I85.00 Esophageal Varices: V28 HCC 63; In Cirrhosis, I85.10

If you searched esophageal varices ICD-10 or I85.00, here is the short answer. I85.00 (Esophageal varices without bleeding) is a billable code that maps to CMS-HCC V28 HCC 63 (Chronic Liver Failure/End-Stage Liver Disorders). The PY2026 V28 CSV on HCC Buddy main has the row `I8500,63.0,,,`, the V28 column of the CMS 2026 Final ICD-10-CM Mappings lists 63 for it, and the live card shows HCC 63.

The bigger question at the desk is which varices code to use. I85.00 is for esophageal varices with no documented cause, which the Tabular calls idiopathic or primary. When the varices are documented with cirrhosis, alcoholic liver disease, portal hypertension, schistosomiasis, or toxic liver disease, the Alphabetic Index sends you to the secondary codes, I85.10 without bleeding or I85.11 with bleeding, and the underlying disease, such as the cirrhosis, is coded first. All four varices codes map to HCC 63.

The I85 codes, descriptors, and Tabular notes are the same in the FY2026 and FY2027 files, and the FY2027 Tabular and Index addenda have no entries for them.

Desk table: esophageal varices

I85, I85.0, and I85.1 are nonbillable headings, and the live cards say so. The PY2026 V28 CSV has no row for I86.4.

How the Index gets you to the right I85 code

Start at the main term Varix and the subterm esophagus. The FY2027 Alphabetic Index reads:

• Varix, esophagus (idiopathic) (primary) (ulcerated) goes to I85.00. Its subterm bleeding goes to I85.01.
• Varix, esophagus, in (due to) has subterms for alcoholic liver disease, cirrhosis of liver, portal hypertension, schistosomiasis, and toxic liver disease. Each goes to I85.10, and each has a bleeding subterm that goes to I85.11.
• Varix, esophagus, secondary goes to I85.10, and its bleeding subterm goes to I85.11.
• Varix, gastric and Varix, stomach go to I86.4.

The words in parentheses after "esophagus" are nonessential modifiers. Section I.A.7 (Punctuation) of the FY2027 guidelines explains that a nonessential modifier does not apply when it and a subentry are mutually exclusive, and "the subentry takes precedence." So "primary" does not pull a varix that the provider ties to cirrhosis back to I85.00. The "in (due to)" subentry wins.

From the bleeding side, Hemorrhage, esophagus, varix goes to I85.01, and its subterm secondary goes to I85.11.

The Index has no subterm for size or grade. Small, large, or grade 2 esophageal varices are coded the same way as any other esophageal varices, by cause and by whether they are bleeding. "Ulcerated" is one of the nonessential modifiers on I85.00, so an ulcerated varix is not coded as bleeding unless the provider documents bleeding.

Varices with cirrhosis: I85.10, and code the liver disease first

Section I.A.15 says the word "with" or "in" "should be interpreted to mean 'associated with' or 'due to'" when it appears in the Alphabetic Index, and that "The classification presumes a causal relationship between the two conditions linked by these terms." These conditions "should be coded as related even in the absence of provider documentation explicitly linking them, unless the documentation clearly states the conditions are unrelated."

The Index entry is Varix, esophagus, in (due to), cirrhosis of liver. So when the provider documents esophageal varices and cirrhosis, the varices are coded as secondary, I85.10 or I85.11, unless the note clearly says the two are unrelated. The same is true for alcoholic liver disease, portal hypertension, schistosomiasis, and toxic liver disease. If the documentation is unclear, ask the provider.

The Tabular backs this up. I85.1 Secondary esophageal varices lists "Esophageal varices secondary to cirrhosis of liver" and "Esophageal varices secondary to alcoholic liver disease" among its inclusion terms, and it carries a Code first note for the "underlying disease". Section I.B.7 says: "When there is a 'code first' note and an underlying condition is present, the underlying condition should be sequenced first, if known." So the claim lists the cirrhosis code, such as K74.69 (Other cirrhosis of liver) or K70.30 (Alcoholic cirrhosis of liver without ascites), ahead of I85.10.

Category I85 also carries a Use additional code note "to identify: alcohol abuse and dependence (F10.-)". Add that code only when the provider documents the alcohol use disorder.

Picking I85.00 over I85.10 does not change the V28 result, because both map to HCC 63. It still matters, because the claim should say what the provider documented, and a missing underlying disease code is an easy audit finding.

The CSV rows behind the answer

Each varices code has one row in the PY2026 V28 CSV, with no age or sex condition:

• `I8500,63.0,,,`
• `I8501,63.0,,,`
• `I8510,63.0,,,`
• `I8511,63.0,,,`

The columns are ICD10, CC, MCE_AGE_CONDITION, AGE_EDIT_CONDITION, and SEX_EDIT_CONDITION. There is no row for I864.

The CMS 2026 Final ICD-10-CM Mappings agree. They list V28 category 63 for I85.00, I85.01, I85.10, and I85.11. This post covers the CMS-HCC V28 result only.

Hierarchy: HCC 63 sits above cirrhosis HCC 64

HCC 63 is Chronic Liver Failure/End-Stage Liver Disorders. In the V28 hierarchy file, the row `HCC63,HCC64,HCC65,HCC68,HCC202,,` shows that HCC 63 supersedes HCC 64 (Cirrhosis of Liver), HCC 65 (Chronic Hepatitis), HCC 68 (Cholangitis and Obstruction of Bile Duct Without Gallstones), and HCC 202 (Coma, Brain Compression/Anoxic Damage). The row `HCC62,HCC63,HCC64,HCC65,HCC68,,` shows that HCC 62 (Liver Transplant Status/Complications) supersedes HCC 63.

So when a member has a supported cirrhosis code and a supported varices code in the same year, the HCC 64 category drops and only HCC 63 counts. The hierarchy works on the model categories, not on the claim. Keep reporting the cirrhosis code, because the I85.1 Code first note calls for it.

The PY2026 V28 relative factors list HCC 63 with a CNA reference of 0.962 and a COMMUNITY_ND value of 1.032. HCC 64 has a CNA reference of 0.447. These are community segment values, not member totals, and the segment a member is scored in depends on that member's enrollment data.

The live hubs list HCC 63 with 14 codes and HCC 64 with 6 codes, and both counts match the CSV.

Neighbors coders mix up

Portal hypertension. K76.6 maps to HCC 63 on its own, the same category as the varices. It carries a Use additional code note "for any associated complications, such as: portal hypertensive gastropathy (K31.89)". K31.89 has no V28 HCC. Varices due to portal hypertension go to I85.10 or I85.11 through the Index entry Varix, esophagus, in (due to), portal hypertension.

Cirrhosis. K74.69 holds cryptogenic, macronodular, micronodular, mixed type, portal, and postnecrotic cirrhosis, and the Index sends Cirrhosis with no further detail to K74.60. Category K74 has an Excludes1 note for "alcoholic cirrhosis (of liver) (K70.3)", so alcoholic cirrhosis goes to K70.30 or K70.31, not K74.6-. The K70.30 and K70.31 rows in the CSV carry `age >= 15` in the MCE_AGE_CONDITION column.

Gastric varices. I86.4 sits in a different category, I86 Varicose veins of other sites, and has no V28 HCC. When the provider documents varices in both the esophagus and the stomach, code each site the provider documents from its own Index entry.

Liver transplant. HCC 62 supersedes HCC 63. See the T86.41 liver transplant desk.

History of varices or current varices

Some searches ask for the code for a history of esophageal varices. Section IV.J says: "Code all documented conditions that coexist at the time of the encounter/visit and that require or affect patient care, treatment or management. Do not code conditions that were previously treated and no longer exist." It adds that "history codes (categories Z80-Z87) may be used as secondary codes if the historical condition or family history has an impact on current care or influences treatment." Section IV.I says that "Chronic diseases treated on an ongoing basis may be coded and reported as many times as the patient receives treatment and care for the condition(s)."

The Index sends a personal history of a circulatory system disease to Z86.79 (Personal history of other diseases of the circulatory system), which has no V28 HCC.

So the provider's words decide it:

• If the provider documents esophageal varices as a current condition that is being monitored, evaluated, or treated at this visit, the I85 code is supported.
• If the provider documents that the varices were treated in the past and no longer exist, a history code may fit, and it does not map.
• If the note says only "history of varices" while the plan shows ongoing management for them, the two facts do not line up. Ask the provider whether the varices are current.

MEAT for esophageal varices

For I85.00 through I85.11, the note should support the varices as a current condition the provider is managing, not just a line in the past history:

• M Monitor: the course of the varices as the provider follows them at this visit
• E Evaluate: the results or findings the provider reviewed for the varices
• A Assess: esophageal varices named as current, with the cause and bleeding status when known
• T Treat: the current treatment or plan the provider documents for them

MEAT is a review mnemonic, not a universal CMS coding rule. Follow the applicable coding, encounter, program, and payer requirements. See MEAT.

Reporting rules that apply

Section IV.H says not to code diagnoses documented as "probable", "suspected," "questionable," "rule out," "compatible with," "consistent with," or "working diagnosis" or other similar terms indicating uncertainty, and to code "the condition(s) to the highest degree of certainty for that encounter/visit, such as symptoms, signs, abnormal test results, or other reason for the visit." Suspected varices in an office note are not coded as I85. Code what the provider has confirmed, or the symptoms they document.

Audit and query traps

1. Coding I85.00 when the provider documents the varices with cirrhosis, alcoholic liver disease, or portal hypertension. The Index "in (due to)" entries and Section I.A.15 send that to I85.10 or I85.11, unless the note clearly says the conditions are unrelated.

2. Reporting I85.10 or I85.11 without a code for the underlying disease, such as the cirrhosis. The I85.1 Code first note calls for it.

3. Coding bleeding from "ulcerated" alone. Bleeding is its own Index subterm, and "ulcerated" is a nonessential modifier.

4. Expecting a V28 HCC from gastric varices. I86.4 has no V28 row.

5. Dropping the cirrhosis code because HCC 63 supersedes HCC 64. The hierarchy is applied by the model, not on the claim.

6. Coding I85 from a history-of line when the provider documents no current management.

7. Coding suspected varices in an office visit. Section IV.H says not to.

8. Using a CNA reference as a member RAF total.

9. Inventing Coding Clinic quotes, competitor comparisons, or PHI examples.

Two-minute check

1. Does the provider name esophageal varices, gastric varices, or both?

2. Does the provider document a cause, such as cirrhosis, alcoholic liver disease, or portal hypertension? With a cause, use I85.1-, and code the underlying disease first. With no cause, use I85.0-.

3. Does the provider document bleeding?

4. Are the varices current and managed at this visit, or documented as past and no longer present?

5. Expect HCC 63 for all four I85 codes and for K76.6, HCC 64 for cirrhosis, no V28 HCC for I86.4, K31.89, or Z86.79, and HCC 63 to supersede HCC 64.

6. Confirm the map on the live card and the CSV row. Confirm MEAT for this year.

Related desks and tools

• Live cards: I85.00, I85.01, I85.10, I85.11, I86.4, K76.6, K74.69, K70.30
• Hubs: HCC 63, HCC 64
• Lookup: ICD-10 to HCC, Encoder
• Evidence habits: MEAT, provider query templates, acute vs history of, hierarchy and trumping rules
• Nearby: T86.41 liver transplant desk, codes that do not map, combination codes, FY2027 code changes

Sources

• Live HCC Buddy ICD-10-CM cards (FY2027 Tabular display) and the V28 HCC 63 and HCC 64 hubs, fetched November 3, 2026
• FY2026 and FY2027 ICD-10-CM order file billable flags, the FY2026 and FY2027 Tabular, the FY2027 Alphabetic Index, and the FY2027 Tabular and Index addenda
• CMS, FY2027 ICD-10-CM Official Guidelines for Coding and Reporting, Sections I.A.7, I.A.15, I.B.7, IV.H, IV.I, and IV.J
• PY2026 V28 mapping, hierarchy, and relative factor files on HCC Buddy main
• CMS, ICD-10 codes (FY2027 ICD-10-CM code files and addendum, effective October 1, 2026)
• CMS, 2026 Model Software/ICD-10 Mappings (PY2026 V28 mappings, hierarchies, relative factors, and the 2026 Final ICD-10-CM Mappings)

V28 mappings come from the cited live code pages and the PY2026 V28 CSV. Coefficients are source-labeled references, not member totals. Not medical advice. Not a Coding Clinic reprint.

Current as of November 3, 2026. Always confirm the PY2026 V28 CSV and the live code card before you lock a map claim.