ICD-10 K22.3
Billable / Specific MCCPerforation of esophagus
About ICD-10-CM K22.3
ICD-10-CM code K22.3 represents Perforation of esophagus. This is a billable/specific code in the Digestive System chapter (block K22). The 2026 edition of ICD-10-CM K22.3 became effective on October 1, 2025.
Coding Tips for K22.3
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
K22.3 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.
Inclusion Terms / Approximate Synonyms
Clinical terms and conditions classified under K22.3. Per CMS ICD-10-CM Tabular 2026.
- Rupture of esophagus
Type 1 Excludes
Pure excludes, these codes can never be coded together with K22.3. The conditions are mutually exclusive (e.g., congenital vs acquired forms).
- traumatic perforation of (thoracic) esophagus (S27.8-)
Inpatient DRG Impact, MCC
codes Perforation of esophagus. As a Major Complication/Comorbidity (MCC), this can shift the DRG assignment to a higher-weighted category, substantial reimbursement impact.
Medicare LCD Coverage for K22.3
Local Coverage Determinations (LCDs) from CMS MACs that list K22.3 as a covered diagnosis.
Showing top 10 of 164 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing K22.3.
5 Medicare
CPT Codes Commonly Billed with K22.3
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- 43753 Gastrostomy tube placement Gastroenterology
Convert K22.3 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 |
|---|---|---|
| K22.3 | 5304 | 00000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To K22.3
Other codes in section K20-K31 (Diseases of esophagus, stomach and duodenum).
ICD-10 K22.3, Billing FAQ
Is ICD-10 code K22.3 billable? +
Yes, K22.3 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
What other names or terms map to K22.3? +
ICD-10 K22.3 includes: Rupture of esophagus.
What codes are Type 1 Excludes for K22.3? +
Type 1 Excludes (never code together with K22.3): traumatic perforation of (thoracic) esophagus (S27.8-)
Is K22.3 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 K22.3? +
Procedures frequently paired with K22.3 include: 43753.
What ICD-9 codes does K22.3 map to? +
Per CMS GEMs, K22.3 maps to ICD-9 codes: 5304. 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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