K50.013 ICD-10-CM Code: Crohn's disease of small intestine with fistula
K50.013 maps to CMS-HCC V28 80. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · HCC coding software
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FY 2026 Apr update / Diseases of the digestive system (K00-K95) / Noninfective enteritis and colitis (K50-K52)
K50.013
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceCrohn's disease of small intestine with fistula
Crohn's disease of the small intestine with an abnormal tunnel-like connection (fistula) between intestinal segments or to other organs.
Buddy Insight
Crohn's disease of the small intestine with fistula represents penetrating disease behavior, where chronic transmural inflammation creates abnormal connections between bowel segments or to other organs.
CMS-HCC V28
MappedHCC 80
Coefficient HCC 80: 0.550 (Community Non-Dual Aged (CNA))
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
MappedHCC 048
Code-level coefficient reference
ESRD/PACE
MappedHCC 35
Code-level coefficient reference
RXHCC
MappedHCC 67
Code-level coefficient reference
Code Book Path
Inclusion Terms
Official- Crohn's disease [regional enteritis] of duodenumInherited from K50.0
- Crohn's disease [regional enteritis] of ileumInherited from K50.0
- Crohn's disease [regional enteritis] of jejunumInherited from K50.0
- Regional ileitisInherited from K50.0
- Terminal ileitisInherited from K50.0
Excludes 2
Official- certain conditions originating in the perinatal period (P04-P96)Inherited from K00-K95
- certain infectious and parasitic diseases (A00-B99)Inherited from K00-K95
- complications of pregnancy, childbirth and the puerperium (O00-O9A)Inherited from K00-K95
- congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)Inherited from K00-K95
- endocrine, nutritional and metabolic diseases (E00-E88)Inherited from K00-K95
- injury, poisoning and certain other consequences of external causes (S00-T88)Inherited from K00-K95
- neoplasms (C00-D49)Inherited from K00-K95
- symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)Inherited from K00-K95
Related Codes
Includes
Official- noninfective inflammatory bowel diseaseInherited from K50-K52, K50
- granulomatous enteritisInherited from K50-K52, K50
Excludes 1
Official- irritable bowel syndrome (K58.-)Inherited from K50-K52, K50, K50.0
- megacolon (K59.3-)Inherited from K50-K52, K50, K50.0
- ulcerative colitis (K51.-)Inherited from K50-K52, K50, K50.0
- Crohn's disease of both small and large intestine (K50.8-)Inherited from K50-K52, K50, K50.0
Code First
OfficialNo Code First sequencing instructions are included in this display for K50.013. Check the code and parent instructions in the Code Book.
Use Additional
Official- code to identify any associated fistulas, if applicable:Inherited from K50
- anal fistula (K60.3-)Inherited from K50
- anorectal fistula (K60.5-)Inherited from K50
- rectal fistula (K60.4-)Inherited from K50
- code to identify manifestations, such as:Inherited from K50
- pyoderma gangrenosum (L88)Inherited from K50
Code Also
OfficialNo Code Also instructions are included in this display for K50.013. Check the code and parent instructions in the Code Book.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
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 K50.013 an HCC code?
Yes. K50.013 (Crohn's disease of small intestine with fistula) maps to HCC 80, Crohn's Disease (Regional Enteritis) under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.550. 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: K50.013 is billable and maps to V28 HCC 80, Crohn's Disease (Regional Enteritis). Open it in the Code Book for the tabular path, RAF, and MEAT checklist.
- Code
- K50.013
- Description
- Crohn's disease of small intestine with fistula
- HCC (V28)
- HCC 80 — Crohn's Disease (Regional Enteritis)
- RAF reference coefficient
- 0.550
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
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 K50.013 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for K50.013
For K50.013, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.
- 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
Coder workflow notes
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What This Code Means
K50.013 is the ICD-10-CM diagnosis code for crohn's disease of small intestine with fistula. Crohn's disease of the small intestine with an abnormal tunnel-like connection (fistula) between intestinal segments or to other organs. K50.013 sits in the ICD-10-CM chapter for diseases of the digestive system (k00-k95), within the section covering noninfective enteritis and colitis (k50-k52).
Under the CMS-HCC V28 risk adjustment model, K50.013 maps to Crohn's Disease (Regional Enteritis) (HCC 80) with a source-labeled community, non-dual, aged reference coefficient of 0.550. For CY2026 non-PACE Medicare Advantage, CMS uses 100% of the 2024 CMS-HCC model (V28). PACE uses a separate model blend. 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.
Fistulas are a common complication of Crohn's disease requiring specific documentation. For K50.013, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule. 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 K50.013 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Fistulas are a common complication of Crohn's disease requiring specific documentation
- •Document the location and type of fistula if available for additional specificity
Clinical Significance
Crohn's disease of the small intestine with fistula represents penetrating disease behavior, where chronic transmural inflammation creates abnormal connections between bowel segments or to other organs. Fistulas are a hallmark complication of Crohn's disease, often requiring biologic therapy and potentially complex surgical intervention. This complication significantly increases disease burden and treatment complexity.
Documentation Requirements
- ✓Provider documentation of Crohn's disease of the small intestine with fistula
- ✓Type and location of fistula (enteroenteric, enterocutaneous, enterovesical, enterovaginal, etc.)
- ✓Diagnostic confirmation method (imaging, surgical exploration, or clinical examination)
- ✓Current drainage status and treatment approach (biologics, seton placement, surgical repair)
- ✓Impact on nutritional status and quality of life
Commonly Confused Codes
- •K50.00: Crohn's disease of small intestine without complications: no fistula present
- •K50.113: Crohn's disease of large intestine with fistula: large intestine location
- •K50.813: Crohn's disease of both small and large intestine with fistula: both sites
- •K50.014: Crohn's disease of small intestine with abscess: different complication (pus collection vs. tract)
- •K63.2: Fistula of intestine: not attributed to Crohn's disease