2026 ICD-10-CM Diagnosis Code K28.6Chronic or unspecified gastrojejunal ulcer with both hemorrhage and perforation

ICD-10-CM Codes›K00–K95›K20-K31›K28

ICD-10-CM K28.6
CMSSource: CMS FY 2026 ICD-10-CM dataset · Effective Oct 1, 2025 – Sep 30, 2026

K28.6 is a billable ICD-10-CM diagnosis code for chronic or unspecified gastrojejunal ulcer with both hemorrhage and perforation. It is valid on HIPAA claims for fiscal year 2026 (October 1, 2025 through September 30, 2026) and groups to MS-DRG 377 through 379. 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 75 closely related codes. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Gastrointestinal hemorrhage.

For Medicare Advantage risk adjustment, K28.6 maps to CMS-HCC Category 78 (Intestinal Obstruction/Perforation) under the V28 model, adding a risk factor of about 0.326 for a community, non-dual, aged beneficiary in payment year 2026.

Code Identity

ICD-10-CM Code
K28.6
Billable Status
Yes — Valid for Submission
Code Describes
Chronic or unspecified gastrojejunal ulcer with both hemorrhage and perforation
Short Description
Chronic or unsp gastrojejunal ulcer w both hemor and perf
Parent Code
K28
Gastrojejunal ulcer

Code Classification

ChapterK00–K95Diseases of the digestive system
SectionK20-K31Diseases of esophagus, stomach and duodenum
CategoryK28Gastrojejunal ulcer
This CodeK28.6Chronic or unspecified gastrojejunal ulcer with both hemorrhage and perforation

Medicare Risk Adjustment (HCC)Billing

K28.6 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 2026.

CMS-HCC V28 Category (Payment Model)
HCC 78— Intestinal Obstruction/Perforation
Payment HCC · PY 2026 one of 76 ICD-10-CM codes in this category
Risk Adjustment Factor (RAF) Weight
+0.326
community, non-dual, aged · ranges 0.326–0.688 across segments
Hierarchy
Superseded by HCC 77
a more severe related category takes the payment when both are reported
Prior Model (CMS-HCC V24)
HCC 33
V24 retired V28 pays 100% of MA risk scores since PY 2026
Other CMS Models
PACE (CMS-HCC V22): HCC 33 · ESRD (V21): HCC 33 · ESRD (V24): HCC 33
ESRD V21 weights: 0.072 dialysis, 0.285–0.346 functioning graft · ESRD V24 weights: 0.078 dialysis, 0.250–0.474 functioning graft
Part D (RxHCC)
Not mapped
K28.6 does not risk-adjust in the RxHCC prescription drug model

Source: CMS Payment Year 2026 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.

  • Chronic gastric ulcer with hemorrhage
  • Chronic gastric ulcer with hemorrhage and with obstruction
  • Chronic gastric ulcer with hemorrhage and with perforation
  • Chronic gastric ulcer with hemorrhage, with perforation and with obstruction
  • Chronic gastric ulcer with obstruction
  • Chronic gastric ulcer with perforation AND with obstruction
  • Chronic gastrojejunal ulcer with hemorrhage
  • Chronic gastrojejunal ulcer with hemorrhage and obstruction
  • Chronic gastrojejunal ulcer with hemorrhage and perforation
  • Chronic gastrojejunal ulcer with hemorrhage and with perforation but without obstruction
  • Chronic gastrojejunal ulcer with hemorrhage, with perforation and with obstruction
  • Chronic gastrojejunal ulcer with obstruction
  • Chronic gastrojejunal ulcer with perforation
  • Chronic gastrojejunal ulcer with perforation AND with obstruction
  • Chronic peptic ulcer with hemorrhage AND obstruction
  • Chronic peptic ulcer with hemorrhage AND perforation
  • Chronic peptic ulcer with hemorrhage AND with perforation but without obstruction
  • Chronic peptic ulcer with hemorrhage but without obstruction
  • Chronic peptic ulcer with hemorrhage, with perforation AND with obstruction
  • Chronic peptic ulcer with perforation AND obstruction
  • Chronic peptic ulcer with perforation but without obstruction
  • Gastric anastomotic hemorrhage
  • Gastric ulcer with hemorrhage and obstruction
  • Gastric ulcer with hemorrhage, with perforation and with obstruction
  • Gastrojejunal ulcer with hemorrhage AND obstruction
  • Gastrojejunal ulcer with hemorrhage AND perforation
  • Gastrojejunal ulcer with hemorrhage and with perforation but without obstruction
  • Gastrojejunal ulcer with hemorrhage but without obstruction
  • Gastrojejunal ulcer with hemorrhage, with perforation and with obstruction
  • Gastrojejunal ulcer with perforation AND obstruction
  • Gastrojejunal ulcer with perforation but without obstruction
  • Peptic ulcer with hemorrhage AND with perforation but without obstruction
  • Peptic ulcer with hemorrhage but without obstruction

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.

CCSR DIG021
Gastrointestinal hemorrhage
Default principal diagnosis: inpatient Yes · outpatient Yes

Patient EducationClinical

Gastrointestinal Bleeding

Your digestive or gastrointestinal (GI) tract includes the esophagus, stomach, small intestine, large intestine or colon, rectum, and anus. Bleeding can come from any of these areas. The amount of bleeding can be so small that only a lab test can find it.

Read the full article at MedlinePlus

Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.

Convert K28.6 to ICD-9-CMHistory

The closest ICD-9-CM equivalents under the General Equivalence Mappings.

ICD-9-CM
534.60 Chr margin ulc hem/perf
Approximate The match is approximate rather than exact.

Code HistoryHistory

FY 2016AddedAdded to the ICD-10-CM code setEffective October 1, 2015, the first year of ICD-10-CM.
FY 2017–2025No changes
FY 2026CurrentCurrent code set, no changesEffective October 1, 2025 through September 30, 2026.

Questions About K28.6Overview

Is K28.6 (Gastrojejunal ulcer) a billable code?

Yes. This is a billable ICD-10-CM code, specific enough to report chronic or unspecified gastrojejunal ulcer with both hemorrhage and perforation on HIPAA-covered claims from October 1, 2025 through September 30, 2026.

What MS-DRG does K28.6 group to?

When chronic or unspecified gastrojejunal ulcer with both hemorrhage and perforation is the principal diagnosis on an inpatient stay, it groups to MS-DRG 377, 378, 379, with relative weights from 0.6304 to 1.8280 depending on complications. Higher weights mean higher Medicare reimbursement.

Is K28.6 a CC or MCC?

CMS lists K28.6 as an MCC (major complication or comorbidity) for FY 2026. 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 75 closely related codes in its exclusion list.

What is the ICD-9 equivalent of K28.6?

Under the General Equivalence Mappings, chronic or unspecified gastrojejunal ulcer with both hemorrhage and perforation converts to ICD-9-CM 534.60 (chr margin ulc hem/perf). The mapping is approximate, so confirm the match fits the documentation.

What HCC is K28.6?

K28.6 (chronic or unspecified gastrojejunal ulcer with both hemorrhage and perforation) maps to CMS-HCC Category 78 (Intestinal Obstruction/Perforation), commonly written as HCC 78, in the CMS-HCC V28 model used for Medicare Advantage risk adjustment in payment year 2026. It mapped to HCC 33 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 K28.6 risk-adjust for Medicare Advantage payment?

Yes. When documented and reported on a Medicare Advantage encounter, K28.6 adds a risk adjustment factor of about 0.326 to the beneficiary's RAF score for a community, non-dual, aged enrollee (published V28 weights range from 0.326 to 0.688 depending on the payment segment). A more severe related category (HCC 77) supersedes it when both are reported. See the full factor table on the HCC 78 category page.