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

ICD-10 K38.1

Billable / Specific

Appendicular concretions

K38
Block
2
Synonyms
107
LCDs
3
Payer Policies
2
Linked CPTs

About ICD-10-CM K38.1

ICD-10-CM code K38.1 represents Appendicular concretions. This is a billable/specific code in the Digestive System chapter (block K38). The 2026 edition of ICD-10-CM K38.1 became effective on October 1, 2025.

Inclusion Terms / Approximate Synonyms

Clinical terms and conditions classified under K38.1. Per CMS ICD-10-CM Tabular 2026.

  • Fecalith of appendix
  • Stercolith of appendix

Medicare LCD Coverage for K38.1

Local Coverage Determinations (LCDs) from CMS MACs that list K38.1 as a covered diagnosis.

107 LCDs

Showing top 10 of 107 total . Click a CPT for full coverage scope.

CMS LCD: Billing and Coding: CT of the Abdomen and Pelvis
Article ID: 56421, Effective: 2025-11-01 00:00:00, 5389 covered, 0 non-covered
CPT 74170 →
CMS LCD: Billing and Coding: CT of the Abdomen and Pelvis
Article ID: 56421, Effective: 2025-11-01 00:00:00, 5389 covered, 0 non-covered
CPT 74177 →
CMS LCD: Billing and Coding: CT of the Abdomen and Pelvis
Article ID: 56421, Effective: 2025-11-01 00:00:00, 5389 covered, 0 non-covered
CPT 74160 →
CMS LCD: Billing and Coding: CT of the Abdomen and Pelvis
Article ID: 56421, Effective: 2025-11-01 00:00:00, 5389 covered, 0 non-covered
CPT 74178 →
CMS LCD: Billing and Coding: CT of the Abdomen and Pelvis
Article ID: 56421, Effective: 2025-11-01 00:00:00, 5389 covered, 0 non-covered
CPT 74150 →
CMS LCD: Billing and Coding: CT of the Abdomen and Pelvis
Article ID: 56421, Effective: 2025-11-01 00:00:00, 5389 covered, 0 non-covered
CPT 72194 →
CMS LCD: Billing and Coding: CT of the Abdomen and Pelvis
Article ID: 56421, Effective: 2025-11-01 00:00:00, 5389 covered, 0 non-covered
CPT 74176 →
CMS LCD: Billing and Coding: CT of the Abdomen and Pelvis
Article ID: 56421, Effective: 2025-11-01 00:00:00, 5389 covered, 0 non-covered
CPT 72192 →
CMS LCD: Billing and Coding: CT of the Abdomen and Pelvis
Article ID: 56421, Effective: 2025-11-01 00:00:00, 5389 covered, 0 non-covered
CPT 72193 →
CMS LCD: Billing and Coding: Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy
Article ID: 56632, Effective: 2025-10-01 00:00:00, 558 covered, 0 non-covered
CPT 45341 →

Commercial Payer Coverage

Coverage policies from major commercial payers referencing K38.1.

3 policies

3 Medicare

Billing and Coding: CT of the Abdomen and Pelvis
Policy ID: ART-56421
Billing and Coding: Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy
Policy ID: ART-56456
Billing and Coding: Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy
Policy ID: ART-56632

CPT Codes Commonly Billed with K38.1

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

2 linkages
  • 44970 Laparoscopic appendectomy — acute appendicitis (all types), other appendicitis, unspecified appendicitis, appendicular abscess, fecalith, concretion, diverticulum General Surgery
  • 44950 Open appendectomy — same indications as laparoscopic General Surgery

Convert K38.1 to ICD-9-CM

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

ICD-10ICD-9Mapping Flags
K38.1 5439 10000

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

Codes Adjacent To K38.1

Other codes in section K35-K38 (Diseases of appendix).

K35 Acute appendicitis (non-billable) K35.2 Acute appendicitis with generalized peritonitis (non-billable) K35.20 Acute appendicitis with generalized peritonitis, without abscess (non-billable) K35.200 Acute appendicitis with generalized peritonitis, without perforation or abscess K35.201 Acute appendicitis with generalized peritonitis, with perforation, without abscess K35.209 Acute appendicitis with generalized peritonitis, without abscess, unspecified as to perforation K35.21 Acute appendicitis with generalized peritonitis, with abscess (non-billable) K35.210 Acute appendicitis with generalized peritonitis, without perforation, with abscess K35.211 Acute appendicitis with generalized peritonitis, with perforation and abscess K35.219 Acute appendicitis with generalized peritonitis, with abscess, unspecified as to perforation K35.3 Acute appendicitis with localized peritonitis (non-billable) K35.30 Acute appendicitis with localized peritonitis, without perforation or gangrene K35.31 Acute appendicitis with localized peritonitis and gangrene, without perforation K35.32 Acute appendicitis with perforation, localized peritonitis, and gangrene, without abscess K35.33 Acute appendicitis with perforation, localized peritonitis, and gangrene, with abscess K35.8 Other and unspecified acute appendicitis (non-billable) K35.80 Unspecified acute appendicitis K35.89 Other acute appendicitis (non-billable) K35.890 Other acute appendicitis without perforation or gangrene K35.891 Other acute appendicitis without perforation, with gangrene

ICD-10 K38.1, Billing FAQ

Is ICD-10 code K38.1 billable? +

Yes, K38.1 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 K38.1? +

ICD-10 K38.1 includes: Fecalith of appendix; Stercolith of appendix.

What CPT codes are commonly billed with K38.1? +

Procedures frequently paired with K38.1 include: 44970, 44950.

What ICD-9 codes does K38.1 map to? +

Per CMS GEMs, K38.1 maps to ICD-9 codes: 5439. Useful for legacy data review and historical claim analysis.

Get the full PayerReady toolkit

Free access to CPT/ICD-10 lookup, denial appeals, fee comparator, and claim auditing with credentialing enrollment.

Start free →

Run this code through our claim audit tool

Check NCCI bundling, MUE limits, and modifier logic before submission.

Try the auditor →

Did this page help?

Quick signal so we know what to improve.

Thanks!

If you want a code reference page that doesn't exist yet, email coding@payerready.com.

Sorry to hear that.

Tell us what's missing or wrong: coding@payerready.com. We respond within 5 business days.

Reviewed by the PayerReady Medical Coding Team

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

Powered by 11K CPT · 98K ICD-10 · 860K MPFS rates · 4.5M NCCI edits · 9.5M NPIs. Our data methodology · About our coding team

Faster Approvals

Ready to Cut Your Enrollment Timeline in Half?

Join providers in all 50 states who handed off credentialing to a dedicated specialist. Create your free account in minutes and start enrolling the same day.

All 50 States Covered
No Long-Term Contracts
HIPAA HIPAA Compliant Platform
Dedicated Specialist Included