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

ICD-10 K55.8

Billable / Specific HCC v28: 108 CC

Other vascular disorders of intestine

K55
Block
0
Synonyms
310
LCDs
10
Payer Policies
2
Linked CPTs

About ICD-10-CM K55.8

ICD-10-CM code K55.8 represents Other vascular disorders of intestine. This is a billable/specific code in the Digestive System chapter (block K55). The 2026 edition of ICD-10-CM K55.8 became effective on October 1, 2025.

Coding Tips for K55.8

Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.

HCC capture: document with MEAT each year

K55.8 is a CMS-HCC v28 risk-adjustment code (category 108). 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.

Inpatient DRG impact: CC

K55.8 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

CMS-HCC v28 (current)
Category 108
ESRD-HCC
Category 108
RxHCC (Part D)
Category 108

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 Other vascular disorders of intestine. As a Complication/Comorbidity (CC), this contributes to DRG severity adjustment when documented alongside the principal diagnosis.

Medicare LCD Coverage for K55.8

Local Coverage Determinations (LCDs) from CMS MACs that list K55.8 as a covered diagnosis.

310 LCDs

Showing top 10 of 310 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: Diagnostic Colonoscopy
Article ID: 55937, Effective: 2026-02-04 00:00:00, 244 covered, 1 non-covered
CPT 45398 →

Commercial Payer Coverage

Coverage policies from major commercial payers referencing K55.8.

10 policies

5 Medicare

Billing and Coding: Diagnostic Colonoscopy
Policy ID: ART-55937
Billing and Coding: Upper Gastrointestinal Endoscopy and Visualization
Policy ID: ART-56389
Billing and Coding: Colonoscopy and Sigmoidoscopy-Diagnostic
Policy ID: ART-56394
Billing and Coding: CT of the Abdomen and Pelvis
Policy ID: ART-56421
Billing and Coding: Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy
Policy ID: ART-56632

CPT Codes Commonly Billed with K55.8

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

2 linkages
  • 61650 CMS LCD: Billing and Coding: Transcatheter Infusion Therapy CMS LCD
  • 61651 CMS LCD: Billing and Coding: Transcatheter Infusion Therapy CMS LCD

Convert K55.8 to ICD-9-CM

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

ICD-10ICD-9Mapping Flags
K55.8 5579 10000

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

ICD-10 K55.8, Billing FAQ

Is ICD-10 code K55.8 billable? +

Yes, K55.8 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.

Does K55.8 affect Medicare Advantage HCC risk adjustment? +

Yes. K55.8 maps to CMS-HCC v28 category 108. Capture this diagnosis annually for accurate Medicare Advantage risk score.

Is K55.8 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 K55.8? +

Procedures frequently paired with K55.8 include: 61650, 61651.

What ICD-9 codes does K55.8 map to? +

Per CMS GEMs, K55.8 maps to ICD-9 codes: 5579. 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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