ICD-10 K55.062
Billable / Specific HCC v28: 107 MCCDiffuse acute infarction of intestine, part unspecified
About ICD-10-CM K55.062
ICD-10-CM code K55.062 represents Diffuse acute infarction of intestine, part unspecified. This is a billable/specific code in the Digestive System chapter (block K55). The 2026 edition of ICD-10-CM K55.062 became effective on October 1, 2025.
Coding Tips for K55.062
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
K55.062 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.
K55.062 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 infarction 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 K55.062
Local Coverage Determinations (LCDs) from CMS MACs that list K55.062 as a covered diagnosis.
Showing top 10 of 306 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing K55.062.
5 Medicare
CPT Codes Commonly Billed with K55.062
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
We don't have CPT pairings indexed for this specific code yet. Use the CPT search above to find common procedures, or check your payer's published medical policy for code-specific guidance.
Convert K55.062 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 |
|---|---|---|
| K55.062 | 5570 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To K55.062
Other codes in section K55-K64 (Other diseases of intestines).
ICD-10 K55.062, Billing FAQ
Is ICD-10 code K55.062 billable? +
Yes, K55.062 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
Does K55.062 affect Medicare Advantage HCC risk adjustment? +
Yes. K55.062 maps to CMS-HCC v28 category 107. Capture this diagnosis annually for accurate Medicare Advantage risk score.
Is K55.062 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 ICD-9 codes does K55.062 map to? +
Per CMS GEMs, K55.062 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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