2027 ICD-10-CM Diagnosis Code K56.3Gallstone ileus
ICD-10-CM Codes›K00–K95›K55-K64›K56
- Billable — Valid for Submission
- CC — Complication or Comorbidity
- Risk Adjusts — HCC 78
- Not Chronic
K56.3 is a billable ICD-10-CM diagnosis code for gallstone ileus. It is valid on HIPAA claims for fiscal year 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 388 through 390. As a secondary diagnosis, it counts as a complication or comorbidity (CC) and moves an inpatient stay to a higher severity level within its MS-DRG family. It does not count, however, when the principal diagnosis is one of 29 closely related codes. Coders also document this condition as enterolith. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Biliary tract disease and Intestinal obstruction and ileus.
For Medicare Advantage risk adjustment, K56.3 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 2027.
Code Identity
Code Classification
Medicare Risk Adjustment (HCC)Billing
K56.3 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.
- Enterolith
- Enterolith of large intestine
- Enterolith of small intestine
- Gallstone ileus
- Gallstone ileus of large intestine
- Gallstone ileus of small intestine
Instructional NotesGuidance
Instructions from the official ICD-10-CM Tabular List that apply to K56.3: its own notes plus those printed at K56 and Chapter 11. A note printed at a category, block or chapter applies to every code under it.
Applicable To
Conditions this code is used for: synonyms of the title or, for "other specified" codes, the conditions assigned to it. The list is not exhaustive.
- Obstruction of intestine by gallstone
Excludes1
Not coded here: the excluded code is never reported together with this one, unless the two conditions are unrelated.
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.
- stenosis of anus or rectum (K62.4)
- 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)
Source: CMS ICD-10-CM Tabular List. How to read instructional notes.
Referenced in Other NotesGuidance
Instructional notes printed at other codes that name K56.3, its category, or a range that includes it.
Excludes1 2
These codes carry an Excludes1 note naming K56.3: they are not reported together with it, unless the two conditions are unrelated.
Excludes2 1
These codes carry an Excludes2 note naming K56.3: its condition is not part of those codes, and both may be reported when the patient has both.
- Block R10-R19 Symptoms and signs involving the digestive system and abdomenintestinal obstruction (K56.-) names K56.-, which includes this code
Index to Diseases and InjuriesGuidance
Alphabetical index entries that point to this code.
Gallstone (colic) (cystic duct) (gallbladder) (impacted) (multiple) See Also: Calculus, gallbladder;
bowel, colon, rectum See Also: Impaction, fecal; K56.49
by gallstone K56.3
gallstone (s) See: Calculus, gallbladder;
intestine (calculous) NEC See Also: Impaction, fecal; K56.49
gallstone, with ileus K56.3
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
Patient EducationClinical
Gallstones
Your gallbladder is a pear-shaped organ under your liver. It stores bile, a fluid made by your liver to digest fat. As your stomach and intestines digest food, your gallbladder releases bile through a tube called the common bile duct. The duct connects your gallbladder and liver to your small intestine.
Read the full article at MedlinePlus
Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.
Convert K56.3 to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About K56.3Overview
What is the ICD-10 code for gallstone ileus?
The ICD-10-CM code for gallstone ileus is K56.3 (sometimes written as K563). It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
Is K56.3 (Paralytic ileus and intestinal obstruction without hernia) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report gallstone ileus on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
What MS-DRG does K56.3 group to?
When gallstone ileus is the principal diagnosis on an inpatient stay, it groups to MS-DRG 389, 388, 390, with relative weights from 0.5403 to 1.4706 depending on complications. Higher weights mean higher Medicare reimbursement.
Is K56.3 a CC or MCC?
CMS lists K56.3 as a CC (complication or comorbidity) for FY 2027. Reported as a secondary diagnosis, it moves the inpatient stay to a higher-weighted DRG within its severity family. It does not count when the principal diagnosis is one of the 29 closely related codes in its exclusion list.
Can K56.3 be reported with E84.11?
Not as a rule. The Excludes1 note at K56, which applies to K56.3, lists "cystic fibrosis with meconium ileus (E84.11)". An Excludes1 note means the excluded code is never reported together with this one; the only exception is when the two conditions are unrelated to each other (Official Guidelines, Section I.A.12.a).
What HCC is K56.3?
K56.3 (gallstone ileus) 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 2027. 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 K56.3 risk-adjust for Medicare Advantage payment?
Yes. When documented and reported on a Medicare Advantage encounter, K56.3 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.
