ICD-10 K55.052
Billable / Specific HCC v28: 107 MCCDiffuse acute (reversible) ischemia of intestine, part unspecified
About ICD-10-CM K55.052
ICD-10-CM code K55.052 represents Diffuse acute (reversible) ischemia of intestine, part unspecified. This is a billable/specific code in the Digestive System chapter (block K55). The 2026 edition of ICD-10-CM K55.052 became effective on October 1, 2025.
Coding Tips for K55.052
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
K55.052 is a CMS-HCC v28 risk-adjustment code (category 107). 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.
K55.052 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 Diffuse acute (reversible) ischemia of intestine, part unspecified. As a Major Complication/Comorbidity (MCC), this can shift the DRG assignment to a higher-weighted category, substantial reimbursement impact.
Medicare LCD Coverage for K55.052
Local Coverage Determinations (LCDs) from CMS MACs that list K55.052 as a covered diagnosis.
Showing top 10 of 380 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing K55.052.
5 Medicare
Convert K55.052 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 |
|---|---|---|
| K55.052 | 5570 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To K55.052
Other codes in section K55-K64 (Other diseases of intestines).
ICD-10 K55.052, Billing FAQ
Is ICD-10 code K55.052 billable? +
Yes, K55.052 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
Does K55.052 affect Medicare Advantage HCC risk adjustment? +
Yes. K55.052 maps to CMS-HCC v28 category 107. Capture this diagnosis annually for accurate Medicare Advantage risk score.
Is K55.052 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 K55.052? +
Procedures frequently paired with K55.052 include: 61650, 61651.
What ICD-9 codes does K55.052 map to? +
Per CMS GEMs, K55.052 maps to ICD-9 codes: 5570. 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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