K56.601
BillableComplete intestinal obstruction, unspecified as to cause
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is K56.601 an HCC code?
Yes. K56.601 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 K56.601
For K56.601to 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 K56.601 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
K56.601 is the ICD-10-CM diagnosis code for complete intestinal obstruction, unspecified as to cause. A complete blockage of the intestine where the specific cause has not been identified or documented. Intestinal contents cannot pass through at all. K56.601 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, K56.601 maps to Intestinal Obstruction/Perforation (HCC 78) with a community, non-dual, aged base RAF weight of 0.000. Under the older V24 model, K56.601 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.
Complete obstruction of unknown cause is a serious condition; ensure documentation reflects clinical severity and urgency. Because K56.601 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 K56.601 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Complete obstruction of unknown cause is a serious condition; ensure documentation reflects clinical severity and urgency
- •This code should be replaced with a more specific diagnosis code once the cause is determined
Clinical Significance
K56.601 represents complete intestinal obstruction where the specific cause has not been identified or documented. This is a surgical emergency requiring immediate intervention as no intestinal contents can pass, leading to bowel distention, potential necrosis, and risk of perforation if not promptly addressed.
Documentation Requirements
- ✓Clinical evidence of complete bowel obstruction with no passage
- ✓Imaging showing dilated bowel with no distal passage of contents
- ✓Documentation that specific cause cannot be determined
- ✓Evidence of diagnostic workup attempting to identify etiology
- ✓Surgical consultation and emergency intervention
- ✓Assessment of bowel viability during intervention
- ✓Post-operative findings regarding actual cause when identified
- ✓Documentation of the complete nature of obstruction
Commonly Confused Codes
- •K56.52 — Intestinal adhesions with complete obstruction (when adhesional cause is documented)
- •K56.609 — Unspecified intestinal obstruction (when complete vs partial degree is unclear)
- •K56.691 — Other complete intestinal obstruction (when specific cause is known but uncommon)
- •K56.2 — Volvulus (when twisting mechanism is identified)
- •K56.1 — Intussusception (when telescoping mechanism is identified)