K26.4 is not a CMS-HCC payment code. MEAT criteria · RAF Calculator · HCC coding software

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Code lookupK26.4

Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Diseases of the digestive system (K00-K95) / Diseases of esophagus, stomach and duodenum (K20-K31)

K26.4

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

Chronic or unspecified duodenal ulcer with hemorrhage

A chronic or long-standing ulcer in the duodenum that is actively bleeding into the digestive tract.

Overview Risk Models Code Book Documentation Audit Notes Edition comparison

CMS-HCC V28

N/A

—

Not risk-adjusted for this model/period.

Not mapped

CMS-HCC V24

Historical

Not used for standard CY2026 Medicare Advantage payment. Select a historical period to review V24.

Not used for CY2026 payment

ACA/HHS

N/A

—

Not risk-adjusted for this model/period.

Not mapped

ESRD/PACE

N/A

—

Not risk-adjusted for this model/period.

Not mapped

RXHCC

N/A

—

Not risk-adjusted for this model/period.

Not mapped

Code Book Path

Official

K26Duodenal ulcer K26.4Chronic or unspecified duodenal ulcer with hemorrhage

Inclusion Terms

Official

No inclusion terms are included in this display for K26.4. Check the code and parent instructions in the Code Book.

Excludes 2

Official

certain conditions originating in the perinatal period (P04-P96)Inherited from K00-K95, K20-K31
certain infectious and parasitic diseases (A00-B99)Inherited from K00-K95, K20-K31
complications of pregnancy, childbirth and the puerperium (O00-O9A)Inherited from K00-K95, K20-K31
congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)Inherited from K00-K95, K20-K31
endocrine, nutritional and metabolic diseases (E00-E88)Inherited from K00-K95, K20-K31
injury, poisoning and certain other consequences of external causes (S00-T88)Inherited from K00-K95, K20-K31
neoplasms (C00-D49)Inherited from K00-K95, K20-K31
symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)Inherited from K00-K95, K20-K31
hiatus hernia (K44.-)Inherited from K00-K95, K20-K31

Related Codes

Official

K26.0Acute duodenal ulcer with hemorrhage K26.1Acute duodenal ulcer with perforation K26.2Acute duodenal ulcer with both hemorrhage and perforation K26.3Acute duodenal ulcer without hemorrhage or perforation K26.5Chronic or unspecified duodenal ulcer with perforation

Includes

Official

erosion (acute) of duodenumInherited from K26
duodenum ulcer (peptic)Inherited from K26
postpyloric ulcer (peptic)Inherited from K26

Excludes 1

Official

peptic ulcer NOS (K27.-)Inherited from K26

Code First

Official

No Code First sequencing instructions are included in this display for K26.4. Check the code and parent instructions in the Code Book.

Use Additional

Official

code to identify:Inherited from K26
alcohol abuse and dependence (F10.-)Inherited from K26

Code Also

Official

No Code Also instructions are included in this display for K26.4. Check the code and parent instructions in the Code Book.

Buddy Documentation Tip

HCC Buddy guidance

This code applies to both chronic and unspecified duodenal ulcers with hemorrhage; document chronicity when possible

Coordinate with endoscopy findings or clinical evidence of bleeding to support hemorrhage documentation

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 K26.4 an HCC code?

No. K26.4 is a billable ICD-10-CM code with no mapping under the current CMS-HCC V28 community payment model, and none under the ESRD, Part D RxHCC, or HHS-HCC models.

Code: K26.4
Description: Chronic or unspecified duodenal ulcer with hemorrhage
HCC (V28): No CMS-HCC V28 mapping
RAF reference coefficient: —
Billable: Yes
Payment year: 2026

Coder workflow notes

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What This Code Means

K26.4 is the ICD-10-CM diagnosis code for chronic or unspecified duodenal ulcer with hemorrhage. A chronic or long-standing ulcer in the duodenum that is actively bleeding into the digestive tract. K26.4 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).

K26.4 is a billable ICD-10-CM code, but no current CMS-HCC V28 community payment mapping is shown, and none under the ESRD, Part D RxHCC, or HHS-HCC models. Do not assign risk adjustment value from this page when no source-backed mapping is shown; verify the applicable model and payment year.

This code applies to both chronic and unspecified duodenal ulcers with hemorrhage; document chronicity when possible.

HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for K26.4 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•This code applies to both chronic and unspecified duodenal ulcers with hemorrhage; document chronicity when possible
•Coordinate with endoscopy findings or clinical evidence of bleeding to support hemorrhage documentation