ICD-10 K63.0
Billable / Specific CCAbscess of intestine
About ICD-10-CM K63.0
ICD-10-CM code K63.0 represents Abscess of intestine. This is a billable/specific code in the Digestive System chapter (block K63). The 2026 edition of ICD-10-CM K63.0 became effective on October 1, 2025.
Coding Tips for K63.0
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
K63.0 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.
Type 1 Excludes
Pure excludes, these codes can never be coded together with K63.0. The conditions are mutually exclusive (e.g., congenital vs acquired forms).
- abscess of intestine with Crohn's disease (K50.014, K50.114, K50.814, K50.914,)
- abscess of intestine with diverticular disease (K57.0, K57.2, K57.4, K57.8)
- abscess of intestine with ulcerative colitis (K51.014, K51.214, K51.314, K51.414, K51.514, K51.814, K51.914)
Type 2 Excludes
Not included here, the excluded code is not part of K63.0, but a patient may have both conditions at the same time. Both codes may be coded together when applicable.
- abscess of anal and rectal regions (K61.-)
- abscess of appendix (K35.3-)
Inpatient DRG Impact, CC
code Abscess of intestine. As a Complication/Comorbidity (CC), this contributes to DRG severity adjustment when documented alongside the principal diagnosis.
Medicare LCD Coverage for K63.0
Local Coverage Determinations (LCDs) from CMS MACs that list K63.0 as a covered diagnosis.
Showing top 10 of 107 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing K63.0.
3 Medicare
CPT Codes Commonly Billed with K63.0
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 K63.0 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 |
|---|---|---|
| K63.0 | 5695 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To K63.0
Other codes in section K55-K64 (Other diseases of intestines).
ICD-10 K63.0, Billing FAQ
Is ICD-10 code K63.0 billable? +
Yes, K63.0 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
What codes are Type 1 Excludes for K63.0? +
Type 1 Excludes (never code together with K63.0): abscess of intestine with Crohn's disease (K50.014, K50.114, K50.814, K50.914,); abscess of intestine with diverticular disease (K57.0, K57.2, K57.4, K57.8); abscess of intestine with ulcerative colitis (K51.014, K51.214, K51.314, K51.414, K51.514, K51.814, K51.914)
What codes are Type 2 Excludes for K63.0? +
Type 2 Excludes (may be coded together when both conditions exist): abscess of anal and rectal regions (K61.-); abscess of appendix (K35.3-)
Is K63.0 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 ICD-9 codes does K63.0 map to? +
Per CMS GEMs, K63.0 maps to ICD-9 codes: 5695. 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 July 16, 2026.
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