2027 ICD-10-CM Diagnosis Code Z97.16Presence of artificial legs, bilateral (complete) (partial)
Z97.16 is a billable ICD-10-CM diagnosis code for presence of artificial legs, bilateral (complete) (partial). It is valid on HIPAA claims for fiscal year 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 564 through 566. The code is not accepted as a principal diagnosis by the Medicare Code Editor and exempt from POA reporting. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Implant, device or graft related encounter.
For Medicare Advantage risk adjustment, Z97.16 maps to CMS-HCC Category 409 (Amputation Status, Lower Limb/Amputation Complications) under the V28 model, adding a risk factor of about 0.598 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 Z97.16.
Present on Admission (POA)Billing
Z97.16 is exempt from POA reporting on inpatient claims to general acute care hospitals. Review the other POA exempt codes in Persons with potential health hazards related to family and personal history and certain conditions influencing health status (Z77-Z99).
Medicare Risk Adjustment (HCC)Billing
Z97.16 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 Z97.16: its own notes plus those printed at Z97, block Z77-Z99, and Chapter 21. A note printed at a category, block or chapter applies to every code under it.
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.
Code Also
A second code may be needed to fully describe the condition; the note gives no sequencing direction.
Notes
General instructions on how these codes are used.
- 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 Z97.16, its category, or a range that includes it.
Excludes1 2
These codes carry an Excludes1 note naming Z97.16: they are not reported together with it, unless the two conditions are unrelated.
Excludes2 4
These codes carry an Excludes2 note naming Z97.16: its condition is not part of those codes, and both may be reported when the patient has both.
- Z87.7 Personal history of (corrected) congenital malformationspresence of other devices (Z97.-) names Z97.-, which includes this code
- M96 Intraoperative and postprocedural complications and disorders of musculoskeletal system, not elsewhere classified
- Z45.018 Encounter for adjustment and management of other part of cardiac pacemaker
- Z46 Encounter for fitting and adjustment of other devices
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
Artificial Limbs
People can lose all or part of an arm or leg for a number of reasons. Common ones include:
Read the full article at MedlinePlus
Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.
Convert Z97.16 to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About Z97.16Overview
What is the ICD-10 code for presence of artificial legs, bilateral (complete) (partial)?
The ICD-10-CM code for presence of artificial legs, bilateral (complete) (partial) is Z97.16 (sometimes written as Z9716). It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
Is Z97.16 (Presence of artificial limb (complete) (partial)) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report presence of artificial legs, bilateral (complete) (partial) on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
What MS-DRG does Z97.16 group to?
On inpatient claims, presence of artificial legs, bilateral (complete) (partial) maps to MS-DRG 564, 566, 565, with relative weights from 0.7374 to 1.4909 depending on complications. Higher weights mean higher Medicare reimbursement.
Can Z97.16 be a principal diagnosis?
No. The Medicare Code Editor rejects this code as a principal diagnosis because presence of artificial legs, bilateral (complete) (partial) describes a circumstance that influences health status rather than a current illness. Report it as a secondary diagnosis.
Is Z97.16 exempt from POA reporting?
Yes. CMS lists this code among those exempt from present on admission reporting, so hospitals do not assign a POA indicator for presence of artificial legs, bilateral (complete) (partial) on inpatient claims. The code appears in the Persons with potential health hazards related to family and personal history and certain conditions influencing health status (Z77-Z99) range of the CMS exempt list.
What HCC is Z97.16?
Z97.16 (presence of artificial legs, bilateral (complete) (partial)) maps to CMS-HCC Category 409 (Amputation Status, Lower Limb/Amputation Complications), commonly written as HCC 409, in the CMS-HCC V28 model used for Medicare Advantage risk adjustment in payment year 2027. It does not map to any RxHCC in the Part D prescription drug model.
Does Z97.16 risk-adjust for Medicare Advantage payment?
Yes. When documented and reported on a Medicare Advantage encounter, Z97.16 adds a risk adjustment factor of about 0.598 to the beneficiary's RAF score for a community, non-dual, aged enrollee (published V28 weights range from 0.284 to 0.844 depending on the payment segment). A more severe related category (HCC 263 and HCC 405) supersedes it when both are reported. See the full factor table on the HCC 409 category page.
