ICD-10 K56.52
Billable / Specific HCC v28: 33 CCIntestinal adhesions [bands] with complete obstruction
About ICD-10-CM K56.52
ICD-10-CM code K56.52 represents Intestinal adhesions [bands] with complete obstruction. This is a billable/specific code in the Digestive System chapter (block K56). The 2026 edition of ICD-10-CM K56.52 became effective on October 1, 2025.
Coding Tips for K56.52
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
K56.52 is a CMS-HCC v28 risk-adjustment code (category 33). 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.
K56.52 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 Intestinal adhesions [bands] with complete obstruction. As a Complication/Comorbidity (CC), this contributes to DRG severity adjustment when documented alongside the principal diagnosis.
Medicare LCD Coverage for K56.52
Local Coverage Determinations (LCDs) from CMS MACs that list K56.52 as a covered diagnosis.
Showing top 10 of 227 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing K56.52.
5 Medicare
1 Aetna
CPT Codes Commonly Billed with K56.52
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.
Codes Adjacent To K56.52
Other codes in section K55-K64 (Other diseases of intestines).
ICD-10 K56.52, Billing FAQ
Is ICD-10 code K56.52 billable? +
Yes, K56.52 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
Does K56.52 affect Medicare Advantage HCC risk adjustment? +
Yes. K56.52 maps to CMS-HCC v28 category 33. Capture this diagnosis annually for accurate Medicare Advantage risk score.
Is K56.52 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.
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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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