ICD-10 K76.6
Billable / Specific HCC v28: 27 CCPortal hypertension
About ICD-10-CM K76.6
ICD-10-CM code K76.6 represents Portal hypertension. This is a billable/specific code in the Digestive System chapter (block K76). The 2026 edition of ICD-10-CM K76.6 became effective on October 1, 2025.
Coding Tips for K76.6
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
K76.6 is a CMS-HCC v28 risk-adjustment code (category 27). 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.
K76.6 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.
Use Additional Code
When coding K76.6, also report these additional codes when applicable.
- code for any associated complications, such as:
- portal hypertensive gastropathy (K31.89)
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 Portal hypertension. As a Complication/Comorbidity (CC), this contributes to DRG severity adjustment when documented alongside the principal diagnosis.
Medicare LCD Coverage for K76.6
Local Coverage Determinations (LCDs) from CMS MACs that list K76.6 as a covered diagnosis.
Showing top 10 of 283 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing K76.6.
2 Aetna
1 Cigna
5 Medicare
CPT Codes Commonly Billed with K76.6
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- 91111 CMS LCD: Billing and Coding: Wireless Capsule Endoscopy CMS LCD
- 91110 CMS LCD: Billing and Coding: Wireless Capsule Endoscopy CMS LCD
- 37238 CMS LCD: Billing and Coding: Endovenous Stenting CMS LCD
- 37239 CMS LCD: Billing and Coding: Endovenous Stenting CMS LCD
- 37183 CMS LCD: Billing and Coding: Endovenous Stenting CMS LCD
- 37182 CMS LCD: Billing and Coding: Endovenous Stenting CMS LCD
Convert K76.6 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 |
|---|---|---|
| K76.6 | 5723 | 00000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To K76.6
Other codes in section K70-K77 (Diseases of liver).
ICD-10 K76.6, Billing FAQ
Is ICD-10 code K76.6 billable? +
Yes, K76.6 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
Does K76.6 affect Medicare Advantage HCC risk adjustment? +
Yes. K76.6 maps to CMS-HCC v28 category 27. Capture this diagnosis annually for accurate Medicare Advantage risk score.
Is K76.6 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 K76.6? +
Procedures frequently paired with K76.6 include: 91111, 91110, 37238, 37239, 37183.
What ICD-9 codes does K76.6 map to? +
Per CMS GEMs, K76.6 maps to ICD-9 codes: 5723. 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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