E84.11
BillableMeconium ileus in cystic fibrosis
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is E84.11 an HCC code?
Yes. E84.11 maps to Cystic Fibrosis under the CMS-HCC V28 risk adjustment model (and Cystic Fibrosis 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 E84.11
For E84.11 to 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 E84.11 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
E84.11 is the ICD-10-CM diagnosis code for meconium ileus in cystic fibrosis. Meconium ileus is a serious intestinal blockage in newborns with cystic fibrosis caused by thick, sticky meconium (first stool) that cannot pass normally. E84.11 sits in the ICD-10-CM chapter for endocrine, nutritional and metabolic diseases (e00-e89), within the section covering metabolic disorders (e70-e88).
Under the CMS-HCC V28 risk adjustment model, E84.11 maps to Cystic Fibrosis (HCC 277) with a community, non-dual, aged base RAF weight of 0.405. Under the older V24 model, E84.11 mapped to the same category but with a base RAF weight of 0.473 — 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.
This code is typically used in neonatal cases; verify the patient's age and clinical presentation matches meconium ileus specifically. Because E84.11 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 E84.11 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This code is typically used in neonatal cases; verify the patient's age and clinical presentation matches meconium ileus specifically
- •Document whether surgical intervention was required, as this affects severity and treatment coding
Clinical Significance
Meconium ileus is a neonatal intestinal obstruction occurring in approximately 15-20% of newborns with cystic fibrosis and is often the presenting sign of the disease. While primarily a pediatric diagnosis, it remains reportable as part of the patient's cystic fibrosis history and carries the same high RAF weight as other CF codes.
Documentation Requirements
- ✓Confirmed cystic fibrosis diagnosis
- ✓Documentation of meconium ileus (current or historical)
- ✓Surgical intervention history if applicable (bowel resection, ostomy)
- ✓Ongoing GI complications from meconium ileus
- ✓Current CF management plan including pancreatic enzyme replacement
Excludes 1 — Do NOT code together
- meconium ileus not due to cystic fibrosis (P76.0)
Commonly Confused Codes
- •E84.19 — Cystic fibrosis with other intestinal manifestations: use for non-meconium-ileus GI involvement (DIOS, rectal prolapse)
- •E84.0 — Cystic fibrosis with pulmonary manifestations: for pulmonary involvement; may be coded in addition to E84.11
- •P76.0 — Meconium plug syndrome: neonatal condition NOT associated with cystic fibrosis
- •K56.0 — Paralytic ileus: acquired ileus not related to meconium or cystic fibrosis