ICD-10 K50.813
Billable / Specific HCC v28: 35 CCCrohn's disease of both small and large intestine with fistula
About ICD-10-CM K50.813
ICD-10-CM code K50.813 represents Crohn's disease of both small and large intestine with fistula. This is a billable/specific code in the Digestive System chapter (block K50). The 2026 edition of ICD-10-CM K50.813 became effective on October 1, 2025.
Coding Tips for K50.813
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
K50.813 is a CMS-HCC v28 risk-adjustment code (category 35). 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.
K50.813 is designated CC for MS-DRG grouping. On inpatient claims, this code can shift the DRG to the with-CC variant when documented as a present-on-admission secondary diagnosis. Hospital CDI programs flag CC 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, CC
codes Crohn's disease of both small and large intestine with fistula. As a Complication/Comorbidity (CC), this contributes to DRG severity adjustment when documented alongside the principal diagnosis.
Medicare LCD Coverage for K50.813
Local Coverage Determinations (LCDs) from CMS MACs that list K50.813 as a covered diagnosis.
Showing top 10 of 935 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing K50.813.
2 Cigna
5 Medicare
CPT Codes Commonly Billed with K50.813
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- 91299 CMS LCD: Billing and Coding: Endoscopy by Capsule CMS LCD
Convert K50.813 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 |
|---|---|---|
| K50.813 | 5552 | 10111 |
| K50.813 | 56981 | 10112 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To K50.813
Other codes in section K50-K52 (Noninfective enteritis and colitis).
ICD-10 K50.813, Billing FAQ
Is ICD-10 code K50.813 billable? +
Yes, K50.813 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
Does K50.813 affect Medicare Advantage HCC risk adjustment? +
Yes. K50.813 maps to CMS-HCC v28 category 35. Capture this diagnosis annually for accurate Medicare Advantage risk score.
Is K50.813 a CC or MCC for inpatient DRG? +
Yes, this code is designated as CC. Documenting as a secondary diagnosis on inpatient claims can shift the DRG to a higher-weighted category.
What CPT codes are commonly billed with K50.813? +
Procedures frequently paired with K50.813 include: 91299.
What ICD-9 codes does K50.813 map to? +
Per CMS GEMs, K50.813 maps to ICD-9 codes: 5552, 56981. 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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