ICD-10 K92.1
Billable / Specific CCMelena
About ICD-10-CM K92.1
ICD-10-CM code K92.1 represents Melena. This is a billable/specific code in the Digestive System chapter (block K92). The 2026 edition of ICD-10-CM K92.1 became effective on October 1, 2025.
Coding Tips for K92.1
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
K92.1 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 K92.1. The conditions are mutually exclusive (e.g., congenital vs acquired forms).
- occult blood in feces (R19.5)
Inpatient DRG Impact, CC
codes Melena. As a Complication/Comorbidity (CC), this contributes to DRG severity adjustment when documented alongside the principal diagnosis.
Medicare LCD Coverage for K92.1
Local Coverage Determinations (LCDs) from CMS MACs that list K92.1 as a covered diagnosis.
Showing top 10 of 978 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing K92.1.
5 Medicare
CPT Codes Commonly Billed with K92.1
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- 43235 Diagnostic EGD — abdominal pain, nausea, vomiting, GERD, gastric ulcer, gastritis, hematemesis, melena, Barrett esophagus, dysphagia, esophagitis, weight loss, iron deficiency anemia, polyp Gastroenterology
- 45378 Diagnostic colonoscopy — colorectal screening, family hx colon cancer, polyp, melena, iron def anemia, diverticulosis, ulcerative colitis, Crohn, occult blood, rectal polyp, weight loss, IBS Gastroenterology
- 45380 Colonoscopy with biopsy — colon polyp, neoplasm of colon, melena, iron deficiency anemia, screening, personal hx polyps, UC, occult blood Gastroenterology
- 45381 Colonoscopy with directed submucosal injection — polyp removal facilitation, same dx as polypectomy Gastroenterology
- 85027 CBC automated — anemia, iron deficiency, fatigue, routine exam, abnormal labs, melena, hematemesis Laboratory
- 99283 ED visit level 3 — chest pain, dyspnea, pneumonia, UTI, forearm fracture, tibia fracture, syncope, GI bleed Emergency Medicine
- 91113 CMS LCD: Billing and Coding: Colon Capsule Endoscopy (CCE) CMS LCD
Convert K92.1 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 |
|---|---|---|
| K92.1 | 5781 | 00000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To K92.1
Other codes in section K90-K95 (Other diseases of the digestive system).
ICD-10 K92.1, Billing FAQ
Is ICD-10 code K92.1 billable? +
Yes, K92.1 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 K92.1? +
Type 1 Excludes (never code together with K92.1): occult blood in feces (R19.5)
Is K92.1 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 K92.1? +
Procedures frequently paired with K92.1 include: 43235, 45378, 45380, 45381, 85027.
What ICD-9 codes does K92.1 map to? +
Per CMS GEMs, K92.1 maps to ICD-9 codes: 5781. 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 May 31, 2026.
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