B46.2
BillableGastrointestinal mucormycosis
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is B46.2 an HCC code?
Yes. B46.2 maps to Opportunistic Infections under the CMS-HCC V28 risk adjustment model (and Opportunistic Infections under V24).
HCC Category Mapping
RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.
MEAT Criteria for B46.2
For B46.2to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically — it has to be re-documented and supported each calendar year.
- MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
- EEvaluate: test results, medication response, or physical findings reviewed by the provider
- AAssess: explicit mention in the assessment or plan with acknowledgment of status
- TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis
Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed B46.2 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
B46.2 is the ICD-10-CM diagnosis code for gastrointestinal mucormycosis. A fungal infection of the stomach and intestines caused by mucor fungi, which can cause severe inflammation and tissue damage in the digestive tract. B46.2 sits in the ICD-10-CM chapter for certain infectious and parasitic diseases (a00-b99), within the section covering mycoses (b35-b49).
Under the CMS-HCC V28 risk adjustment model, B46.2 maps to Opportunistic Infections (HCC 6) with a community, non-dual, aged base RAF weight of 0.381. Under the older V24 model, B46.2 mapped to the same category but with a base RAF weight of 0.424 — V28 recalibrated weights across the entire model. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition.
Document the specific gastrointestinal site affected if documented. Because B46.2 maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. When documentation is ambiguous, coders should issue a provider query rather than assume the highest-specificity variant.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for B46.2 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Document the specific gastrointestinal site affected if documented
- •Note any complications such as perforation or necrosis
Clinical Significance
Gastrointestinal mucormycosis is the least common but one of the most lethal forms of mucormycosis, primarily affecting the stomach, colon, and ileum. It occurs in malnourished patients, premature neonates, and transplant recipients. Diagnosis is often delayed due to nonspecific gastrointestinal symptoms, contributing to extremely high mortality rates exceeding 85%.
Documentation Requirements
- ✓Endoscopic biopsy or surgical specimen confirming Mucorales in gastrointestinal tissue
- ✓Specific gastrointestinal site documented (stomach, ileum, colon)
- ✓Imaging findings: bowel wall thickening, perforation, or necrosis on CT
- ✓Clinical presentation: abdominal pain, distension, gastrointestinal bleeding, perforation
- ✓Underlying risk factors: malnutrition, prematurity, transplant, neutropenia
Commonly Confused Codes
- •B46.0 (Pulmonary mucormycosis) - different site; gastrointestinal and pulmonary are separate forms
- •B46.4 (Disseminated mucormycosis) - if gastrointestinal involvement is part of multi-organ disease, use disseminated code
- •K63.1 (Perforation of intestine, nontraumatic) - fungal etiology must be captured with B46.2, not just the complication