N85.6 is not a CMS-HCC payment code. MEAT criteria · RAF Calculator · free HCC coding tools

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Code lookupN85.6

Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Diseases of the genitourinary system (N00-N99) / Noninflammatory disorders of female genital tract (N80-N98)

N85.6

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Intrauterine synechiae

Scar tissue formation inside the uterus that causes the uterine walls to stick together, potentially affecting fertility and menstrual function.

Overview Risk Models Code Book Documentation Audit Notes Edition comparison

CMS-HCC V28

N/A

—

Not risk-adjusted for this model/period.

Not mapped

CMS-HCC V24

Historical

Not used for standard CY2026 Medicare Advantage payment. Select a historical period to review V24.

Not used for CY2026 payment

ACA/HHS

N/A

—

Not risk-adjusted for this model/period.

Not mapped

ESRD/PACE

N/A

—

Not risk-adjusted for this model/period.

Not mapped

RXHCC

N/A

—

Not risk-adjusted for this model/period.

Not mapped

Code Book Path

Official

N85Other noninflammatory disorders of uterus, except cervix N85.6Intrauterine synechiae

Inclusion Terms

Official

No inclusion terms are included in this display for N85.6. Check the code and parent instructions in the Code Book.

Excludes 2

Official

certain conditions originating in the perinatal period (P04-P96)Inherited from N00-N99
certain infectious and parasitic diseases (A00-B99)Inherited from N00-N99
complications of pregnancy, childbirth and the puerperium (O00-O9A)Inherited from N00-N99
congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)Inherited from N00-N99
endocrine, nutritional and metabolic diseases (E00-E88)Inherited from N00-N99
injury, poisoning and certain other consequences of external causes (S00-T88)Inherited from N00-N99
neoplasms (C00-D49)Inherited from N00-N99
symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)Inherited from N00-N99

Related Codes

Official

N85.0Endometrial hyperplasia N85.2Hypertrophy of uterus N85.3Subinvolution of uterus N85.4Malposition of uterus N85.5Inversion of uterus

Includes

Official

No Includes notes are included in this display for N85.6. Check the code and parent instructions in the Code Book.

Excludes 1

Official

endometriosis (N80.-)Inherited from N85
inflammatory diseases of uterus (N71.-)Inherited from N85
noninflammatory disorders of cervix, except malposition (N86-N88)Inherited from N85
polyp of corpus uteri (N84.0)Inherited from N85
uterine prolapse (N81.-)Inherited from N85

Code First

Official

No Code First sequencing instructions are included in this display for N85.6. Check the code and parent instructions in the Code Book.

Use Additional

Official

No Use Additional Code instructions are included in this display for N85.6. Check the code and parent instructions in the Code Book.

Code Also

Official

No Code Also instructions are included in this display for N85.6. Check the code and parent instructions in the Code Book.

Buddy Documentation Tip

HCC Buddy guidance

Document whether synechiae are partial or complete, as this affects severity and treatment options

Verify if this is a result of prior uterine procedures (D&C, hysteroscopy) or infection for complete clinical picture

Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →

Is N85.6 an HCC code?

No. N85.6 is a billable ICD-10-CM code with no mapping under the current CMS-HCC V28 community payment model, and none under the ESRD, Part D RxHCC, or HHS-HCC models.

Code: N85.6
Description: Intrauterine synechiae
HCC (V28): No CMS-HCC V28 mapping
RAF reference coefficient: —
Billable: Yes
Payment year: 2026

Coder workflow notes

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What This Code Means

N85.6 is the ICD-10-CM diagnosis code for intrauterine synechiae. Scar tissue formation inside the uterus that causes the uterine walls to stick together, potentially affecting fertility and menstrual function. N85.6 sits in the ICD-10-CM chapter for diseases of the genitourinary system (n00-n99), within the section covering noninflammatory disorders of female genital tract (n80-n98).

N85.6 is a billable ICD-10-CM code, but no current CMS-HCC V28 community payment mapping is shown, and none under the ESRD, Part D RxHCC, or HHS-HCC models. Do not assign risk adjustment value from this page when no source-backed mapping is shown; verify the applicable model and payment year.

Document whether synechiae are partial or complete, as this affects severity and treatment options.

HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for N85.6 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Document whether synechiae are partial or complete, as this affects severity and treatment options
•Verify if this is a result of prior uterine procedures (D&C, hysteroscopy) or infection for complete clinical picture