K50.913 ICD-10-CM Code: Crohn's disease, unspecified, with fistula
K50.913 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)
K50.913
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceCrohn's disease, unspecified, with fistula
Crohn's disease of unspecified location with fistula, an abnormal tunnel-like connection between intestinal segments or to other organs.
Buddy Insight
Crohn's disease, unspecified, with fistula indicates penetrating disease behavior at an unspecified location.
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
OfficialNo inclusion terms are included in this display for K50.913. 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
- 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
- megacolon (K59.3-)Inherited from K50-K52, K50
- ulcerative colitis (K51.-)Inherited from K50-K52, K50
Code First
OfficialNo Code First sequencing instructions are included in this display for K50.913. 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 K50.913. 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 K50.913 an HCC code?
Yes. K50.913 (Crohn's disease, unspecified, 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: K50.913 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
- K50.913
- Description
- Crohn's disease, unspecified, 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 K50.913 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for K50.913
For K50.913, 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
K50.913 is the ICD-10-CM diagnosis code for crohn's disease, unspecified, with fistula. Crohn's disease of unspecified location with fistula, an abnormal tunnel-like connection between intestinal segments or to other organs. K50.913 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, K50.913 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.
Use K50.913 when the provider wording supports crohn's disease, unspecified, with fistula. Check the FY2026 tabular notes and the full code path before the final code choice. For K50.913, 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 K50.913 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use K50.913 when the provider wording supports crohn's disease, unspecified, with fistula. Check the FY2026 tabular notes and the full code path before the final code choice.
- •For this DOS, capture the provider's current assessment and the care action documented for crohn's disease, unspecified, with fistula. Keep the checklist tied to the note.
- •Do not swap K50.913 with K50.911. The FY2026 tabular describes K50.911 as crohn's disease, unspecified, with rectal bleeding. Follow the documented detail.
- •The FY2026 Alphabetic Index routes Enteritis (acute) (diarrheal) (hemorrhagic) (noninfective) under regional (of) with complication > fistula to K50.913. Confirm that the indexed wording matches the provider documentation before using this route.
- •Ask Buddy to show the official notes for K50.913 or compare its code path with K50.911.
Clinical Significance
Crohn's disease, unspecified, with fistula indicates penetrating disease behavior at an unspecified location. Fistulas are a hallmark of Crohn's disease and their presence provides clinical clues about disease location. The fistula type (perianal, enteroenteric, etc.) often helps determine the affected bowel segment, making the unspecified site a query opportunity.
Documentation Requirements
- ✓Provider documentation of Crohn's disease with fistula formation
- ✓Type and location of fistula documented
- ✓Documentation that the primary disease site could not be determined
- ✓Diagnostic method confirming fistula
- ✓Treatment plan (medical and/or surgical)
Commonly Confused Codes
- •K50.013: Crohn's disease of small intestine with fistula: small intestine specified
- •K50.113: Crohn's disease of large intestine with fistula: large intestine specified
- •K50.813: Crohn's disease of both sites with fistula: both sites specified
- •K50.914: Crohn's disease, unspecified, with abscess: abscess vs. fistula
- •K63.2: Fistula of intestine: not attributed to Crohn's disease