K87
BillableDisorders of gallbladder, biliary tract and pancreas in diseases classified elsewhere
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is K87 an HCC code?
No. K87 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
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 K87
For K87to 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 K87 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
K87 is the ICD-10-CM diagnosis code for disorders of gallbladder, biliary tract and pancreas in diseases classified elsewhere. Problems affecting the gallbladder, bile ducts, or pancreas that occur as a result of another disease classified elsewhere in the ICD-10 system. K87 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).
K87 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.
No significant HCC impact, reflecting its role as a manifestation code. The HCC value would come from the underlying primary condition that must be coded first. Coders reviewing K87 should check whether additional documentation would support a more specific child code in the same hierarchy that does map to a payment HCC — capturing the correct specificity is the highest-leverage RAF improvement available within accurate coding.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for K87 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This is a secondary code; always code the primary disease first (e.g., tuberculosis, syphilis, or systemic disease)
- •Requires dual coding with the underlying disease to properly capture the clinical picture
Clinical Significance
This code captures gallbladder, biliary tract, and pancreatic disorders that occur secondary to diseases classified elsewhere in ICD-10. It requires the primary condition to be coded first, with this as an additional code to capture the biliary/pancreatic manifestation.
Documentation Requirements
- ✓Documentation of primary disease causing the biliary/pancreatic disorder
- ✓Clear relationship between primary condition and biliary/pancreatic manifestation
- ✓Evidence of gallbladder, bile duct, or pancreatic involvement
- ✓Specific identification of the underlying disease process
- ✓Clinical manifestations of biliary or pancreatic dysfunction
- ✓Exclusion of primary biliary/pancreatic diseases
- ✓Supporting laboratory or imaging findings
- ✓Treatment directed at both primary condition and biliary manifestation
Excludes 1 — Do NOT code together
Code First
- underlying disease
Commonly Confused Codes
- •K80-K86 codes — Use when biliary/pancreatic condition is primary rather than secondary
- •K76.9 — Liver disease unspecified for hepatic rather than biliary involvement
- •K92.2 — GI bleeding when bleeding is the primary manifestation
- •R93.2 — Abnormal findings on imaging when structural abnormality isn't established
- •Z87.891 — Personal history of nicotine dependence for past conditions