What is ICD-10 code K50.113?

K50.113 is the ICD-10-CM diagnosis code for Crohn's disease of large intestine with fistula. Crohn's disease of the large intestine with an abnormal tunnel-like connection (fistula) between the intestine and other organs or skin. It belongs to the ICD-10-CM chapter for diseases of the digestive system (k00-k95). K50.113 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. K50.113 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Yes. K50.113 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. K50.113 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

Which HCC does K50.113 map to under V28?

K50.113 maps to CMS-HCC V28 80 (Crohn's Disease (Regional Enteritis)). The category number and label come from the CMS-HCC V28 model file for payment year 2026.

What does K50.113 pay in RAF?

K50.113 carries a community, non-dual, aged (CNA) RAF weight of 0.550 under CMS-HCC V28 for payment year 2026. The weight comes from the CMS V28 relative-factor file, not a hand-typed table.

What is the V28 vs V24 difference for K50.113?

CMS phased in the V28 risk adjustment model over payment years 2024 (33%), 2025 (67%), and 2026 (100%), replacing V24. V28 consolidates HCC categories, removes some lower-acuity conditions, and recalibrates RAF weights across the entire model. For K50.113, V28 maps to Crohn's Disease (Regional Enteritis) at RAF 0.550 while V24 mapped to Inflammatory Bowel Disease at RAF 0.308. Both models can still appear in legacy data and in payer-specific lookback periods.

What documentation supports K50.113?

Document the location and type of fistula when possible (enterocutaneous, enterovesical, etc.) for complete coding Fistulas are a common complication of Crohn's disease; ensure documentation clearly identifies this complication Because K50.113 maps to a payment HCC, the documentation must also satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's risk adjustment score. See the MEAT criteria checklist at /meat-criteria for what Monitor, Evaluate, Assess, or Treat looks like in a note. MEAT is generic documentation evidence, not a payer-specific rule.

2026 ICD-10-CM K50.113: Crohn's disease of large

K50.113 maps to CMS-HCC V28 80 (RAF 0.550). Documentation must support MEAT. MEAT criteria · RAF calculator · free HCC coding tools

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Code lookupK50.113Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Diseases of the digestive system (K00-K95) / Noninfective enteritis and colitis (K50-K52)

K50.113

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

Crohn's disease of large intestine with fistula

Crohn's disease of the large intestine with an abnormal tunnel-like connection (fistula) between the intestine and other organs or skin.

Buddy Insight

Crohn's disease of the large intestine with fistula indicates penetrating disease behavior in the colon, creating abnormal connections to other structures.

CMS-HCC V28

Mapped

HCC 80

Crohn's Disease (Regional Ent...

RAF 0.550

CMS-HCC V24

Mapped

HCC 35

Inflammatory Bowel Disease

RAF 0.308

ACA/HHS

Mapped

HCC 48

HHS-HCC 48

Varies by metal level

ESRD/PACE

Mapped

HCC 35

Inflammatory Bowel Disease

RAF 0.048

RXHCC

Mapped

HCC 67

Inflammatory Bowel Disease

RAF 0.494

Code Book Path

Official

K50.1Crohn's disease of large intestine

K50.11Crohn's disease of large intestine with complications

K50.113Crohn's disease of large intestine with fistula

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for K50.113 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for K50.113 in this effective period.

Related Child Codes

Official

K50.111Crohn's disease of large intestine with rectal bleeding

K50.112Crohn's disease of large intestine with intestinal obstruction

K50.114Crohn's disease of large intestine with abscess

K50.118Crohn's disease of large intestine with other complication

K50.119Crohn's disease of large intestine with unspecified complications

Includes

Official

ICD-10-CM does not list Includes notes for K50.113 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for K50.113 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for K50.113 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for K50.113 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for K50.113 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

Provider documentation of Crohn's disease of the large intestine with fistula

Type and location of fistula (colovesical, colovaginal, colocutaneous, perianal, etc.)

Diagnostic method (imaging, endoscopy, examination under anesthesia)

Drainage status and treatment approach

MEAT Support

HCC Buddy guidance

Provider documentation of Crohn's disease of the large intestine with fistula

Type and location of fistula (colovesical, colovaginal, colocutaneous, perianal, etc.)

Diagnostic method (imaging, endoscopy, examination under anesthesia)

Drainage status and treatment approach

Audit Caution

HCC Buddy guidance

Coding a perianal fistula as K60.3 instead of K50.113 when it is clearly a manifestation of Crohn's disease

Confusing fistula with abscess — different complications requiring different codes

Using the uncomplicated code when a fistula is documented

Not capturing both fistula and abscess when they coexist (common in Crohn's disease)

Common Mistakes

HCC Buddy guidance

K50.10 — Crohn's disease of large intestine without complications: no fistula present

K50.013 — Crohn's disease of small intestine with fistula: small intestine location

K50.813 — Crohn's disease of both small and large intestine with fistula: both sites

K50.114 — Crohn's disease of large intestine with abscess: abscess (pus collection) vs. fistula (tract)

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 K50.113 an HCC code?

Yes. K50.113 (Crohn's disease of large intestine with fistula) maps to Crohn's Disease (Regional Enteritis) under the CMS-HCC V28 risk adjustment model (and Inflammatory Bowel Disease under V24), with a community non-dual aged RAF of 0.550. It is billable for payment year 2026.

Coder answer: K50.113 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: K50.113
Description: Crohn's disease of large intestine with fistula
HCC (V28): HCC 80 — Crohn's Disease (Regional Enteritis)
RAF: 0.550
Billable: Yes
Payment year: 2026

HCC Category Mapping

V28HCC 80, Crohn's Disease (Regional Enteritis)

0.550

V24HCC 35, Inflammatory Bowel Disease

0.308

ESRDHCC 35, Inflammatory Bowel Disease

0.048

RxHCCHCC 67, Inflammatory Bowel Disease

0.494

Each model's RAF is its CMS base weight for that model's standard population, so 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 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.

Work K50.113 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

MEAT Criteria for K50.113

For K50.113 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 K50.113 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

K50.113 is the ICD-10-CM diagnosis code for crohn's disease of large intestine with fistula. Crohn's disease of the large intestine with an abnormal tunnel-like connection (fistula) between the intestine and other organs or skin. K50.113 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, K50.113 maps to Crohn's Disease (Regional Enteritis) (HCC 80) with a community, non-dual, aged base RAF weight of 0.550. Under the older CMS-HCC V24 model, K50.113 maps to Inflammatory Bowel Disease (HCC 35) with a community, non-dual, aged base RAF weight of 0.308. 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.

Document the location and type of fistula when possible (enterocutaneous, enterovesical, etc.) for complete coding. Because K50.113 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 K50.113 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Document the location and type of fistula when possible (enterocutaneous, enterovesical, etc.) for complete coding
•Fistulas are a common complication of Crohn's disease; ensure documentation clearly identifies this complication

Clinical Significance

Crohn's disease of the large intestine with fistula indicates penetrating disease behavior in the colon, creating abnormal connections to other structures. Colonic fistulas may be colovesical (to bladder), colovaginal, colocutaneous, or enteroenteric. This complication significantly impacts quality of life and often requires biologic therapy, surgical diversion, or complex resection.

Documentation Requirements

✓Provider documentation of Crohn's disease of the large intestine with fistula
✓Type and location of fistula (colovesical, colovaginal, colocutaneous, perianal, etc.)
✓Diagnostic method (imaging, endoscopy, examination under anesthesia)
✓Drainage status and treatment approach
✓Impact on functional status and quality of life

Commonly Confused Codes

•K50.10: Crohn's disease of large intestine without complications: no fistula present
•K50.013: Crohn's disease of small intestine with fistula: small intestine location
•K50.813: Crohn's disease of both small and large intestine with fistula: both sites
•K50.114: Crohn's disease of large intestine with abscess: abscess (pus collection) vs. fistula (tract)
•K60.3: Anal fistula: not attributed to Crohn's disease