K56.49
BillableOther impaction of intestine
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is K56.49 an HCC code?
Yes. K56.49 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 K56.49
For K56.49to 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 K56.49 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
K56.49 is the ICD-10-CM diagnosis code for other impaction of intestine. A blockage of the intestine caused by material other than gallstones, fecal matter, or other specified causes. This is a catch-all category for various impaction types. K56.49 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, K56.49 maps to Intestinal Obstruction/Perforation (HCC 78) with a community, non-dual, aged base RAF weight of 0.326. Under the older V24 model, K56.49 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.
Use this code only when the specific type of impaction is not documented or does not fit other categories. Because K56.49 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 K56.49 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use this code only when the specific type of impaction is not documented or does not fit other categories
- •Review documentation carefully to determine if a more specific impaction code applies
Clinical Significance
K56.49 represents other types of intestinal impaction not elsewhere classified, indicating foreign material or substances blocking the bowel that are not gallstones or fecal matter. This condition can result from medications, foreign bodies, or other materials and may require endoscopic or surgical intervention depending on the location and nature of the impacting material.
Documentation Requirements
- ✓Identification of the specific impacting material or substance
- ✓Imaging studies demonstrating intestinal obstruction from impaction
- ✓Documentation excluding fecal impaction and gallstone ileus
- ✓Clinical presentation consistent with bowel obstruction
- ✓Intervention method used to address the impaction
- ✓Assessment of bowel viability and complications
- ✓Documentation of predisposing factors when identifiable
- ✓Follow-up plan to prevent recurrence
Commonly Confused Codes
- •K56.41 — Fecal impaction (fecal rather than other material)
- •K56.3 — Gallstone ileus (gallstone rather than other impacting material)
- •T18.3 — Foreign body in small intestine (acute foreign body ingestion rather than impaction)
- •K56.60 — Partial intestinal obstruction unspecified (when impaction mechanism not documented)
- •K30 — Functional dyspepsia (functional rather than mechanical obstruction)