ICD-10 I85.11
Billable / Specific HCC v28: 27 MCCSecondary esophageal varices with bleeding
About ICD-10-CM I85.11
ICD-10-CM code I85.11 represents Secondary esophageal varices with bleeding. This is a billable/specific code in the Circulatory System chapter (block I85). The 2026 edition of ICD-10-CM I85.11 became effective on October 1, 2025.
Coding Tips for I85.11
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
I85.11 is a CMS-HCC v28 risk-adjustment code (category 27). 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.
I85.11 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.
Medicare Advantage HCC Impact
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 Secondary esophageal varices with bleeding. As a Major Complication/Comorbidity (MCC), this can shift the DRG assignment to a higher-weighted category, substantial reimbursement impact.
Medicare LCD Coverage for I85.11
Local Coverage Determinations (LCDs) from CMS MACs that list I85.11 as a covered diagnosis.
Showing top 10 of 171 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing I85.11.
5 Medicare
3 Aetna
CPT Codes Commonly Billed with I85.11
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- 91111 CMS LCD: Billing and Coding: Wireless Capsule Endoscopy CMS LCD
- 91110 CMS LCD: Billing and Coding: Wireless Capsule Endoscopy CMS LCD
- 61650 CMS LCD: Billing and Coding: Transcatheter Infusion Therapy CMS LCD
- 61651 CMS LCD: Billing and Coding: Transcatheter Infusion Therapy CMS LCD
- J2353 CMS LCD: Billing and Coding: Octreotide Acetate for Injectable Suspension (Sandostatin� LAR Depot) CMS LCD
Convert I85.11 to ICD-9-CM
Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.
| ICD-10 | ICD-9 | Mapping Flags |
|---|---|---|
| I85.11 | 45620 | 00000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To I85.11
Other codes in section I80-I89 (Diseases of veins, lymphatic vessels and lymph nodes, not elsewhere classified).
ICD-10 I85.11, Billing FAQ
Is ICD-10 code I85.11 billable? +
Yes, I85.11 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
Does I85.11 affect Medicare Advantage HCC risk adjustment? +
Yes. I85.11 maps to CMS-HCC v28 category 27. Capture this diagnosis annually for accurate Medicare Advantage risk score.
Is I85.11 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 CPT codes are commonly billed with I85.11? +
Procedures frequently paired with I85.11 include: 91111, 91110, 61650, 61651, J2353.
What ICD-9 codes does I85.11 map to? +
Per CMS GEMs, I85.11 maps to ICD-9 codes: 45620. 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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