Question 1

What is ICD-10 code K80.81?

Accepted Answer

K80.81 is the ICD-10-CM diagnosis code for other cholelithiasis with obstruction. Other types of gallstones not fitting the previous categories, with blockage of bile flow. K80.81 sits in the ICD-10-CM chapter for diseases of the digestive system (k00-k95), within the section covering disorders of gallbladder, biliary tract and pancreas (k80-k87).

K80.81 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.

This is the obstructive variant of other cholelithiasis; confirm obstruction is documented.

Question 2

Is K80.81 an HCC code?

Accepted Answer

No. K80.81 is a billable ICD-10-CM code but does not map to any payment HCC category under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can still be reported on Medicare Advantage encounter data submissions, but it does not contribute to the beneficiary's Risk Adjustment Factor (RAF) score and therefore does not affect the risk-adjusted capitation payment to the plan. V28 reached 100% phase-in for payment year 2026.

Question 3

Is K80.81 billable?

Accepted Answer

Yes. K80.81 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. K80.81 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

Question 4

What is the V28 vs V24 difference for K80.81?

Accepted Answer

K80.81 does not map to a payment HCC under either the CMS-HCC V28 risk adjustment model or the older V24 model. V28 reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition. Because neither model rewards K80.81 with a risk adjustment factor, it contributes zero to a Medicare Advantage beneficiary's RAF score in either version. Coders should check whether provider documentation supports a more specific child code that does map to a payment HCC.

Question 5

What should coders know when reporting K80.81?

Accepted Answer

This is the obstructive variant of other cholelithiasis; confirm obstruction is documented Verify that more specific K80 codes are not applicable before using this catch-all code

K80.81

Is K80.81 an HCC code?

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Open K80.81 in the Interactive Encoder