HCC 78: Intestinal Obstruction/Perforation ICD-10-CM
CMS-HCC Category 78 (Intestinal Obstruction/Perforation) is a payment HCC in the V28 Medicare Advantage risk adjustment model. For payment year 2026 it adds a risk adjustment factor between 0.326 and 0.688 to a beneficiary's RAF score depending on the payment segment (0.326 for a community, non-dual, aged enrollee). 76 ICD-10-CM diagnosis codes map to HCC 78. A more severe related category (HCC 77) supersedes it when both are reported.
RAF Weight by Payment Segment 7 segments
| Payment Segment | Relative Factor |
|---|---|
| Community, non-dual, aged | 0.326 |
| Community, partial-benefit dual, aged | 0.478 |
| Community, full-benefit dual, aged | 0.382 |
| Community, non-dual, disabled | 0.534 |
| Community, partial-benefit dual, disabled | 0.688 |
| Community, full-benefit dual, disabled | 0.548 |
| Institutional | 0.380 |
A beneficiary is scored in exactly one segment, set by Medicaid (dual) status, aged or disabled entitlement, and residence. Factors are relative weights, not dollar amounts; new-enrollee segments score on demographics only. In the hierarchy, HCC 77 (Intestine Transplant Status/Complications) supersedes HCC 78 when reported together.
ICD-10-CM Codes That Map to HCC 78 76 codes
- A54.85 Gonococcal peritonitis from V24 HCC 33
- K25.1 Acute gastric ulcer with perforation from V24 HCC 33
- K25.2 Acute gastric ulcer with both hemorrhage and perforation from V24 HCC 33
- K25.5 Chronic or unspecified gastric ulcer with perforation from V24 HCC 33
- K25.6 Chronic or unspecified gastric ulcer with both hemorrhage and perforation from V24 HCC 33
- K26.1 Acute duodenal ulcer with perforation from V24 HCC 33
- K26.2 Acute duodenal ulcer with both hemorrhage and perforation from V24 HCC 33
- K26.5 Chronic or unspecified duodenal ulcer with perforation from V24 HCC 33
- K26.6 Chronic or unspecified duodenal ulcer with both hemorrhage and perforation from V24 HCC 33
- K27.1 Acute peptic ulcer, site unspecified, with perforation from V24 HCC 33
- K27.2 Acute peptic ulcer, site unspecified, with both hemorrhage and perforation from V24 HCC 33
- K27.5 Chronic or unspecified peptic ulcer, site unspecified, with perforation from V24 HCC 33
- K27.6 Chronic or unspecified peptic ulcer, site unspecified, with both hemorrhage and perforation from V24 HCC 33
- K28.1 Acute gastrojejunal ulcer with perforation from V24 HCC 33
- K28.2 Acute gastrojejunal ulcer with both hemorrhage and perforation from V24 HCC 33
- K28.5 Chronic or unspecified gastrojejunal ulcer with perforation from V24 HCC 33
- K28.6 Chronic or unspecified gastrojejunal ulcer with both hemorrhage and perforation from V24 HCC 33
- K50.012 Crohn's disease of small intestine with intestinal obstruction from V24 HCC 33, HCC 35
- K50.112 Crohn's disease of large intestine with intestinal obstruction from V24 HCC 33, HCC 35
- K50.812 Crohn's disease of both small and large intestine with intestinal obstruction from V24 HCC 33, HCC 35
- K50.912 Crohn's disease, unspecified, with intestinal obstruction from V24 HCC 33, HCC 35
- K51.012 Ulcerative (chronic) pancolitis with intestinal obstruction from V24 HCC 33, HCC 35
- K51.212 Ulcerative (chronic) proctitis with intestinal obstruction from V24 HCC 33, HCC 35
- K51.312 Ulcerative (chronic) rectosigmoiditis with intestinal obstruction from V24 HCC 33, HCC 35
- K51.412 Inflammatory polyps of colon with intestinal obstruction from V24 HCC 33, HCC 35
- K51.512 Left sided colitis with intestinal obstruction from V24 HCC 33, HCC 35
- K51.812 Other ulcerative colitis with intestinal obstruction from V24 HCC 33, HCC 35
- K51.912 Ulcerative colitis, unspecified with intestinal obstruction from V24 HCC 33, HCC 35
- K56.0 Paralytic ileus from V24 HCC 33
- K56.1 Intussusception from V24 HCC 33
- K56.2 Volvulus from V24 HCC 33
- K56.3 Gallstone ileus from V24 HCC 33
- K56.41 Fecal impaction from V24 HCC 33
- K56.49 Other impaction of intestine from V24 HCC 33
- K56.50 Intestinal adhesions [bands], unspecified as to partial versus complete obstruction from V24 HCC 33
- K56.51 Intestinal adhesions [bands], with partial obstruction from V24 HCC 33
- K56.52 Intestinal adhesions [bands] with complete obstruction from V24 HCC 33
- K56.600 Partial intestinal obstruction, unspecified as to cause from V24 HCC 33
- K56.601 Complete intestinal obstruction, unspecified as to cause from V24 HCC 33
- K56.609 Unspecified intestinal obstruction, unspecified as to partial versus complete obstruction from V24 HCC 33
- K56.690 Other partial intestinal obstruction from V24 HCC 33
- K56.691 Other complete intestinal obstruction from V24 HCC 33
- K56.699 Other intestinal obstruction unspecified as to partial versus complete obstruction from V24 HCC 33
- K56.7 Ileus, unspecified from V24 HCC 33
- K59.31 Toxic megacolon from V24 HCC 33
- K63.1 Perforation of intestine (nontraumatic) from V24 HCC 33
- K65.0 Generalized (acute) peritonitis from V24 HCC 33
- K65.1 Peritoneal abscess from V24 HCC 33
- K65.2 Spontaneous bacterial peritonitis from V24 HCC 33
- K65.3 Choleperitonitis from V24 HCC 33
- K65.4 Sclerosing mesenteritis from V24 HCC 33
- K65.8 Other peritonitis from V24 HCC 33
- K65.9 Peritonitis, unspecified from V24 HCC 33
- K67 Disorders of peritoneum in infectious diseases classified elsewhere from V24 HCC 33
- K68.12 Psoas muscle abscess from V24 HCC 33
- K68.19 Other retroperitoneal abscess from V24 HCC 33
- P77.1 Stage 1 necrotizing enterocolitis in newborn new to V28
- P77.2 Stage 2 necrotizing enterocolitis in newborn new to V28
- P77.3 Stage 3 necrotizing enterocolitis in newborn new to V28
- P77.9 Necrotizing enterocolitis in newborn, unspecified new to V28
- P78.0 Perinatal intestinal perforation new to V28
- Q40.0 Congenital hypertrophic pyloric stenosis new to V28
- Q41.0 Congenital absence, atresia and stenosis of duodenum new to V28
- Q41.1 Congenital absence, atresia and stenosis of jejunum new to V28
- Q41.2 Congenital absence, atresia and stenosis of ileum new to V28
- Q41.8 Congenital absence, atresia and stenosis of other specified parts of small intestine new to V28
- Q41.9 Congenital absence, atresia and stenosis of small intestine, part unspecified new to V28
- Q42.0 Congenital absence, atresia and stenosis of rectum with fistula new to V28
- Q42.1 Congenital absence, atresia and stenosis of rectum without fistula new to V28
- Q42.2 Congenital absence, atresia and stenosis of anus with fistula new to V28
- Q42.3 Congenital absence, atresia and stenosis of anus without fistula new to V28
- Q42.8 Congenital absence, atresia and stenosis of other parts of large intestine new to V28
- Q42.9 Congenital absence, atresia and stenosis of large intestine, part unspecified new to V28
- Q43.1 Hirschsprung's disease new to V28
- Q43.2 Other congenital functional disorders of colon new to V28
- Q43.3 Congenital malformations of intestinal fixation new to V28
Every code above carries the full HCC 78 weight when documented and reported on a Medicare Advantage encounter. The code link opens its full page with the complete risk adjustment card.
Questions About HCC 78
What is HCC 78 in the CMS-HCC model?
HCC 78 is CMS-HCC Category 78 (Intestinal Obstruction/Perforation) in the V28 risk adjustment model. It covers 76 ICD-10-CM diagnosis codes that raise a Medicare Advantage beneficiary's risk score when documented.
What is the RAF weight for HCC 78?
For payment year 2026, HCC 78 adds 0.326 to the RAF score of a community, non-dual, aged beneficiary. The published weights range from 0.326 to 0.688 across the seven payment segments shown above.
Which categories supersede HCC 78?
HCC 77 (Intestine Transplant Status/Complications) sits above HCC 78 in the hierarchy: when a beneficiary has diagnoses in both, only the more severe category is paid.
Related References
Source: Centers for Medicare & Medicaid Services, Payment Year 2026 risk adjustment mapping and model software releases (CMS-HCC V28), applied to the FY 2026 ICD-10-CM code set. ICD List is not affiliated with CMS.
