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A04.7 ICD-10-CM Code: Enterocolitis due to Clostridium difficile

A04.7 is not a CMS-HCC payment code. MEAT criteria · RAF calculator · free HCC coding tools

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FY 2026 Apr update / Certain infectious and parasitic diseases (A00-B99) / Intestinal infectious diseases (A00-A09)

A04.7

Header CodeICD-10-CMOfficial ICD-10-CMCodebook guidance

Enterocolitis due to Clostridium difficile

Enterocolitis due to Clostridium difficile

CMS-HCC V28

N/A

Not mapped

CMS-HCC V24

N/A

Not mapped

ACA/HHS

N/A

Not mapped

ESRD/PACE

N/A

Not mapped

RXHCC

N/A

Not mapped

Code Book Path

Official
A04Other bacterial intestinal infections
A04.7Enterocolitis due to Clostridium difficile

Inclusion Terms

Official
  • Clostridioides difficile colitis
  • Foodborne intoxication by Clostridium difficile
  • Pseudomembraneous colitis

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for A04.7 in this effective period.

Related Child Codes

Official
A04.71Enterocolitis due to Clostridium difficile, recurrent
A04.72Enterocolitis due to Clostridium difficile, not specified as recurrent

Includes

Official

ICD-10-CM does not list Includes notes for A04.7 in this effective period.

Excludes 1

Official
  • bacterial foodborne intoxications, NEC (A05.-)
  • tuberculous enteritis (A18.32)

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for A04.7 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for A04.7 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for A04.7 in this effective period.

Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →

Code
A04.7
Description
Enterocolitis due to Clostridium difficile
HCC (V28)
No CMS-HCC V28 mapping
RAF
Billable
No
Payment year
2026

Coder workflow notes

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What This Code Means

A04.7 is the ICD-10-CM diagnosis code for enterocolitis due to clostridium difficile. A04.7 sits in the ICD-10-CM chapter for certain infectious and parasitic diseases (a00-b99), within the section covering intestinal infectious diseases (a00-a09).

Header codes like A04.7 cannot be reported on claims directly, they organize child codes that share clinical context but the actual diagnosis must be coded to the highest level of specificity supported by the documentation. Coders should look at A04.7's child codes and select the one that matches the patient's documented presentation, since payers reject header codes submitted as the primary diagnosis. For risk adjustment workflows, header codes never contribute to a Medicare Advantage member's RAF score on their own; only billable child codes that happen to map to a payment HCC affect risk-adjusted plan payments.

HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for A04.7 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Child Codes

Code Hierarchy

A04.7 code history

Code setChange
FY2018 (effective Oct 1, 2017)Billability changed (now non-billable header)

Source: official CMS ICD-10-CM order and addenda files, FY2016 through FY2027.

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