded as 'diagnoses' or 'problems'. This can arise in two main ways:
- (a) When a person who may or may not be sick encounters the health services for some specific purpose, such as to receive limited care or service for a current condition, to donate an organ or tissue, to receive prophylactic vaccination (immunization), or to discuss a problem which is in itself not a disease or injury.
- (b) When some circumstance or problem is present which influences the person's health status but is not in itself a current illness or injury.
Source: CMS ICD-10-CM Tabular List. How to read instructional notes.
Referenced in Other NotesGuidance
Instructional notes printed at other codes that name Z68.43, its category, or a range that includes it.
Use Additional Code 5
These codes say to use an additional code from the note, and Z68.43 is one of the codes named.
- E88.82 Obesity due to disruption of MC4R pathwaycode to identify body mass index (BMI), if known (Z68.-) names Z68.-, which includes this code
- R63.6 Underweightcode to identify body mass index (BMI), if known (Z68.-) names Z68.-, which includes this code
- Z15.2 Genetic susceptibility to obesitycode to identify body mass index (BMI), if known (Z68.-) names Z68.-, which includes this code
- Z71.3 Dietary counseling and surveillancecode to identify body mass index (BMI), if known (Z68.-) names Z68.-, which includes this code
- E66 Overweight and obesity
Index to Diseases and InjuriesGuidance
Alphabetical index entries that point to this code.
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
Patient EducationClinical
Body Weight
Body weight is the total mass of your body. Keeping track of your weight is one way to check for changes in your health, but it can't tell you the whole story. That's because your weight includes muscle, bone, fat, and water. Also, everyday factors can play a role in your weight, such as your:
The full article covers:
- What is body weight?
- What factors help determine a healthy body weight?
- What are body weight ranges?
- What if I have a sudden gain or loss of weight?
- How can I maintain a healthy body weight?
Read the full article at MedlinePlus
Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.
Convert Z68.43 to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About Z68.43Overview
What is the ICD-10 code for body mass index [BMI] 50.0-59.9, adult?
The ICD-10-CM code for body mass index [BMI] 50.0-59.9, adult is Z68.43 (sometimes written as Z6843). It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
Is Z68.43 (Body mass index [BMI] 40 or greater, adult) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report body mass index [BMI] 50.0-59.9, adult on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
What MS-DRG does Z68.43 group to?
On inpatient claims, body mass index [BMI] 50.0-59.9, adult maps to MS-DRG 641, 640, with relative weights from 0.7864 to 1.3392 depending on complications. Higher weights mean higher Medicare reimbursement.
Is Z68.43 a CC or MCC?
CMS lists Z68.43 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 9 closely related codes in its exclusion list.
Can Z68.43 be a principal diagnosis?
No. The Medicare Code Editor rejects this code as a principal diagnosis because body mass index [BMI] 50.0-59.9, adult describes a circumstance that influences health status rather than a current illness. Report it as a secondary diagnosis.
What HCC is Z68.43?
Z68.43 (body mass index [BMI] 50.0-59.9, adult) maps to CMS-HCC Category 48 (Morbid Obesity), commonly written as HCC 48, in the CMS-HCC V28 model used for Medicare Advantage risk adjustment in payment year 2027. It mapped to HCC 22 under the retired V24 model. It also maps in the PACE (CMS-HCC V22), ESRD (V21), and ESRD (V24) models. It does not map to any RxHCC in the Part D prescription drug model.
Does Z68.43 risk-adjust for Medicare Advantage payment?
Yes. When documented and reported on a Medicare Advantage encounter, Z68.43 adds a risk adjustment factor of about 0.186 to the beneficiary's RAF score for a community, non-dual, aged enrollee (published V28 weights range from 0.118 to 0.442 depending on the payment segment). HCC 48 sits at the top of its hierarchy, so no other condition category supersedes it. See the full factor table on the HCC 48 category page.
