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I85.00 ICD-10-CM Code: Esophageal varices without bleeding

I85.00 maps to CMS-HCC V28 63. A source-labeled RAF reference is available. Documentation must support MEAT. MEAT criteria · RAF Calculator · HCC Buddy coding tools

ICD-10-CM Code View

HCC Buddy Code Card

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FY 2026 Apr update / Diseases of the circulatory system (I00-I99) / Diseases of veins, lymphatic vessels and lymph nodes, not elsewhere classified (I80-I89)

I85.00

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Esophageal varices without bleeding

Enlarged veins in the esophagus (food pipe) that are not currently bleeding, usually caused by liver disease.

Buddy the Bee presenting code insight

Buddy Insight

Primary esophageal varices without bleeding indicate portal hypertension, most commonly from advanced liver disease such as cirrhosis.

CMS-HCC V28

HCC 63

Code-level coefficient reference

CMS-HCC V24

Historical

Historical

Not used for CY2026 payment

ACA/HHS

HCC 035_2

Code-level coefficient reference

ESRD/PACE

HCC 27

Code-level coefficient reference

RXHCC

N/A

—

Not mapped

Code Book Path

Official
I85Esophageal varices
I85.0Esophageal varices
I85.00Esophageal varices without bleeding

Inclusion Terms

Official
  • Esophageal varices NOS

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for I85.00 in this effective period.

Related Child Codes

Official
I85.01Esophageal varices with bleeding

Includes

Official

ICD-10-CM does not list Includes notes for I85.00 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for I85.00 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for I85.00 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for I85.00 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for I85.00 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance
Documentation of presence of esophageal varices
Endoscopy report or imaging confirming variceal diagnosis
Primary etiology documented (e.g., cirrhosis, portal hypertension, hepatic fibrosis)
Variceal grading (small, medium, large) when available

MEAT Support

HCC Buddy guidance
Documentation of presence of esophageal varices
Endoscopy report or imaging confirming variceal diagnosis
Primary etiology documented (e.g., cirrhosis, portal hypertension, hepatic fibrosis)
Variceal grading (small, medium, large) when available

Audit Caution

HCC Buddy guidance
Failing to distinguish between primary and secondary esophageal varices — primary varices (I85.0x) are associated with intrinsic hepatic disease while secondary (I85.1x) result from other causes
Coding active bleeding when documentation only mentions a history of variceal bleeding or bleeding risk — the bleeding code requires current active hemorrhage
Not coding the underlying etiology separately — always assign additional codes for the causative condition such as alcoholic cirrhosis (K70.30) or portal hypertension (K76.6)
Using esophageal varices codes for gastric varices — gastric varices have their own code (I86.4) and should not be captured under I85

Common Mistakes

HCC Buddy guidance
I85.01 — Same varices with bleeding; use only when active hemorrhage is documented
I85.10 — Secondary esophageal varices; use when varices result from an external cause rather than primary liver disease
K22.8 — Other specified diseases of esophagus; non-variceal esophageal conditions should not be coded here
I86.4 — Gastric varices; varices in the stomach rather than esophagus require a different code

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 →

Is I85.00 an HCC code?

Yes. I85.00 (Esophageal varices without bleeding) maps to HCC 63, Chronic Liver Failure/End-Stage Liver Disorders under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.962. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes. It is billable for payment year 2026.

Coder answer: I85.00 is billable and maps to V28 HCC 63, Chronic Liver Failure/End-Stage Liver Disorders. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.

Code
I85.00
Description
Esophageal varices without bleeding
HCC (V28)
HCC 63 — Chronic Liver Failure/End-Stage Liver Disorders
RAF reference coefficient
0.962
Billable
Yes
Payment year
2026

HCC Category Mapping

V28HCC 63, Chronic Liver Failure/End-Stage Liver Disorders
0.962
ESRDHCC 27, End-Stage Liver Disease
Not separately weighted

These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. Weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. Actual per-patient RAF contribution depends on member context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.

Work I85.00 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT Criteria for I85.00

For I85.00 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 I85.00 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

I85.00 is the ICD-10-CM diagnosis code for esophageal varices without bleeding. Enlarged veins in the esophagus (food pipe) that are not currently bleeding, usually caused by liver disease. I85.00 sits in the ICD-10-CM chapter for diseases of the circulatory system (i00-i99), within the section covering diseases of veins, lymphatic vessels and lymph nodes, not elsewhere classified (i80-i89).

Under the CMS-HCC V28 risk adjustment model, I85.00 maps to Chronic Liver Failure/End-Stage Liver Disorders (HCC 63) with a source-labeled community, non-dual, aged reference coefficient of 0.962. No V24 mapping is shown for I85.00; use the applicable model and payment year when reviewing the V28 mapping. 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. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes.

If bleeding is documented, use I85.01 instead; verify bleeding status carefully in clinical documentation. Because I85.00 maps to an HCC category, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) before the diagnosis is used for risk adjustment. 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, source-labeled coefficient references, and MEAT documentation criteria for I85.00 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

  • •If bleeding is documented, use I85.01 instead; verify bleeding status carefully in clinical documentation
  • •Assign an additional code for the underlying cause (typically portal hypertension or cirrhosis) to provide complete clinical picture

Clinical Significance

Primary esophageal varices without bleeding indicate portal hypertension, most commonly from advanced liver disease such as cirrhosis. Even without active bleeding, esophageal varices indicate significant portal hypertension and carry a substantial risk of future hemorrhage, necessitating surveillance endoscopy and prophylactic treatment. This diagnosis is a critical marker of disease severity that substantially impacts the patient's risk profile and expected healthcare utilization.

Documentation Requirements

  • ✓Documentation of presence of esophageal varices
  • ✓Endoscopy report or imaging confirming variceal diagnosis
  • ✓Primary etiology documented (e.g., cirrhosis, portal hypertension, hepatic fibrosis)
  • ✓Variceal grading (small, medium, large) when available
  • ✓Current management plan (beta-blocker prophylaxis, band ligation schedule, or acute intervention)

Commonly Confused Codes

  • •I85.01: Same varices with bleeding; use only when active hemorrhage is documented
  • •I85.10: Secondary esophageal varices; use when varices result from an external cause rather than primary liver disease
  • •K22.8: Other specified diseases of esophagus; non-variceal esophageal conditions should not be coded here
  • •I86.4: Gastric varices; varices in the stomach rather than esophagus require a different code
  • •K92.0: Hematemesis not otherwise specified; if the source of upper gastrointestinal bleeding is not confirmed as variceal, a more general code may apply

Child Codes

I85.00Esophageal varices without bleeding
HCC 63
I85.01Esophageal varices with bleeding
HCC 63

Code Hierarchy

└I85Esophageal varices└I85.0Esophageal varices└I85.00Esophageal varices without bleeding
└I85.00Esophageal varices without bleeding

Because I85.00 maps to an HCC category, the documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) before the diagnosis is used for risk adjustment.

I85.00 maps to CMS-HCC V28 category 63, Chronic Liver Failure/End-Stage Liver Disorders. See the ICD-10 to HCC mapping hub for how the V28 crosswalk works. The mapping identifies a payment HCC category for I85.00. Review its source-labeled HCC coefficient above, check the RAF Calculator with complete member context for CMS-HCC V28 PY2026, and confirm the documentation the chart needs before the code is submitted. HCC Buddy shows no RAF score unless every required source and calculation check passes.

Work I85.00 in HCC Buddy

Open I85.00 in the Code Book for the full Index-to-Tabular path, MEAT checklist, and V28 HCC mapping, or in the Encoder to code from a keyword search. Pro includes 7 days to try everything, no card required.

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