ICD-10-CM 2026 · Effective October 1, 2025

ICD-10 E84.11

Billable / Specific HCC v28: 110 MCC

Meconium ileus in cystic fibrosis

E84
Block
0
Synonyms
96
LCDs
10
Payer Policies
0
Linked CPTs

About ICD-10-CM E84.11

ICD-10-CM code E84.11 represents Meconium ileus in cystic fibrosis. This is a billable/specific code in the Endocrine, Nutritional, and Metabolic chapter (block E84). The 2026 edition of ICD-10-CM E84.11 became effective on October 1, 2025.

Coding Tips for E84.11

Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.

HCC capture: document with MEAT each year

E84.11 is a CMS-HCC v28 risk-adjustment code (category 110). To count for the patient Risk Adjustment Factor (RAF), document the diagnosis with MEAT language each calendar year: Monitored, Evaluated, Assessed, Treated. A diagnosis on the problem list alone does not satisfy CMS RADV audit standards. Include the diagnosis in the assessment with current status and current treatment plan.

Inpatient DRG impact: MCC

E84.11 is designated MCC for MS-DRG grouping. On inpatient claims, this code can shift the DRG to the with-MCC variant when documented as a present-on-admission secondary diagnosis. Hospital CDI programs flag MCC opportunities during chart review. Failure to capture this code may leave 30 to 80 percent of the inpatient stay revenue unrealized.

Type 1 Excludes

Pure excludes, these codes can never be coded together with E84.11. The conditions are mutually exclusive (e.g., congenital vs acquired forms).

  • meconium ileus not due to cystic fibrosis (P76.0)

Medicare Advantage HCC Impact

CMS-HCC v28 (current)
Category 110
ESRD-HCC
Category 110
RxHCC (Part D)
Category 110

Capture this diagnosis annually for accurate risk adjustment. Missed HCC captures are the #1 revenue leak in Medicare Advantage risk programs.

Inpatient DRG Impact, MCC

codes Meconium ileus in cystic fibrosis. As a Major Complication/Comorbidity (MCC), this can shift the DRG assignment to a higher-weighted category, substantial reimbursement impact.

Medicare LCD Coverage for E84.11

Local Coverage Determinations (LCDs) from CMS MACs that list E84.11 as a covered diagnosis.

96 LCDs

Showing top 10 of 96 total . Click a CPT for full coverage scope.

CMS LCD: Billing and Coding: Respiratory Care
Article ID: 57224, Effective: 2026-01-01 00:00:00, 901 covered, 0 non-covered
CPT 94660 →
CMS LCD: Billing and Coding: Respiratory Care
Article ID: 57224, Effective: 2026-01-01 00:00:00, 901 covered, 0 non-covered
CPT 94726 →
CMS LCD: Billing and Coding: Respiratory Care
Article ID: 57224, Effective: 2026-01-01 00:00:00, 901 covered, 0 non-covered
CPT 94664 →
CMS LCD: Billing and Coding: Respiratory Care
Article ID: 57224, Effective: 2026-01-01 00:00:00, 901 covered, 0 non-covered
CPT 94618 →
CMS LCD: Billing and Coding: Respiratory Care
Article ID: 57224, Effective: 2026-01-01 00:00:00, 901 covered, 0 non-covered
CPT 94772 →
CMS LCD: Billing and Coding: Respiratory Care
Article ID: 57224, Effective: 2026-01-01 00:00:00, 901 covered, 0 non-covered
CPT 94642 →
CMS LCD: Billing and Coding: Respiratory Care
Article ID: 57224, Effective: 2026-01-01 00:00:00, 901 covered, 0 non-covered
CPT G0238 →
CMS LCD: Billing and Coding: Respiratory Care
Article ID: 57224, Effective: 2026-01-01 00:00:00, 901 covered, 0 non-covered
CPT 94004 →
CMS LCD: Billing and Coding: Respiratory Care
Article ID: 57224, Effective: 2026-01-01 00:00:00, 901 covered, 0 non-covered
CPT 94668 →
CMS LCD: Billing and Coding: Respiratory Care
Article ID: 57224, Effective: 2026-01-01 00:00:00, 901 covered, 0 non-covered
CPT 94680 →

Commercial Payer Coverage

Coverage policies from major commercial payers referencing E84.11.

10 policies

2 Cigna

Anesthesia Services for Interventional Pain Management Procedures in an Adult - (0551)
Policy ID: MM_0551
Vitamin D Testing - (0526) ---- future effective policy
Policy ID: MM_0526

5 Medicare

Billing and Coding: Computerized Axial Tomography (CT), Thorax
Policy ID: ART-56580
Billing and Coding: Vitamin D Assay Testing
Policy ID: ART-56798
Billing and Coding: Respiratory Care
Policy ID: ART-57224
Billing and Coding: Monitored Anesthesia Care
Policy ID: ART-57361
Billing and Coding: Vitamin D Assay Testing
Policy ID: ART-57484

CPT Codes Commonly Billed with E84.11

Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.

No procedure linkages on file for E84.11

We don't have CPT pairings indexed for this specific code yet. Use the CPT search above to find common procedures, or check your payer's published medical policy for code-specific guidance.

Convert E84.11 to ICD-9-CM

Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.

ICD-10ICD-9Mapping Flags
E84.11 27701 00000

Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).

ICD-10 E84.11, Billing FAQ

Is ICD-10 code E84.11 billable? +

Yes, E84.11 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.

What codes are Type 1 Excludes for E84.11? +

Type 1 Excludes (never code together with E84.11): meconium ileus not due to cystic fibrosis (P76.0)

Does E84.11 affect Medicare Advantage HCC risk adjustment? +

Yes. E84.11 maps to CMS-HCC v28 category 110. Capture this diagnosis annually for accurate Medicare Advantage risk score.

Is E84.11 a CC or MCC for inpatient DRG? +

Yes, this code is designated as MCC. Documenting as a secondary diagnosis on inpatient claims can shift the DRG to a higher-weighted category.

What ICD-9 codes does E84.11 map to? +

Per CMS GEMs, E84.11 maps to ICD-9 codes: 27701. Useful for legacy data review and historical claim analysis.

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Reviewed by the PayerReady Medical Coding Team

Verified against the CMS 2026 code set on May 31, 2026.

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