K56.1
BillableIntussusception
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is K56.1 an HCC code?
Yes. K56.1 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 K56.1
For K56.1to 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.
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 0.000. Under the older V24 model, K56.1 mapped to the same category but with a base RAF weight of 0.226 — 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)