ICD-10 K56.609
Billable / Specific HCC v28: 33 CCUnspecified intestinal obstruction, unspecified as to partial versus complete obstruction
About ICD-10-CM K56.609
ICD-10-CM code K56.609 represents Unspecified intestinal obstruction, unspecified as to partial versus complete obstruction. This is a billable/specific code in the Digestive System chapter (block K56). The 2026 edition of ICD-10-CM K56.609 became effective on October 1, 2025.
Coding Tips for K56.609
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
K56.609 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.
K56.609 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.
Inclusion Terms / Approximate Synonyms
Clinical terms and conditions classified under K56.609. Per CMS ICD-10-CM Tabular 2026.
- Intestinal obstruction NOS
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 Unspecified intestinal obstruction, unspecified as to partial versus complete obstruction. As a Complication/Comorbidity (CC), this contributes to DRG severity adjustment when documented alongside the principal diagnosis.
Medicare LCD Coverage for K56.609
Local Coverage Determinations (LCDs) from CMS MACs that list K56.609 as a covered diagnosis.
Showing top 10 of 119 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing K56.609.
5 Medicare
1 Aetna
CPT Codes Commonly Billed with K56.609
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 K56.609
Other codes in section K55-K64 (Other diseases of intestines).
ICD-10 K56.609, Billing FAQ
Is ICD-10 code K56.609 billable? +
Yes, K56.609 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
What other names or terms map to K56.609? +
ICD-10 K56.609 includes: Intestinal obstruction NOS.
Does K56.609 affect Medicare Advantage HCC risk adjustment? +
Yes. K56.609 maps to CMS-HCC v28 category 33. Capture this diagnosis annually for accurate Medicare Advantage risk score.
Is K56.609 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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