K90.0 ICD-10-CM Code: Celiac disease
HCC Buddy Code Card
Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.
FY 2026 Apr update / Diseases of the digestive system (K00-K95) / Other diseases of the digestive system (K90-K95)
K90.0
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceCeliac disease
An autoimmune condition where the small intestine cannot properly digest gluten (a protein in wheat, barley, and rye), causing malabsorption and digestive symptoms.
Buddy Insight
Celiac disease is an autoimmune condition where gluten triggers small intestine inflammation, leading to malabsorption and nutritional deficiencies.
CMS-HCC V28
00
RAF 0
CMS-HCC V24
00
RAF 0
ACA/HHS
00
RAF 0
ESRD/PACE
00
RAF 0
RXHCC
MappedHCC 66
RAF 0.0
Code Trumping
Basket needed
Code Book Path
Inclusion Terms
Official- Celiac disease with steatorrhea
- Celiac gluten-sensitive enteropathy
- Nontropical sprue
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for K90.0 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for K90.0 in this effective period.
Excludes 1
Official- intestinal malabsorption following gastrointestinal surgery (K91.2)
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for K90.0 in this effective period.
Use Additional
Official- code for associated disorders including:
- dermatitis herpetiformis (L13.0)
- gluten ataxia (G32.81)
Code Also
Official- exocrine pancreatic insufficiency (K86.81)
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.
Is K90.0 an HCC code?
No. K90.0 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 K90.0
For K90.0to 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 K90.0 during that encounter, not just copy-forwarded from a problem list.
What This Code Means
K90.0 is the ICD-10-CM diagnosis code for celiac disease. An autoimmune condition where the small intestine cannot properly digest gluten (a protein in wheat, barley, and rye), causing malabsorption and digestive symptoms. K90.0 sits in the ICD-10-CM chapter for diseases of the digestive system (k00-k95), within the section covering other diseases of the digestive system (k90-k95).
K90.0 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 in current models, which may not adequately capture the lifelong dietary restrictions, monitoring requirements, and potential complications of celiac disease. Coders reviewing K90.0 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-impact RAF improvement available within accurate coding.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for K90.0 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Document whether the patient is on a gluten-free diet and compliance status
- •Link to associated conditions such as dermatitis herpetiformis (L13.0) or nutritional deficiencies when present
Clinical Significance
Celiac disease is an autoimmune condition where gluten triggers small intestine inflammation, leading to malabsorption and nutritional deficiencies. This lifelong condition requires strict gluten-free diet adherence and monitoring for complications including lymphoma and osteoporosis.
Documentation Requirements
- ✓Positive celiac serology (anti-tissue transglutaminase, anti-endomysial antibodies)
- ✓Small bowel biopsy showing villous atrophy
- ✓Clinical response to gluten-free diet
- ✓Symptoms of malabsorption (diarrhea, weight loss, bloating)
- ✓Evidence of nutritional deficiencies (iron, B12, folate, vitamin D)
- ✓Genetic testing (HLA-DQ2/DQ8) when performed
- ✓Exclusion of other causes of malabsorption
- ✓Documentation of gluten exposure history
Use Additional Code
Code Also
- exocrine pancreatic insufficiency (K86.81)
Commonly Confused Codes
- •K90.9: Intestinal malabsorption unspecified when celiac disease not confirmed
- •K58.9: Irritable bowel syndrome for functional bowel symptoms
- •K59.1: Diarrhea when malabsorption not established
- •Z87.19: Personal history of digestive system diseases for treated condition
- •T78.1: Other adverse food reactions for non-celiac gluten sensitivity