2027 ICD-10-CM Diagnosis Code I85.01Esophageal varices with bleeding
ICD-10-CM Codes›I00–I99›I80-I89›I85
- Billable — Valid for Submission
- MCC — Major Complication or Comorbidity
- Risk Adjusts — HCC 63
- Chronic Condition
I85.01 is a billable ICD-10-CM diagnosis code for esophageal varices with bleeding. It is valid on HIPAA claims for fiscal year 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 368 through 370. As a secondary diagnosis, it counts as a major complication or comorbidity (MCC) and places an inpatient stay in the highest severity level of its MS-DRG family. It does not count, however, when the principal diagnosis is one of 80 closely related codes. Coders also document this condition as bleeding esophageal varices. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Gastrointestinal hemorrhage and Other specified diseases of veins and lymphatics.
For Medicare Advantage risk adjustment, I85.01 maps to CMS-HCC Category 63 (Chronic Liver Failure/End-Stage Liver Disorders) under the V28 model, adding a risk factor of about 0.962 for a community, non-dual, aged beneficiary in payment year 2027.
Code Identity
Code Classification
Medicare Risk Adjustment (HCC)Billing
I85.01 maps to a payment category in the CMS-HCC model used to risk-adjust Medicare Advantage payments. Weights are the published community factors for payment year 2027.
Source: CMS Payment Year 2027 risk adjustment mappings and model software. Weights are relative factors, not dollar amounts; a beneficiary's total RAF also includes demographics and interactions. Browse all CMS-HCC categories.
Approximate SynonymsGuidance
Alternate terms and clinical phrases that map to this code.
- Bleeding esophageal varices
Instructional NotesGuidance
Instructions from the official ICD-10-CM Tabular List that apply to I85.01: its own notes plus those printed at I85 and Chapter 9. A note printed at a category, block or chapter applies to every code under it.
Excludes2
Not included here: the excluded condition is not part of this code, but a patient may have both, so both codes may be reported.
- certain conditions originating in the perinatal period (P04-P96)
- certain infectious and parasitic diseases (A00-B99)
- complications of pregnancy, childbirth and the puerperium (O00-O9A)
- congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99)
- endocrine, nutritional and metabolic diseases (E00-E88)
- injury, poisoning and certain other consequences of external causes (S00-T88)
- neoplasms (C00-D49)
- symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)
- systemic connective tissue disorders (M30-M36)
- transient cerebral ischemic attacks and related syndromes (G45.-)
Use Additional Code
Add a second code, after this one, to fully describe the condition.
Source: CMS ICD-10-CM Tabular List. How to read instructional notes.
Referenced in Other NotesGuidance
Instructional notes printed at other codes that name I85.01, its category, or a range that includes it.
Excludes2 3
These codes carry an Excludes2 note naming I85.01: its condition is not part of those codes, and both may be reported when the patient has both.
Index to Diseases and InjuriesGuidance
Alphabetical index entries that point to this code.
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
Clinical InformationClinical
Esophageal Varices Hemorrhage
bleeding from esophageal varices.
Patient EducationClinical
Esophagus Disorders
Esophagus disorders are problems with how your esophagus works. The esophagus is the tube that carries food from your mouth to your stomach. You usually don't notice it unless you swallow something too big, hot, or cold. You might also notice it if something is wrong.
The full article covers:
- What are esophagus disorders?
- What causes esophagus disorders?
- What are common esophagus disorders?
- What are symptoms of esophagus disorders?
- How are esophagus disorders diagnosed?
- How are esophagus disorders treated?
- Can esophagus disorders be prevented?
Read the full article at MedlinePlus
Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.
Convert I85.01 to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About I85.01Overview
What is the ICD-10 code for esophageal varices with bleeding?
The ICD-10-CM code for esophageal varices with bleeding is I85.01 (sometimes written as I8501). It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
Is I85.01 (Esophageal varices) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report esophageal varices with bleeding on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
What MS-DRG does I85.01 group to?
When esophageal varices with bleeding is the principal diagnosis on an inpatient stay, it groups to MS-DRG 369, 370, 368, with relative weights from 0.6741 to 1.6434 depending on complications. Higher weights mean higher Medicare reimbursement.
Is I85.01 a CC or MCC?
CMS lists I85.01 as an MCC (major complication or comorbidity) for FY 2027. Reported as a secondary diagnosis, it places the inpatient stay in the highest-weighted DRG of its severity family. It does not count when the principal diagnosis is one of the 80 closely related codes in its exclusion list.
Does I85.01 need an additional code?
When the condition applies, yes. The Use Additional Code note at I85, which applies to I85.01, reads: code to identify: alcohol abuse and dependence (F10.-). The additional code is reported after I85.01.
What HCC is I85.01?
I85.01 (esophageal varices with bleeding) maps to CMS-HCC Category 63 (Chronic Liver Failure/End-Stage Liver Disorders), commonly written as HCC 63, in the CMS-HCC V28 model used for Medicare Advantage risk adjustment in payment year 2027. It mapped to HCC 27 under the retired V24 model. It also maps in the PACE (CMS-HCC V22), ESRD (V21), and ESRD (V24) models. It does not map to any RxHCC in the Part D prescription drug model.
Does I85.01 risk-adjust for Medicare Advantage payment?
Yes. When documented and reported on a Medicare Advantage encounter, I85.01 adds a risk adjustment factor of about 0.962 to the beneficiary's RAF score for a community, non-dual, aged enrollee (published V28 weights range from 0.861 to 1.209 depending on the payment segment). A more severe related category (HCC 62) supersedes it when both are reported. See the full factor table on the HCC 63 category page.
