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 (living at home, age 65 or over, not also enrolled in Medicaid). 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.
