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

ICD-10 K91.1

Billable / Specific

Postgastric surgery syndromes

K91
Block
3
Synonyms
69
LCDs
8
Payer Policies
2
Linked CPTs

About ICD-10-CM K91.1

ICD-10-CM code K91.1 represents Postgastric surgery syndromes. This is a billable/specific code in the Digestive System chapter (block K91). The 2026 edition of ICD-10-CM K91.1 became effective on October 1, 2025.

Inclusion Terms / Approximate Synonyms

Clinical terms and conditions classified under K91.1. Per CMS ICD-10-CM Tabular 2026.

  • Dumping syndrome
  • Postgastrectomy syndrome
  • Postvagotomy syndrome

Medicare LCD Coverage for K91.1

Local Coverage Determinations (LCDs) from CMS MACs that list K91.1 as a covered diagnosis.

69 LCDs

Showing top 10 of 69 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 K91.1.

8 policies

4 Medicare

Billing and Coding: Diagnostic Colonoscopy
Policy ID: ART-55937
Billing and Coding: CT of the Abdomen and Pelvis
Policy ID: ART-56421
Billing and Coding: Vitamin B<sub>12</sub> Injections
Policy ID: ART-57755
Billing and Coding: Diagnostic Colonoscopy
Policy ID: ART-58428

4 Aetna

Obesity Surgery
Policy ID: CPB-0157
Magnetic Resonance Cholangiopancreatography
Policy ID: CPB-0384
Vitamin B-12 Therapy
Policy ID: CPB-0536
Intravenous Iron Therapy
Policy ID: CPB-0575

CPT Codes Commonly Billed with K91.1

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

2 linkages
  • J3420 CMS LCD: Billing and Coding: Vitamin B<sub>12</sub> Injections CMS LCD
  • J3425 CMS LCD: Billing and Coding: Vitamin B<sub>12</sub> Injections CMS LCD

Convert K91.1 to ICD-9-CM

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

ICD-10ICD-9Mapping Flags
K91.1 5642 00000

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

ICD-10 K91.1, Billing FAQ

Is ICD-10 code K91.1 billable? +

Yes, K91.1 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 K91.1? +

ICD-10 K91.1 includes: Dumping syndrome; Postgastrectomy syndrome; Postvagotomy syndrome.

What CPT codes are commonly billed with K91.1? +

Procedures frequently paired with K91.1 include: J3420, J3425.

What ICD-9 codes does K91.1 map to? +

Per CMS GEMs, K91.1 maps to ICD-9 codes: 5642. 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 17, 2026.

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