Question 1

What is ICD-10 code K26?

Accepted Answer

K26 is the ICD-10-CM diagnosis code for duodenal ulcer. K26 sits in the ICD-10-CM chapter for diseases of the digestive system (k00-k95), within the section covering diseases of esophagus, stomach and duodenum (k20-k31).

K26 is a non-billable category for duodenal ulcer. Move through the official child-code path until the documented detail supports a reportable code.

Question 2

Is K26 an HCC code?

Accepted Answer

K26 is a non-billable header code, so it cannot itself be a payment HCC. Header codes organize more specific child codes that share the same root concept; one of those children may map to a payment HCC under the CMS-HCC V28 or V24 risk adjustment model. Coders should select a child code from the K26 hierarchy that matches the documented presentation, then check that specific child for HCC status.

Question 3

Is K26 billable?

Accepted Answer

No. K26 is a header (non-billable) ICD-10-CM code. Header codes sit at a higher level of the diagnosis hierarchy and exist to organize a family of more specific child codes. Per ICD-10-CM coding guidelines, a header code cannot be reported on a claim as the diagnosis, coders must select a billable child code from the K26 hierarchy that matches the highest level of specificity supported by the provider's documentation. Payers reject header codes submitted as the primary diagnosis.

Question 4

Which HCC does K26 map to under V28?

Accepted Answer

K26 does not map to a CMS-HCC V28 payment category. Check the current CMS-HCC V28 model file for payment year 2026 rather than an older V24 tip sheet.

Question 5

What does K26 pay in RAF?

Accepted Answer

K26 has no separately stated V28 community RAF weight. If it is not a V28 payment HCC, it adds nothing to a community RAF score.

Question 6

What documentation supports K26?

Accepted Answer

K26 is a non-billable category for duodenal ulcer. Move through the official child-code path until the documented detail supports a reportable code. For this DOS, capture the provider's current assessment and the care action documented for duodenal ulcer. Keep the checklist tied to the note. Do not swap K26 with K26.0. The FY2026 tabular describes K26.0 as acute duodenal ulcer with hemorrhage. Follow the documented detail. K26 is not a CMS-HCC payment code, so MEAT is not the payment hook. Documentation still has to support the diagnosis if you report it.

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K26

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K26 ICD-10-CM Code: Duodenal ulcer