K59.4
BillableAnal spasm
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is K59.4 an HCC code?
No. K59.4 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).
What This Code Means
K59.4 is the ICD-10-CM diagnosis code for anal spasm. Involuntary muscle contractions of the anal sphincter causing pain, discomfort, or difficulty with bowel movements. K59.4 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).
K59.4 is a billable ICD-10-CM code but does not map to a payment HCC under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can be reported on Medicare Advantage encounter data submissions but it does not contribute to a beneficiary's RAF score and therefore does not affect risk-adjusted payments to the plan.
Document whether spasm is primary or secondary to other conditions like anal fissures or hemorrhoids.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for K59.4 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Document whether spasm is primary or secondary to other conditions like anal fissures or hemorrhoids
- •Distinguish from other anorectal pain conditions by confirming the spasm component