What is ICD-10 code K56.1?

K56.1 is the ICD-10-CM diagnosis code for Intussusception. A condition where one section of the intestine telescopes or folds into an adjacent section, causing a blockage. This is most common in children but can occur in adults. K56.1 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. K56.1 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. K56.1 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. K56.1 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 K56.1 map to under V28?

K56.1 maps to CMS-HCC V28 78 (Intestinal Obstruction/Perforation). The category number and label come from the CMS-HCC V28 model file for payment year 2026.

What does K56.1 pay in RAF?

K56.1 carries a community, non-dual, aged (CNA) RAF weight of 0.326 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 K56.1?

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 K56.1, V28 maps to Intestinal Obstruction/Perforation at RAF 0.326 while V24 mapped to Intestinal Obstruction/Perforation at RAF 0.219. Both models can still appear in legacy data and in payer-specific lookback periods.

What documentation supports K56.1?

Intussusception is often a pediatric emergency; verify patient age and clinical presentation for accurate coding Specify the site of intussusception if documented (e.g., ileocolic, ileoileal) as additional specificity codes may apply Because K56.1 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 K56.1: Intussusception

K56.1 maps to CMS-HCC V28 78 (RAF 0.326). Documentation must support MEAT. MEAT criteria · RAF calculator · HCC coding software

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Code lookupK56.1Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Diseases of the digestive system (K00-K95) / Other diseases of intestines (K55-K64)

K56.1

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

Intussusception

A condition where one section of the intestine telescopes or folds into an adjacent section, causing a blockage. This is most common in children but can occur in adults.

Buddy Insight

K56.

CMS-HCC V28

Mapped

HCC 78

Intestinal Obstruction/Perfor...

RAF 0.326

CMS-HCC V24

Mapped

HCC 33

Intestinal Obstruction/Perfor...

RAF 0.219

ACA/HHS

Mapped

HCC 45

HHS-HCC 45

Varies by metal level

ESRD/PACE

Mapped

HCC 33

Intestinal Obstruction/Perfor...

RAF 0.078

RXHCC

N/A

—

Not risk-adjusted for this model/period.

Not mapped

Code Book Path

Official

K56Paralytic ileus and intestinal obstruction without hernia

K56.1Intussusception

Inclusion Terms

Official

Intussusception or invagination of bowel
Intussusception or invagination of colon
Intussusception or invagination of intestine
Intussusception or invagination of rectum

Excludes 2

Official

intussusception of appendix (K38.8)

Related Child Codes

Official

K56.0Paralytic ileus

K56.2Volvulus

K56.3Gallstone ileus

K56.4Other impaction of intestine

K56.5Intestinal adhesions [bands] with obstruction (postinfection)

Includes

Official

ICD-10-CM does not list Includes notes for K56.1 in this effective period.

Excludes 1

Official

congenital stricture or stenosis of intestine (Q41-Q42)
cystic fibrosis with meconium ileus (E84.11)
ischemic stricture of intestine (K55.1)
meconium ileus NOS (P76.0)
neonatal intestinal obstructions classifiable to P76.-

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for K56.1 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for K56.1 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for K56.1 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

Clinical presentation consistent with bowel obstruction

Imaging studies (CT, ultrasound) demonstrating telescoping bowel segments

Documentation of target sign or other characteristic imaging findings

Assessment of bowel viability and blood supply

MEAT Support

HCC Buddy guidance

Clinical presentation consistent with bowel obstruction

Imaging studies (CT, ultrasound) demonstrating telescoping bowel segments

Documentation of target sign or other characteristic imaging findings

Assessment of bowel viability and blood supply

Audit Caution

HCC Buddy guidance

Not documenting characteristic imaging findings of intussusception

Confusing with other types of mechanical obstruction

Missing documentation of underlying lead point evaluation

Inadequate specification of bowel segments involved

Common Mistakes

HCC Buddy guidance

K56.2 — Volvulus (twisting rather than telescoping of bowel)

K56.60 — Partial intestinal obstruction unspecified (when specific mechanism not documented)

K92.2 — Gastrointestinal hemorrhage (bleeding complication rather than primary diagnosis)

D12.6 — Benign neoplasm of colon (potential lead point rather than intussusception itself)

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 K56.1 an HCC code?

Yes. K56.1 (Intussusception) maps to Intestinal Obstruction/Perforation under the CMS-HCC V28 risk adjustment model (and Intestinal Obstruction/Perforation under V24), with a community non-dual aged RAF of 0.326. It is billable for payment year 2026.

Coder answer: K56.1 is billable and maps to V28 HCC 78, Intestinal Obstruction/Perforation. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.

Code: K56.1
Description: Intussusception
HCC (V28): HCC 78 — Intestinal Obstruction/Perforation
RAF: 0.326
Billable: Yes
Payment year: 2026

HCC Category Mapping

V28HCC 78, Intestinal Obstruction/Perforation

0.326

V24HCC 33, Intestinal Obstruction/Perforation

0.219

ESRDHCC 33, Intestinal Obstruction/Perforation

0.078

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 K56.1 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

MEAT Criteria for K56.1

For K56.1 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 K56.1 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

K56.1 is the ICD-10-CM diagnosis code for intussusception. A condition where one section of the intestine telescopes or folds into an adjacent section, causing a blockage. This is most common in children but can occur in adults. K56.1 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, K56.1 maps to Intestinal Obstruction/Perforation (HCC 78) with a community, non-dual, aged base RAF weight of 0.326. Under the older V24 model, K56.1 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.

Intussusception is often a pediatric emergency; verify patient age and clinical presentation for accurate coding. Because K56.1 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 K56.1 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Intussusception is often a pediatric emergency; verify patient age and clinical presentation for accurate coding
•Specify the site of intussusception if documented (e.g., ileocolic, ileoileal) as additional specificity codes may apply

Clinical Significance

K56.1 represents intussusception, a serious condition where one bowel segment telescopes into another, causing obstruction and potentially compromising blood supply. While more common in children, adult intussusception often indicates underlying pathology such as tumors and requires urgent surgical evaluation to prevent bowel necrosis and perforation.

Documentation Requirements

✓Clinical presentation consistent with bowel obstruction
✓Imaging studies (CT, ultrasound) demonstrating telescoping bowel segments
✓Documentation of target sign or other characteristic imaging findings
✓Assessment of bowel viability and blood supply
✓Identification of any lead point or underlying cause
✓Surgical consultation and intervention planning
✓Documentation of complete vs incomplete obstruction
✓Post-intervention monitoring and complications

Excludes 2, Not included here, may code separately

intussusception of appendix (K38.8)

Commonly Confused Codes

•K56.2: Volvulus (twisting rather than telescoping of bowel)
•K56.60: Partial intestinal obstruction unspecified (when specific mechanism not documented)
•K92.2: Gastrointestinal hemorrhage (bleeding complication rather than primary diagnosis)
•D12.6: Benign neoplasm of colon (potential lead point rather than intussusception itself)
•K56.69: Other intestinal obstruction (when intussusception not specifically identified)