Question 1

What is ICD-10 code K91.1?

Accepted Answer

K91.1 is the ICD-10-CM diagnosis code for postgastric surgery syndromes. A group of symptoms that develop after stomach surgery, which may include pain, bloating, nausea, or other digestive problems. K91.1 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).

K91.1 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 the specific symptoms present to support medical necessity and justify treatment decisions.

Question 2

Is K91.1 an HCC code?

Accepted Answer

No. K91.1 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 K91.1 billable?

Accepted Answer

Yes. K91.1 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. K91.1 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 K91.1?

Accepted Answer

K91.1 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 K91.1 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 K91.1?

Accepted Answer

Document the specific symptoms present to support medical necessity and justify treatment decisions This is a broader category than K91.0; use K91.1 when multiple postgastric symptoms are present beyond isolated vomiting

HCC Buddy Code Card

K91.1

Is K91.1 an HCC code?

What This Code Means

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Child Codes

Code Hierarchy

Open K91.1 in the Interactive Encoder

K91.1 ICD-10-CM Code: Postgastric surgery syndromes

HCC Buddy Code Card

K91.1

Is K91.1 an HCC code?

What This Code Means

Coding Tips

Child Codes

Code Hierarchy

Open K91.1 in the Interactive Encoder