Z89 — Amputation Status Codes

🦾 Z89 — Acquired Absence of Limb (Amputation Status)

Quick Orientation

Z89 codes document acquired absence of a limb — meaning the limb was surgically amputated or traumatically lost. These are status codes, always secondary, never PDX. They pair directly with Z47.81 (post-amputation aftercare) in IRF admissions and with prosthetic CPT codes in PM&R encounters. Congenital absence of limb is coded separately under Q71-Q73 — do not use Z89 for congenital limb deficiency.

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📑 Table of Contents

1. Z89 Code Fundamentals
2. Upper Extremity — Finger Level (Z89.0)
3. Upper Extremity — Hand and Wrist (Z89.1)
4. Upper Extremity — Above Wrist (Z89.2)
5. Lower Extremity — Toe Level (Z89.4)
6. Lower Extremity — Foot and Ankle (Z89.5)
7. Lower Extremity — Above Ankle (Z89.6)
8. Common Coding Pitfalls
9. Essential Code Pairings
10. Coding Scenarios
11. Related Notes

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🧭 Z89 Code Fundamentals

Critical Rules

• Z89 codes are always secondary — never PDX
• Use only for acquired absence — not congenital
• Code the underlying cause of amputation as additional dx when relevant (e.g., diabetes, PAD, trauma)
• Laterality is required — right, left, or bilateral/unspecified
• Level of amputation must match documentation — partial vs. complete, foot vs. ankle vs. below knee vs. above knee

Concept	Rule
Congenital limb absence	Q71-Q73, NOT Z89
Traumatic amputation, acute	S48/S58/S68/S78/S88/S98 (injury codes), NOT Z89
Healed/established amputation	Z89.-
Multiple limb amputations	Code each separately
Bilateral amputation	Use bilateral code where available; code each side if not

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🖐️ Upper Extremity Amputations — Finger Level (Z89.0)

Code	Description
Z89.011	Acquired absence of right thumb
Z89.012	Acquired absence of left thumb
Z89.019	Acquired absence of thumb, unspecified
Z89.021	Acquired absence of right index finger
Z89.022	Acquired absence of left index finger
Z89.029	Acquired absence of index finger, unspecified
Z89.111	Acquired absence of right hand
Z89.112	Acquired absence of left hand
Z89.119	Acquired absence of hand, unspecified
Z89.121	Acquired absence of right wrist
Z89.122	Acquired absence of left wrist
Z89.129	Acquired absence of wrist, unspecified

Finger-Level Coding

Individual finger codes exist for thumb and index finger specifically. For middle, ring, and little finger absence, use Z89.02- (other finger) codes. Multiple finger absence on same hand — code each absent finger separately.

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✋ Upper Extremity Amputations — Hand and Wrist Level (Z89.1)

Code	Description
Z89.111	Acquired absence of right hand
Z89.112	Acquired absence of left hand
Z89.119	Acquired absence of hand, unspecified
Z89.121	Acquired absence of right wrist
Z89.122	Acquired absence of left wrist
Z89.129	Acquired absence of wrist, unspecified
Z89.131	Acquired absence of right forearm
Z89.132	Acquired absence of left forearm
Z89.139	Acquired absence of forearm, unspecified
Z89.141	Acquired absence of right shoulder
Z89.142	Acquired absence of left shoulder
Z89.149	Acquired absence of shoulder, unspecified

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💪 Upper Extremity Amputations — Above Wrist (Z89.2)

Code	Description
Z89.201	Acquired absence of right upper limb, unspecified level
Z89.202	Acquired absence of left upper limb, unspecified level
Z89.209	Acquired absence of upper limb, unspecified
Z89.211	Acquired absence of right upper limb below elbow
Z89.212	Acquired absence of left upper limb below elbow
Z89.219	Acquired absence of upper limb below elbow, unspecified
Z89.221	Acquired absence of right upper limb above elbow
Z89.222	Acquired absence of left upper limb above elbow
Z89.229	Acquired absence of upper limb above elbow, unspecified
Z89.231	Acquired absence of right shoulder joint
Z89.232	Acquired absence of left shoulder joint
Z89.239	Acquired absence of shoulder joint, unspecified
Z89.241	Acquired absence of right arm at shoulder joint (forequarter)
Z89.242	Acquired absence of left arm at shoulder joint (forequarter)
Z89.249	Acquired absence of arm at shoulder joint, unspecified

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🦶 Lower Extremity Amputations — Toe Level (Z89.4)

Code	Description
Z89.411	Acquired absence of right great toe
Z89.412	Acquired absence of left great toe
Z89.419	Acquired absence of great toe, unspecified
Z89.421	Acquired absence of right toe(s)
Z89.422	Acquired absence of left toe(s)
Z89.429	Acquired absence of toe(s), unspecified
Z89.431	Acquired absence of right foot
Z89.432	Acquired absence of left foot
Z89.439	Acquired absence of foot, unspecified
Z89.441	Acquired absence of right ankle
Z89.442	Acquired absence of left ankle
Z89.449	Acquired absence of ankle, unspecified

Toe Amputation — Diabetic Context

Toe amputations are extremely common in diabetic patients with peripheral vascular disease. Always code the underlying etiology:

• E11.51 — Type 2 DM with diabetic peripheral angiopathy without gangrene
• E11.52 — Type 2 DM with diabetic peripheral angiopathy with gangrene
• I70.- — Atherosclerosis of native arteries of extremities

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🦵 Lower Extremity Amputations — Foot and Ankle Level (Z89.5)

Code	Description
Z89.511	Acquired absence of right leg below knee
Z89.512	Acquired absence of left leg below knee
Z89.519	Acquired absence of leg below knee, unspecified
Z89.521	Acquired absence of right knee
Z89.522	Acquired absence of left knee
Z89.529	Acquired absence of knee, unspecified
Z89.531	Acquired absence of right leg above knee
Z89.532	Acquired absence of left leg above knee
Z89.539	Acquired absence of leg above knee, unspecified
Z89.541	Acquired absence of right hip joint
Z89.542	Acquired absence of left hip joint
Z89.549	Acquired absence of hip joint, unspecified

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🦿 Lower Extremity Amputations — Above Ankle (Z89.6)

Code	Description
Z89.601	Acquired absence of right leg, unspecified level
Z89.602	Acquired absence of left leg, unspecified level
Z89.609	Acquired absence of leg, unspecified
Z89.611	Acquired absence of right leg below knee
Z89.612	Acquired absence of left leg below knee
Z89.619	Acquired absence of leg below knee, unspecified
Z89.621	Acquired absence of right knee
Z89.622	Acquired absence of left knee
Z89.629	Acquired absence of knee, unspecified
Z89.631	Acquired absence of right leg above knee
Z89.632	Acquired absence of left leg above knee
Z89.639	Acquired absence of leg above knee, unspecified
Z89.641	Acquired absence of right hip joint
Z89.642	Acquired absence of left hip joint
Z89.649	Acquired absence of hip joint, unspecified
Z89.9	Acquired absence of limb, unspecified

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⚠️ Common Coding Pitfalls

Pitfalls to Avoid

Pitfall	Correct Approach
Using Z89 for congenital limb absence	Use Q71-Q73 instead
Using Z89 during acute traumatic amputation encounter	Use S-code injury codes with 7th char A; Z89 applies after healing
Missing laterality	Always specify right, left, or bilateral
Missing level of amputation	Below knee (BK), above knee (AK), transmetatarsal — document and code specifically
Forgetting underlying etiology	Always code diabetes, PAD, trauma etiology as additional dx
Using unspecified Z89.9 when level is documented	Code the most specific level available

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🔗 Essential Code Pairings

Z89 Scenario	Pair With
Post-amputation IRF admission	Z47.81 as PDX
Diabetic toe/foot amputation	E11.51 or E11.52
PAD-related amputation	I70.- atherosclerosis codes
Prosthetic training	CPT 97761
Wheelchair dependence post-amp	Z99.3
Reduced mobility	Z74.09
Phantom limb pain	G54.6 (phantom limb syndrome with pain)
Stump complication	T87.- (complications of reattachment and amputation)

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📌 Coding Scenarios

Scenario 1: Right BKA, Diabetic, IRF Prosthetic Rehab

• PDX: Z47.81
• Secondary: Z89.511 — Acquired absence right leg below knee
• Secondary: E11.52 — Type 2 DM with peripheral angiopathy with gangrene
• Secondary: Z74.09 — Reduced mobility
• CPT: 97761 — Prosthetic training

Scenario 2: Bilateral AKA, Traumatic, Acute Care

• PDX: S78.011A — Complete traumatic amputation at right hip joint, initial
• Secondary: S78.012A — Complete traumatic amputation at left hip joint, initial
• Note: Z89 not used during acute traumatic encounter — applies after healing

Scenario 3: Left Great Toe Amputation, Established, Wound Care Visit

• PDX: Z47.81 or Z48.00 depending on what’s being done
• Secondary: Z89.412 — Acquired absence left great toe
• Secondary: E11.51 — Type 2 DM with peripheral angiopathy w/o gangrene

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🔍 Related Notes (Link When Built)

• PM&R Z Codes — Inpatient Coding Reference
• Z93 Artificial Opening Status Codes
• Z94 Transplant Status Codes
• CC MCC Table — PM&R
• Spinal Cord Injury Coding — G82 and S-Codes

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Sources: ICD-10-CM FY2026 Official Guidelines; CMS MS-DRG Grouper v41; AAPC CIC Study Resources.^1,2,3