ICD-10 K92.81
Billable / Specific CCGastrointestinal mucositis (ulcerative)
About ICD-10-CM K92.81
ICD-10-CM code K92.81 represents Gastrointestinal mucositis (ulcerative). This is a billable/specific code in the Digestive System chapter (block K92). The 2026 edition of ICD-10-CM K92.81 became effective on October 1, 2025.
Coding Tips for K92.81
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
K92.81 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 2 Excludes
Not included here, the excluded code is not part of K92.81, but a patient may have both conditions at the same time. Both codes may be coded together when applicable.
- mucositis (ulcerative) of vagina and vulva (N76.81)
- nasal mucositis (ulcerative) (J34.81)
- oral mucositis (ulcerative) (K12.3-)
Coding Notes
Code Also
- type of associated therapy, such as:
- antineoplastic and immunosuppressive drugs (T45.1X-)
- radiological procedure and radiotherapy (Y84.2)
Inpatient DRG Impact, CC
codes Gastrointestinal mucositis (ulcerative). As a Complication/Comorbidity (CC), this contributes to DRG severity adjustment when documented alongside the principal diagnosis.
Medicare LCD Coverage for K92.81
Local Coverage Determinations (LCDs) from CMS MACs that list K92.81 as a covered diagnosis.
Showing top 10 of 190 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing K92.81.
4 Medicare
CPT Codes Commonly Billed with K92.81
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 K92.81 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 |
|---|---|---|
| K92.81 | 538 | 00000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To K92.81
Other codes in section K90-K95 (Other diseases of the digestive system).
ICD-10 K92.81, Billing FAQ
Is ICD-10 code K92.81 billable? +
Yes, K92.81 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
What codes are Type 2 Excludes for K92.81? +
Type 2 Excludes (may be coded together when both conditions exist): mucositis (ulcerative) of vagina and vulva (N76.81); nasal mucositis (ulcerative) (J34.81); oral mucositis (ulcerative) (K12.3-)
Is K92.81 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 K92.81 map to? +
Per CMS GEMs, K92.81 maps to ICD-9 codes: 538. 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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