Question 1

What is ICD-10 code K95.81?

Accepted Answer

K95.81 is the ICD-10-CM diagnosis code for infection due to other bariatric procedure. An infection that develops after bariatric (weight loss) surgery procedures other than gastric band, such as gastric bypass or sleeve gastrectomy. K95.81 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).

K95.81 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.

Identify and document the specific bariatric procedure performed for complete clinical picture.

Question 2

Is K95.81 an HCC code?

Accepted Answer

No. K95.81 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 K95.81 billable?

Accepted Answer

Yes. K95.81 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. K95.81 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 K95.81?

Accepted Answer

K95.81 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 community model rewards K95.81 with a risk adjustment factor, it contributes zero to a Medicare Advantage beneficiary's V28/V24 community RAF score in either version. Coders should check whether provider documentation supports a more specific child code that does map to a community payment HCC.

Question 5

What should coders know when reporting K95.81?

Accepted Answer

Identify and document the specific bariatric procedure performed for complete clinical picture Use K95.01 specifically for gastric band infections; this code is for other bariatric procedures

HCC Buddy Code Card

K95.81

Is K95.81 an HCC code?

Get the V28 RAF + MEAT cheat sheet

What This Code Means

Coding Tips

Use Additional Code

Child Codes

Code Hierarchy

Work K95.81 in HCC Buddy

K95.81 ICD-10-CM Code: Infection due to other bariatric procedure

HCC Buddy Code Card

K95.81

Is K95.81 an HCC code?

Get the V28 RAF + MEAT cheat sheet

What This Code Means

Coding Tips

Use Additional Code

Child Codes

Code Hierarchy

Work K95.81 in HCC Buddy