K56.0
BillableParalytic ileus
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is K56.0 an HCC code?
Yes. K56.0 maps to Intestinal Obstruction/Perforation under the CMS-HCC V28 risk adjustment model (and Intestinal Obstruction/Perforation under V24).
HCC Category Mapping
RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. 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.
MEAT Criteria for K56.0
For K56.0to 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 K56.0 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
K56.0 is the ICD-10-CM diagnosis code for paralytic ileus. A temporary loss of normal intestinal muscle contractions that prevents food and waste from moving through the bowels, often occurring after surgery. K56.0 sits in the ICD-10-CM chapter for diseases of the digestive system (k00-k95), within the section covering other diseases of intestines (k55-k64).
Under the CMS-HCC V28 risk adjustment model, K56.0 maps to Intestinal Obstruction/Perforation (HCC 78) with a community, non-dual, aged base RAF weight of 0.326. Under the older V24 model, K56.0 mapped to the same category but with a base RAF weight of 0.219 — V28 recalibrated weights across the entire model. 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 cause (post-surgical, medication-induced, etc.) and duration to support medical necessity. Because K56.0 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 K56.0 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
Clinical Significance
K56.0 represents paralytic ileus, a serious condition where intestinal motility ceases, often occurring postoperatively or due to electrolyte imbalances, medications, or systemic illness. This condition can lead to bowel distention, perforation, and sepsis if not promptly managed, requiring close monitoring and intervention.
Documentation Requirements
- ✓Documentation of absent or severely reduced bowel sounds
- ✓Clinical evidence of intestinal paralysis (distention, lack of passage of gas/stool)
- ✓Imaging showing dilated bowel loops without mechanical obstruction
- ✓Identification of underlying cause (post-surgical, medication-induced, metabolic)
- ✓Documentation excluding mechanical obstruction
- ✓Evidence of conservative or interventional management
- ✓Monitoring of electrolytes and fluid balance
- ✓Assessment of complications or risk factors
Excludes 1 — Do NOT code together
Commonly Confused Codes
- •K56.7 — Ileus unspecified (when paralytic nature not specifically documented)
- •K56.60 — Partial intestinal obstruction unspecified (mechanical rather than paralytic)
- •K31.84 — Gastroparesis (stomach-specific rather than intestinal)
- •K92.0 — Hematemesis (bleeding rather than motility disorder)
- •R14.0 — Abdominal distention (symptom rather than specific diagnosis)