K56.7
BillableIleus, unspecified
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is K56.7 an HCC code?
Yes. K56.7 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 K56.7
For K56.7to 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 K56.7 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
K56.7 is the ICD-10-CM diagnosis code for ileus, unspecified. A temporary paralysis or lack of movement in the intestines that prevents normal passage of food and waste. K56.7 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, K56.7 maps to Intestinal Obstruction/Perforation (HCC 78) with a community, non-dual, aged base RAF weight of 0.326. Under the older V24 model, K56.7 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.
Ileus is a functional obstruction without mechanical blockage; distinguish from mechanical obstruction codes. Because K56.7 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 K56.7 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Ileus is a functional obstruction without mechanical blockage; distinguish from mechanical obstruction codes
- •Document the cause (post-surgical, medication-induced, etc.) in the medical record when available
Clinical Significance
K56.7 represents ileus of unspecified type, indicating paralysis or lack of normal peristalsis in the intestinal tract without specification as to whether it is paralytic, mechanical, or other type. This condition can lead to significant morbidity from bowel distention, electrolyte imbalances, and potential complications if not properly managed.
Documentation Requirements
- ✓Clinical evidence of absent or decreased bowel motility
- ✓Documentation of ileus without specification of type
- ✓Imaging showing dilated bowel loops
- ✓Assessment of underlying precipitating factors
- ✓Management approach including bowel rest and decompression
- ✓Monitoring of electrolytes and fluid balance
- ✓Evaluation for complications or progression
- ✓Documentation that specific type cannot be determined
Excludes 1 — Do NOT code together
- obstructive ileus (K56.69-)
Commonly Confused Codes
- •K56.0 — Paralytic ileus (when paralytic nature is specifically documented)
- •K56.60 — Partial intestinal obstruction unspecified (when mechanical rather than paralytic)
- •K31.84 — Gastroparesis (when stomach-specific rather than intestinal)
- •K59.8 — Other specified functional intestinal disorders (functional rather than paralytic)
- •R14.0 — Abdominal distention (symptom rather than specific diagnosis)