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E72.538 ICD-10-CM Code: Other specified primary hyperoxaluria

Billing Status: YES. This is a valid, specific, and billable ICD-10-CM reference.

Coding at a Glance

Tabular directives
2 inclusion terms · 12 Excludes1 · 1 Excludes2
Risk adjustment
CMS-HCC V28: 1 category · CMS-HCC V22 category 23 · RxHCC V08 category 43

Inpatient Payment Groups (MS-DRG)

Potential MS-DRG participation — not a DRG assignment.

MS-DRGs this diagnosis helps define, as principal or secondary, per the CMS ICD-10-CM/PCS MS-DRG Definitions Manual v43, Appendix B.

  • MS-DRG 642 — INBORN AND OTHER DISORDERS OF METABOLISM (MDC 10)

A diagnosis appearing in a group's logic does not by itself determine the DRG assigned to a stay; the grouper uses the full claim.

Risk Adjustment (CMS-HCC)

Payment categories this diagnosis maps to under CMS-HCC V28, payment year 2026.

  • HCC 50 — Amyloidosis, Porphyria, and Other Specified Metabolic Disorders

Other models: CMS-HCC V22 HCC 23 · RxHCC V08 HCC 43

Risk scores depend on the enrollee's full accepted diagnosis set and segment; a category mapping alone does not determine payment.

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for E72.538 in the official ICD-10-CM tabular list, quoted as published.

Source: CMS/CDC — ICD-10-CM Tabular ListRelease: FY2026Effective: October 1, 2025

Notes without a marker are published on E72.538 itself; “inherited from” names the category or block whose note applies here.

Inclusion Terms

Alternative terms the tabular list files under this code.

  • Primary hyperoxaluria, type 2
  • Primary hyperoxaluria, type 3

Excludes1 — Not Coded Here

Conditions generally not reported together with this code (Excludes1) -- an error unless the two conditions are documented as unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).

Excludes2 — Not Included Here

Conditions not covered by this code, but which may be reported alongside it when both are present.

Source: inherited from E70-E88

Coder workflow for E72.538

MedCoder structured workflow — derived from this code’s own official record

Before you code E72.538

  1. “Other” (NEC) means the condition is specified in the record but no dedicated code captures it. Confirm the documented form is not one a sibling code names before settling on E72.538; if the record states no specifics at all, the unspecified sibling applies instead. “Other” codes are for documented conditions the classification gives no specific code; “unspecified” codes are for records lacking the detail (Guidelines I.A.9.a, I.A.9.b).

    ReviewE72.530

    See the relationships section · Guide: Other vs unspecified (NEC vs NOS) →

  2. Check the Excludes1 note: if the documentation supports a condition named there, do not simply proceed with E72.538. Excludes1 conditions are not reported together with this code unless the record shows they are unrelated (Guidelines I.A.12.a).

    See the official tabular notes

Choose the right path

  1. Does the documentation support a condition named in E72.538’s Excludes1 note?
    Yes → Do not simply proceed: review the excluded code. Both are reported only when the record shows the two conditions are unrelated.
    No → Continue.

    ReviewE72.54, E70, E71.3, E79, M1A, M10

Consider E72.538. Then confirm the code is valid for the date of service in the Verify section.

Documentation check

The provider’s diagnostic statement
Codes are assigned from the provider’s documented diagnosis, not from clinical criteria, test values or a medication list (Guidelines I.A.19).
Any detail beyond this code’s title
What the record states that a more specific sibling code would capture — or its absence, which itself supports the unspecified code.

Official instructions as workflow

  • Excludes1 — check before selecting E72.538(12 notes)

    Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with E72.538: the two are not reported together. The one exception is when the record shows the two conditions are unrelated to each other.

    CompareE72.54, E70, E71.3, E79, M1A, M10

    See the official tabular notes · Guidelines I.A.12.a

  • Excludes2 — not part of E72.538(1 note)

    Coding workflow: The conditions named in this note are not included in E72.538. When the record documents both, both may be reported; the note is a boundary, not a prohibition.

    CompareQ79.6

    See the official tabular notes · Guidelines I.A.12.b

Coding decision scenarios

Pattern scenarios for this code’s structure — decision rules, not clinical cases

Documentation: Both the condition E72.538 describes and a condition named in its Excludes1 note are documented for the same encounter.

Coding question: Can both codes be reported?

Path: Review the Excludes1 note and the excluded code, and look for a provider statement on whether the two conditions are related.

Reason: Excludes1 means the two are not coded together; the exception is when the record shows the conditions are unrelated to each other (Guidelines I.A.12.a).

ReviewE72.54, E70, E71.3, E79, M1A, M10

Every row is derived from this code’s own record — its title, tabular notes, 7th-character family and same-category siblings — with fixed MedCoder wording; nothing is inferred about a patient. The official notes and guideline text are in the sections each row links to, and they control.

Code Overview

Other specified primary hyperoxaluria is a billable ICD-10-CM diagnosis code (E72.538).

MedCoder summary Summary composed by MedCoder from this code's official ICD-10-CM record. The tabular instructional notes themselves appear verbatim below.

Indexed Clinical Terms (3)

Official source data — entries quoted as published, in the Index’s own lookup phrasing

Clinical term phrases from the official ICD-10-CM Index to Diseases and Injuries that map to this code. These are alphabetic-index entries shown as the Index writes them — lookup phrasing, not necessarily the wording of a final diagnosis.

Verify Before Coding

  • CC as a secondary diagnosis (FY2026). Can raise the stay's MS-DRG severity tier.

From the code registry, the Medicare Code Editor, and the MS-DRG Definitions Manual. Check it against a full claim in Claim Check.

Relationships & Classification

MedCoder structured relationships — computed from published CMS and AHRQ datasets

Other codes that name E72.538 or its code family, from the CMS ICD-10-CM tabular instructional notes. Tabular-note edges are stored at the code family level that carries each note.

Referenced by 9 Excludes1 notes across 3 chapters: E72.54 — Secondary hyperoxaluria (via E72.53.-), P59 — Neonatal jaundice from other and unspecified causes (via E72.-), R79 — Other abnormal findings of blood chemistry (via E72.-), R79.83 — Abnormal findings of blood amino-acid level (via E72.-), R80 — Proteinuria (via E72.-), R80-R82 — Abnormal findings on examination of urine, without diagnosis (R80-R82) (via E72.-), R81 — Glycosuria (via E72.-), R82 — Other and unspecified abnormal findings in urine (via E72.-), R82.992 — Hyperoxaluria (via E72.53.-).

These codes’ tabular lists mark this diagnosis as mutually exclusive — not reported together unless the conditions are documented as unrelated.

Referenced by 4 Excludes2 notes across 2 chapters: G11 — Hereditary ataxia (via E72.-), G71 — Primary disorders of muscles (via E72.-), N25.0 — Renal osteodystrophy (via E72.-), N25.81 — Secondary hyperparathyroidism of renal origin (via E72.-).

These codes’ tabular lists name this diagnosis as distinct — both may be reported when both are documented.

Referenced by 2 Code First instructions across 2 chapters: G63 — Polyneuropathy in diseases classified elsewhere (via E72.-), H42 — Glaucoma in diseases classified elsewhere (via E72.-).

Each of these codes carries a Code First note naming this condition — when that code is reported, THIS code is sequenced first, ahead of it.

MS-DRG Grouper Relationships (FY2026)

Potential MS-DRG participation — not a DRG assignment.

FY2026 MS-DRG: CC — Complication or Comorbidity. Reported as a secondary diagnosis, this code raises the stay's MS-DRG severity tier — except when the principal diagnosis is one of 144 clinically related codes on its CMS exclusion list.

Named in the grouper logic of 1 MS-DRG: DRG 642 (MDC 10).

From the CMS MS-DRG Definitions Manual (Appendices B and C). Actual DRG assignment depends on the complete claim.

Clinical classification (AHRQ CCSR):END016 — Other specified and unspecified nutritional and metabolic disorders (default).

Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses. Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.

Related Codes

Same clinical process (MS-DRG)

Acts as CC — raises the severity of other admissions. CMS groups these diagnoses into one MS-DRG principal-diagnosis exclusion process — a CC/MCC on this list never raises severity when the principal diagnosis is also on it.

E72.21 — Argininemia, E72.22 — Arginosuccinic aciduria, E72.23 — Citrullinemia, E72.29 — Other disorders of urea cycle metabolism, E72.3 — Disorders of lysine and hydroxylysine metabolism, E72.4 — Disorders of ornithine metabolism, E72.50 — Disorder of glycine metabolism, unspecified, E72.51 — Non-ketotic hyperglycinemia, E72.52 — Trimethylaminuria, E72.530 — Primary hyperoxaluria, type 1, E72.539 — Primary hyperoxaluria, unspecified, E72.540 — Dietary hyperoxaluria, E72.541 — Enteric hyperoxaluria, E72.548 — Other secondary hyperoxaluria, E72.549 — Secondary hyperoxaluria, unspecified, E72.59 — Other disorders of glycine metabolism, E72.81 — Disorders of gamma aminobutyric acid metabolism, E72.89 — Other specified disorders of amino-acid metabolism, E72.9 — Disorder of amino-acid metabolism, unspecified, E73.0 — Congenital lactase deficiency, +123 more

Same CMS-HCC risk category (V28)

CMS maps these diagnoses to the same Hierarchical Condition Category (Amyloidosis, Porphyria, and Other Specified Metabolic Disorders) for risk-adjusted payment.

E72.53 — Primary hyperoxaluria, E72.530 — Primary hyperoxaluria, type 1, E72.539 — Primary hyperoxaluria, unspecified, E74.00 — Glycogen storage disease, unspecified, E74.01 — von Gierke disease, E74.03 — Cori disease, E74.04 — McArdle disease, E74.05 — Lysosome-associated membrane protein 2 [LAMP2] deficiency, E74.09 — Other glycogen storage disease, E79.1 — Lesch-Nyhan syndrome, E80.0 — Hereditary erythropoietic porphyria, E80.1 — Porphyria cutanea tarda, E80.20 — Unspecified porphyria, E80.21 — Acute intermittent (hepatic) porphyria, E80.29 — Other porphyria, E80.3 — Defects of catalase and peroxidase, E83.00 — Disorder of copper metabolism, unspecified, E83.01 — Wilson's disease, E83.09 — Other disorders of copper metabolism, E83.31 — Familial hypophosphatemia, +11 more

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical category (Other specified and unspecified nutritional and metabolic disorders).

E72.22 — Arginosuccinic aciduria, E72.23 — Citrullinemia, E72.29 — Other disorders of urea cycle metabolism, E72.3 — Disorders of lysine and hydroxylysine metabolism, E72.4 — Disorders of ornithine metabolism, E72.50 — Disorder of glycine metabolism, unspecified, E72.51 — Non-ketotic hyperglycinemia, E72.52 — Trimethylaminuria, E72.53 — Primary hyperoxaluria, E72.530 — Primary hyperoxaluria, type 1, E72.539 — Primary hyperoxaluria, unspecified, E72.540 — Dietary hyperoxaluria, E72.541 — Enteric hyperoxaluria, E72.548 — Other secondary hyperoxaluria, E72.549 — Secondary hyperoxaluria, unspecified, E72.59 — Other disorders of glycine metabolism, E72.8 — Other specified disorders of amino-acid metabolism, E72.81 — Disorders of gamma aminobutyric acid metabolism, E72.89 — Other specified disorders of amino-acid metabolism, E72.9 — Disorder of amino-acid metabolism, unspecified, +258 more

Lab tests where this diagnosis supports Medicare coverage (NCD)

Medicare's National Coverage Determination (NCD) program lists this diagnosis as medical justification for these lab tests.

Blood Glucose Test

Contextual Map

Every relationship of E72.538 in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.

Run E72.538 with these 14 related codes in Claim Check

Hierarchy

Referenced by Excludes1 notes (9)

Referenced by Excludes2 notes

Referenced by Code First instructions

Clinical classification (CCSR)

Risk adjustment (CMS-HCC)

  • HCC 50 — Amyloidosis, Porphyria, and Other Specified Metabolic Disorders [CMS-HCC]— CMS-HCC V28 · 2026

MS-DRG Grouper

  • CC — Complication or Comorbidity [MS-DRG severity]: “As a secondary diagnosis this code can raise the stay's MS-DRG severity tier (CC).”— CMS MS-DRG Definitions Manual (Appendix C) · FY2026
  • DRG 642 — INBORN AND OTHER DISORDERS OF METABOLISM[MS-DRG]: “INBORN AND OTHER DISORDERS OF METABOLISM (MDC 10)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2026

MDC crossing

  • MDC 10 — Endocrine, Nutritional and Metabolic Diseases and Disorders[MDC crossing]: “Endocrine, Nutritional and Metabolic Diseases and Disorders — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs. 5,008 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2026

Index entries

  • Disorder (of), glycine metabolism, hyperoxaluria, primary, specified type NEC[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Disorder (of), glycine metabolism, hyperoxaluria, primary, type 2[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Disorder (of), glycine metabolism, hyperoxaluria, primary, type 3[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026

Nearest codes (38)

Change history

Sources for this page

Codes, titles, notes, index terms and mappings on this page are transcribed from the datasets below. Relationships MedCoder computed and text MedCoder wrote are labelled where they appear.

Code, title, tabular notes and index terms Official source data
CMS/CDC ICD-10-CM FY2026 tabular list, index and tables, effective October 1, 2025 Release, file and checksum · Publisher’s page
Claim edits Official source data
CMS Definitions of Medicare Code Edits — v43.1 (April 2026) Release, file and checksum · Publisher’s page
Inpatient payment groups Official source data
CMS MS-DRG Definitions Manual (incl. Appendix B diagnosis index, Appendix C CC/MCC list, Appendix E procedure index) and IPPS Final Rule tables — v43 Release, file and checksum · Publisher’s page
Risk adjustment Official source data
2026 Mid-Year Final ICD-10 Mappings + Model Software (cms.gov/files/zip/2026-midyear-final-icd-10-mappings.zip, 2026-midyear-final-model-software.zip) — CMS-HCC V28, PY2026 mid-year final release Release, file and checksum · Publisher’s page
Change history and date-of-service validity Official source data
CMS ICD-10-CM release addenda, ingested release by release into the change ledger Release, file and checksum · Publisher’s page
Comparisons, relationships and the contextual map MedCoder structured relationship
Computed by MedCoder from the tabular notes and tables above; every derived relationship is marked as derived where it appears
Summary and FAQ answers MedCoder explanation
Written by MedCoder to explain the sources above: drafted with AI assistance, checked by a person against the release files, and labelled as MedCoder text where it appears. Not official text.

Labels on this page: Official source data · MedCoder structured relationship · MedCoder explanation. How to read the labels · All data sources and release dates

Cite this page

Reference this page in a research guide, syllabus or article. The release is included because code content changes each year.

MedCoder.ai. "E72.538 — Other specified primary hyperoxaluria." ICD-10-CM FY2026. https://medcoder.ai/icd10/code/e72.538-other-specified-primary-hyperoxaluria

Change history

  • FY2026 — October 1, 2025
    Added to the code set
    Other specified primary hyperoxaluria
    FY2026 changes

Nearest Codes in This Family

Official ICD-10-CM classifications closest to E72.538 in its code family, with their registry titles.

View all codes in the E72 family