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I85.00 ICD-10-CM Code: Esophageal varices without bleeding

Billing Status: YES. This is a valid, specific, and billable ICD-10-CM reference.

Coding at a Glance

Tabular directives
1 inclusion term · 2 use-additional codes
Risk adjustment
CMS-HCC V28: 1 category · CMS-HCC V22 category 27

Inpatient Payment Groups (MS-DRG)

Potential MS-DRG participation — not a DRG assignment.

MS-DRGs this diagnosis helps define, as principal or secondary, per the CMS ICD-10-CM/PCS MS-DRG Definitions Manual v43, Appendix B.

  • MS-DRG 368 — MAJOR ESOPHAGEAL DISORDERS WITH MCC (MDC 06)
  • MS-DRG 369 — MAJOR ESOPHAGEAL DISORDERS WITH CC (MDC 06)
  • MS-DRG 370 — MAJOR ESOPHAGEAL DISORDERS WITHOUT CC/MCC (MDC 06)

A diagnosis appearing in a group's logic does not by itself determine the DRG assigned to a stay; the grouper uses the full claim.

Risk Adjustment (CMS-HCC)

Payment categories this diagnosis maps to under CMS-HCC V28, payment year 2026.

  • HCC 63 — Chronic Liver Failure/End-Stage Liver Disorders (supersedes HCC 64, HCC 65, HCC 68, HCC 202)

Other models: CMS-HCC V22 HCC 27

Risk scores depend on the enrollee's full accepted diagnosis set and segment; a category mapping alone does not determine payment.

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for I85.00 in the official ICD-10-CM tabular list, quoted as published.

Source: CMS/CDC — ICD-10-CM Tabular ListRelease: FY2026Effective: October 1, 2025

Notes without a marker are published on I85.00 itself; “inherited from” names the category or block whose note applies here.

Inclusion Terms

Alternative terms the tabular list files under this code.

  • Esophageal varices NOS

Use Additional Code

Supplementary codes the tabular list directs you to add.

  • Use additional code to identify:
  • alcohol abuse and dependence (F10.-)

Source: inherited from I85

Coder workflow for I85.00

MedCoder structured workflow — derived from this code’s own official record

Documentation check

The provider’s diagnostic statement
Codes are assigned from the provider’s documented diagnosis, not from clinical criteria, test values or a medication list (Guidelines I.A.19).
The associated condition or complication
Whether the associated condition the title names is documented; the “with” convention presumes some links, and a provider statement that the conditions are unrelated defeats it (Guidelines I.A.15).
The conditions the Use Additional Code note names
Reported with this code when documented; a conditional instruction (“if applicable”, “if known”) applies only when the record supports it.

Official instructions as workflow

  • Use Additional Code — after identifying I85.00(2 notes)

    Coding workflow: Check whether the documentation supports the additional code(s) the note names, and report them with I85.00 when it does. Where the instruction is conditional (“if applicable”, “if known”), it applies only when the record documents the condition.

    ReviewF10

    See the official tabular notes · Guidelines I.A.13

Coding decision scenarios

Pattern scenarios for this code’s structure — decision rules, not clinical cases

Documentation: A condition the Use Additional Code note names is documented.

Coding question: Is a second code reported with I85.00?

Path: Review the Use Additional Code note and the code it names.

Reason: The additional code is reported when the record documents the condition; a conditional instruction applies only when its condition is met (Guidelines I.A.13).

ReviewF10

Every row is derived from this code’s own record — its title, tabular notes, 7th-character family and same-category siblings — with fixed MedCoder wording; nothing is inferred about a patient. The official notes and guideline text are in the sections each row links to, and they control.

Code Overview

Esophageal varices without bleeding is a billable ICD-10-CM diagnosis code (I85.00).

MedCoder summary Summary composed by MedCoder from this code's official ICD-10-CM record. The tabular instructional notes themselves appear verbatim below.

Indexed Clinical Terms (1)

Official source data — entries quoted as published, in the Index’s own lookup phrasing

Clinical term phrases from the official ICD-10-CM Index to Diseases and Injuries that map to this code. These are alphabetic-index entries shown as the Index writes them — lookup phrasing, not necessarily the wording of a final diagnosis.

Verify Before Coding

  • CC as a secondary diagnosis (FY2026). Can raise the stay's MS-DRG severity tier.

From the code registry, the Medicare Code Editor, and the MS-DRG Definitions Manual. Check it against a full claim in Claim Check.

Relationships & Classification

MedCoder structured relationships — computed from published CMS and AHRQ datasets

Other codes that name I85.00 or its code family, from the CMS ICD-10-CM tabular instructional notes. Tabular-note edges are stored at the code family level that carries each note.

Referenced by 1 Excludes2 note: K22 — Other diseases of esophagus (via I85.-).

These codes’ tabular lists name this diagnosis as distinct — both may be reported when both are documented.

MS-DRG Grouper Relationships (FY2026)

Potential MS-DRG participation — not a DRG assignment.

FY2026 MS-DRG: CC — Complication or Comorbidity. Reported as a secondary diagnosis, this code raises the stay's MS-DRG severity tier — except when the principal diagnosis is one of 61 clinically related codes on its CMS exclusion list.

Named in the grouper logic of 3 MS-DRGs: DRG 368 (MDC 06), DRG 369 (MDC 06), DRG 370 (MDC 06).

From the CMS MS-DRG Definitions Manual (Appendices B and C). Actual DRG assignment depends on the complete claim.

Clinical classification (AHRQ CCSR):CIR039 — Other specified diseases of veins and lymphatics (default).

Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses. Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.

Related Codes

Same clinical process (MS-DRG)

Acts as CC — raises the severity of other admissions. CMS groups these diagnoses into one MS-DRG principal-diagnosis exclusion process — a CC/MCC on this list never raises severity when the principal diagnosis is also on it.

E16.4 — Increased secretion of gastrin, I27.841 — Fontan-associated lymphatic dysfunction, I27.848 — Other Fontan-associated condition, I27.849 — Fontan related circulation, unspecified, I85.01 — Esophageal varices with bleeding, I85.11 — Secondary esophageal varices with bleeding, I87.8 — Other specified disorders of veins, I87.9 — Disorder of vein, unspecified, I99.8 — Other disorder of circulatory system, I99.9 — Unspecified disorder of circulatory system, K22.6 — Gastro-esophageal laceration-hemorrhage syndrome, K25.0 — Acute gastric ulcer with hemorrhage, K25.1 — Acute gastric ulcer with perforation, K25.2 — Acute gastric ulcer with both hemorrhage and perforation, K25.3 — Acute gastric ulcer without hemorrhage or perforation, K25.4 — Chronic or unspecified gastric ulcer with hemorrhage, K25.5 — Chronic or unspecified gastric ulcer with perforation, K25.6 — Chronic or unspecified gastric ulcer with both hemorrhage and perforation, K25.7 — Chronic gastric ulcer without hemorrhage or perforation, K25.9 — Gastric ulcer, unspecified as acute or chronic, without hemorrhage or perforation, +40 more

Same CMS-HCC risk category (V28)

CMS maps these diagnoses to the same Hierarchical Condition Category (Chronic Liver Failure/End-Stage Liver Disorders) for risk-adjusted payment.

I85.01 — Esophageal varices with bleeding, I85.10 — Secondary esophageal varices without bleeding, I85.11 — Secondary esophageal varices with bleeding, K70.40 — Alcoholic hepatic failure without coma, K70.41 — Alcoholic hepatic failure with coma, K72.10 — Chronic hepatic failure without coma, K72.11 — Chronic hepatic failure with coma, K72.90 — Hepatic failure, unspecified without coma, K72.91 — Hepatic failure, unspecified with coma, K76.6 — Portal hypertension, K76.7 — Hepatorenal syndrome, K76.81 — Hepatopulmonary syndrome, K76.82 — Hepatic encephalopathy

Related risk categories

These categories interact through CMS's HCC hierarchy — one can suppress the other's risk-adjustment weight when both are present on a claim.

Liver Transplant Status/Complications, Coma, Brain Compression/Anoxic Damage, Cirrhosis of Liver, Chronic Hepatitis, Cholangitis and Obstruction of Bile Duct Without Gallstones

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical category (Other specified diseases of veins and lymphatics).

I27.841 — Fontan-associated lymphatic dysfunction, I85.01 — Esophageal varices with bleeding, I85.10 — Secondary esophageal varices without bleeding, I85.11 — Secondary esophageal varices with bleeding, I86.0 — Sublingual varices, I86.1 — Scrotal varices, I86.2 — Pelvic varices, I86.3 — Vulval varices, I86.4 — Gastric varices, I86.8 — Varicose veins of other specified sites, I87.8 — Other specified disorders of veins, I87.9 — Disorder of vein, unspecified, I88.0 — Nonspecific mesenteric lymphadenitis, I88.1 — Chronic lymphadenitis, except mesenteric, I88.8 — Other nonspecific lymphadenitis, I88.9 — Nonspecific lymphadenitis, unspecified, I89.0 — Lymphedema, not elsewhere classified, I89.1 — Lymphangitis, I89.8 — Other specified noninfective disorders of lymphatic vessels and lymph nodes, I89.9 — Noninfective disorder of lymphatic vessels and lymph nodes, unspecified, +4 more

Same Index main term, other category

The ICD-10-CM Index to Diseases and Injuries files this code under the main term “Varix”; these codes share that main term but sit in a different category of the Tabular List.

I83.819 — Varicose veins of unspecified lower extremity with pain (with, pain), I83.891 — Varicose veins of right lower extremity with other complications (leg, right, with, edema), I83.892 — Varicose veins of left lower extremity with other complications (leg, left, with, edema), I83.893 — Varicose veins of bilateral lower extremities with other complications (leg, bilateral, with, edema), I83.899 — Varicose veins of unspecified lower extremity with other complications (with, edema), I83.9 — Asymptomatic varicose veins of lower extremities (leg), I83.90 — Asymptomatic varicose veins of unspecified lower extremity, I83.91 — Asymptomatic varicose veins of right lower extremity (leg, right), I83.92 — Asymptomatic varicose veins of left lower extremity (leg, left), I83.93 — Asymptomatic varicose veins of bilateral lower extremities (leg, bilateral), I86.0 — Sublingual varices (sublingual), I86.1 — Scrotal varices (scrotum), I86.2 — Pelvic varices (ovary), I86.3 — Vulval varices (labia), I86.4 — Gastric varices (gastric), I86.8 — Varicose veins of other specified sites (orbit), O22.0 — Varicose veins of lower extremity in pregnancy (complicating, pregnancy), O22.1 — Genital varices in pregnancy (complicating, pregnancy, genital), O22.4 — Hemorrhoids in pregnancy (complicating, pregnancy, anus or rectum), O43.89 — Other placental disorders (placenta), +57 more

Lab tests where this diagnosis supports Medicare coverage (NCD)

Medicare's National Coverage Determination (NCD) program lists this diagnosis as medical justification for these lab tests.

Fecal Occult Blood Test (FOBT), Gamma-glutamyl Transferase (GGT) Test, Hepatitis Testing, Partial Thromboplastin Time (PTT) Test, Prothrombin Time Test and INR (PT/INR)

Contextual Map

Every relationship of I85.00 in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.

Run I85.00 with this related code in Claim Check

Hierarchy

Referenced by Excludes2 notes

Clinical classification (CCSR)

Risk adjustment (CMS-HCC)

  • HCC 63 — Chronic Liver Failure/End-Stage Liver Disorders [CMS-HCC]: “Chronic Liver Failure/End-Stage Liver Disorders — supersedes HCC 64 (Cirrhosis of Liver), HCC 65 (Chronic Hepatitis), HCC 68 (Cholangitis and Obstruction of Bile Duct Without Gallstones), HCC 202 (Coma, Brain Compression/Anoxic Damage)”— CMS-HCC V28 · 2026

MS-DRG Grouper

MDC crossing

  • MDC 06 — Diseases and Disorders of the Digestive System[MDC crossing]: “Diseases and Disorders of the Digestive System — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs. 5,744 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2026

Index entries

  • Varix (lower limb), esophagus (idiopathic) (primary) (ulcerated)[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026

Nearest codes

Change history

  • FY2016 — In the code set at ICD-10-CM adoption [Change history]— CMS release files (code change ledger) · icd10cm-fy2016

Sources for this page

Codes, titles, notes, index terms and mappings on this page are transcribed from the datasets below. Relationships MedCoder computed and text MedCoder wrote are labelled where they appear.

Code, title, tabular notes and index terms Official source data
CMS/CDC ICD-10-CM FY2026 tabular list, index and tables, effective October 1, 2025 Release, file and checksum · Publisher’s page
Claim edits Official source data
CMS Definitions of Medicare Code Edits — v43.1 (April 2026) Release, file and checksum · Publisher’s page
Inpatient payment groups Official source data
CMS MS-DRG Definitions Manual (incl. Appendix B diagnosis index, Appendix C CC/MCC list, Appendix E procedure index) and IPPS Final Rule tables — v43 Release, file and checksum · Publisher’s page
Risk adjustment Official source data
2026 Mid-Year Final ICD-10 Mappings + Model Software (cms.gov/files/zip/2026-midyear-final-icd-10-mappings.zip, 2026-midyear-final-model-software.zip) — CMS-HCC V28, PY2026 mid-year final release Release, file and checksum · Publisher’s page
Change history and date-of-service validity Official source data
CMS ICD-10-CM release addenda, ingested release by release into the change ledger Release, file and checksum · Publisher’s page
Comparisons, relationships and the contextual map MedCoder structured relationship
Computed by MedCoder from the tabular notes and tables above; every derived relationship is marked as derived where it appears
Summary and FAQ answers MedCoder explanation
Written by MedCoder to explain the sources above: drafted with AI assistance, checked by a person against the release files, and labelled as MedCoder text where it appears. Not official text.

Labels on this page: Official source data · MedCoder structured relationship · MedCoder explanation. How to read the labels · All data sources and release dates

Cite this page

Reference this page in a research guide, syllabus or article. The release is included because code content changes each year.

MedCoder.ai. "I85.00 — Esophageal varices without bleeding." ICD-10-CM FY2026. https://medcoder.ai/icd10/code/i85.00-esophageal-varices-without-bleeding

Change history

  • FY2016 — October 1, 2015
    In the code set at ICD-10-CM adoption
    Esophageal varices without bleeding

No changes since FY2016 — additions, deletions, description changes and billable-status changes are tracked through FY2027 (effective October 1, 2026), and none are recorded for this code. Note changes are tracked from FY2027 only.

Nearest Codes in This Family

Official ICD-10-CM classifications closest to I85.00 in its code family, with their registry titles.

View all codes in the I85 family