K83.1
BillableObstruction of bile duct
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is K83.1 an HCC code?
Yes. K83.1 maps to Cholangitis and Obstruction of Bile Duct Without Gallstones under the CMS-HCC V28 risk adjustment model.
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 K83.1
For K83.1to 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 K83.1 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
K83.1 is the ICD-10-CM diagnosis code for obstruction of bile duct. A blockage in the bile duct that prevents bile from flowing properly, which can cause pain, jaundice, and complications like pancreatitis. K83.1 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).
Under the CMS-HCC V28 risk adjustment model, K83.1 maps to Cholangitis and Obstruction of Bile Duct Without Gallstones (HCC 68) with a community, non-dual, aged base RAF weight of 0.388. K83.1 was not retained as a payment HCC under the older V24 model, so V28 introduced or recategorized it during the 2024–2026 phase-in. 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.
Identify and document the cause of obstruction (stone, stricture, tumor, etc.) for more specific coding if available. Because K83.1 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 K83.1 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Identify and document the cause of obstruction (stone, stricture, tumor, etc.) for more specific coding if available
- •Consider whether this is causing acute pancreatitis or cholangitis, which would require additional codes
Clinical Significance
Bile duct obstruction represents blockage preventing normal bile flow, potentially causing jaundice, cholangitis, and liver damage if untreated. This condition requires urgent evaluation and intervention to prevent serious complications.
Documentation Requirements
- ✓Imaging evidence of bile duct dilatation or obstruction
- ✓Elevated bilirubin and alkaline phosphatase levels
- ✓Clinical signs of cholestasis (jaundice, pruritus, pale stools)
- ✓Identification of obstruction level and cause when possible
- ✓Evidence of biliary tree dilatation upstream from obstruction
- ✓Documentation of associated symptoms
- ✓ERCP, MRCP, or CT findings confirming obstruction
- ✓Response to biliary drainage procedures
Excludes 1 — Do NOT code together
Commonly Confused Codes
- •K80.5 — Choledocholithiasis when stones are the specific cause
- •K83.09 — Other cholangitis when inflammation is the primary issue
- •C24.0 — Extrahepatic bile duct malignancy causing obstruction
- •K87 — Secondary biliary disorders when obstruction is due to other disease
- •R17 — Unspecified jaundice when obstruction not confirmed