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K20.91 ICD-10-CM Code: Esophagitis, unspecified with bleeding

Compare with another codeCheck this code on a claim

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

Coding at a Glance

Tabular directives
4 Excludes1 · 2 Excludes2 · 2 use-additional codes

Billable · FY2027A valid, specific ICD-10-CM code, reportable for dates of service in FY2027.

What you need to know

Source: CMS/NCHS Official ICD-10-CM tabular notes, quoted. From the CMS/NCHS tabular list for the release in force. A note the category or block publishes applies to this code too; the Instructions section marks which is which.

Use additional codeReport with this code when documented
  • code to identify:
  • alcohol abuse and dependence (F10.-)
Excludes1Never report with this code
  • erosion of esophagus (K22.1-)
  • esophagitis with gastro-esophageal reflux disease (K21.0-)
  • reflux esophagitis (K21.0-)
  • ulcerative esophagitis (K22.1-)
Excludes2Not included here; may be reported together
  • eosinophilic gastritis or gastroenteritis (K52.81)
  • hiatus hernia (K44.-)

Most relevant related codes MedCoder-derived

Read off the official notes above and this code’s own position in the tabular list. Which to report is a documentation question; Compare shows the two side by side.

CompareCheck ClaimView Related Codes

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 v44, 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.

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for K20.91 in the official ICD-10-CM tabular list, quoted as published.

Source: CMS/CDC — ICD-10-CM Tabular ListRelease: FY2027Effective: October 1, 2026

Trace:FY2027 changesChange historyRelease, file and checksum

Notes without a marker are published on K20.91 itself; “inherited from” names the category or block whose note applies here.

Excludes1 — Not Coded Here

Conditions generally not reported together with this code (Excludes1) -- an error unless the two conditions are documented as unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).

Source: inherited from K20

Excludes2 — Not Included Here

Conditions not covered by this code, but which may be reported alongside it when both are present.

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 K20

Coder workflow for K20.91

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

Before you code K20.91

  1. Unspecified does not mean incorrect. When the record gives no greater specificity, K20.91 may be the appropriate code. Check the record for detail that supports a more specific sibling — in this subcategory the siblings differ by the presence or absence of the associated condition. An unspecified code is for records that do not provide the detail a more specific code needs; a query, not an assumption, is the route to specificity (Guidelines I.A.9.b, I.B.18).

    See the relationships section · Guide: Other vs unspecified (NEC vs NOS) →

  2. K20.91’s title joins a condition with an associated condition or complication. Confirm each component is documented. Where the classification presumes the link through the “with” convention, only a provider statement that the conditions are unrelated defeats it. A combination code is assigned only when it fully identifies the documented conditions; a required second code for the stage, type or manifestation is still reported when the notes ask for it (Guidelines I.B.9, I.A.15).

    Guide: Combination codes →

  3. Check the Excludes1 note: if the documentation supports a condition named there, do not simply proceed with K20.91. Excludes1 conditions are not reported together with this code unless the record shows they are unrelated (Guidelines I.A.12.a).

    See the official tabular notes

Choose the right path

  1. Does the record document the detail a more specific sibling code needs?
    Yes → Review the specific siblings in this subcategory.
    No → Continue — K20.91 is appropriate when the documentation goes no further.
  2. Does the documentation support a condition named in K20.91’s Excludes1 note?
    Yes → Do not simply proceed: review the excluded code. Both are reported only when the record shows the two conditions are unrelated.
    No → Continue.

    ReviewK22.1, K21.0

Consider K20.91. Then work the Use Additional Code note, and confirm the code is valid for the date of service in the Verify section.

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.
Any detail beyond this code’s title
What the record states that a more specific sibling code would capture — or its absence, which itself supports the unspecified code.

Official instructions as workflow

  • Excludes1 — check before selecting K20.91(4 notes)

    Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with K20.91: the two are not reported together. The one exception is when the record shows the two conditions are unrelated to each other.

    CompareK22.1, K21.0

    See the official tabular notes · Guidelines I.A.12.a

  • Excludes2 — not part of K20.91(2 notes)

    Coding workflow: The conditions named in this note are not included in K20.91. When the record documents both, both may be reported; the note is a boundary, not a prohibition.

    CompareK52.81, K44

    See the official tabular notes · Guidelines I.A.12.b

  • Use Additional Code — after identifying K20.91(2 notes)

    Coding workflow: Check whether the documentation supports the additional code(s) the note names, and report them with K20.91 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: The provider documents the condition in the terms of this code’s title and records no further detail.

Coding question: Is a more specific sibling code supportable?

Path: Review the subcategory for a sibling that names the missing detail.

Reason: A more specific code needs documentation of the distinguishing element; without it the unspecified code is appropriate, and a provider query is the route to specificity (Guidelines I.A.9.b, I.B.18).

Documentation: Both the condition K20.91 describes and a condition named in its Excludes1 note are documented for the same encounter.

Coding question: Can both codes be reported?

Path: Review the Excludes1 note and the excluded code, and look for a provider statement on whether the two conditions are related.

Reason: Excludes1 means the two are not coded together; the exception is when the record shows the conditions are unrelated to each other (Guidelines I.A.12.a).

ReviewK22.1, K21.0

Documentation: Only one of the components this code’s title joins is documented.

Coding question: Is K20.91 supported?

Path: Review the code for the documented component on its own.

Reason: A combination code is assigned only when it fully identifies the documented conditions; otherwise the documented component takes its own code (Guidelines I.B.9).

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.

Don’t confuse K20.91 with…

MedCoder analysis — pairs from this code’s official notes, distinctions written by MedCoder

The codes most likely to be picked instead of K20.91 — named in its own official notes, or sharing its laterality or encounter family — with what separates them and which documentation moves the case. Each links to the full comparison.

  • K22.1— Excludes1 conflict (Excludes1 — generally not reported together)

    Not coded here — the tabular list excludes this pair for the same encounter.

    Not reported together with this code, except where the two conditions are documented as unrelated.

    What moves you there: Documentation of erosion of esophagus moves the case to K22.1; the two are not reported together unless documented as unrelated.

    Full comparison: K20.91 vs K22.1 →

  • K21.0— Excludes1 conflict (Excludes1 — generally not reported together)

    Not coded here — the tabular list excludes this pair for the same encounter.

    Not reported together with this code, except where the two conditions are documented as unrelated.

    What moves you there: Documentation of esophagitis with gastro-esophageal reflux disease moves the case to K21.0; the two are not reported together unless documented as unrelated.

    Full comparison: K20.91 vs K21.0 →

  • K52.81— Excludes2 relationship (Informational)

    Distinct conditions — both may be reported.

    A distinct condition — both may be reported when both are documented.

    What moves you there: Documentation of eosinophilic gastritis or gastroenteritis adds K52.81; it is not part of this code and both may be reported when both are documented.

    Full comparison: K20.91 vs K52.81 →

  • K44— Excludes2 relationship (Informational)

    Distinct conditions — both may be reported.

    A distinct condition — both may be reported when both are documented.

    What moves you there: Documentation of hiatus hernia adds K44; it is not part of this code and both may be reported when both are documented.

    Full comparison: K20.91 vs K44 →

Relationships are read from this code's own official notes, its laterality siblings and its encounter family; the wording of each distinction is MedCoder editorial, and the documentation named in each “what moves you there” line is the official note phrase or sibling title itself. Source: CMS ICD-10-CM tabular instructional notes; ICD-10-CM Official Guidelines, Section I.A.12.a.

Coding context

Guidelines, coding notes, decision aids, relationships (with MS-DRG and CCSR classification), hierarchy, HCC, coverage and the context map: what a coder reaches for after the core. Each section names whether it is official source data, a MedCoder-derived relationship or MedCoder editorial.

Code Overview

Esophagitis, unspecified with bleeding is a billable ICD-10-CM diagnosis code (K20.91).

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

Official Coding Guidelines

No excerpt in the ICD-10-CM Official Guidelines names this code specifically. Its chapter carries only this chapter-wide note:

Chapter 11: Diseases of the Digestive System (K00-K95)

Reserved for future guideline expansion

Decision Points

The directives on this code's own record, as a pre-claim checklist.

  1. 2 Use Additional Code instructions — report the named additional code(s) when the documentation supports them. See the Use Additional Code notes
  2. 4 Excludes1 entries — codes named there are generally not reported together with this code (Guidelines I.A.12.a). See the Excludes1 notes
  3. 2 Excludes2 entries — those conditions are not part of this code and may be reported additionally when documented. See the Excludes2 notes

Checklist rows are derived from this code's own official directives; the wording of each check is MedCoder editorial. The official notes themselves are in the sections each row links to.

Verify Before Coding

  • MCC as a secondary diagnosis (FY2027). 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-derived relationships — computed from published CMS and AHRQ datasets

MS-DRG Grouper Relationships (FY2027)

Potential MS-DRG participation — not a DRG assignment.

FY2027 MS-DRG: MCC — Major 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 38 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):DIG004 — Esophageal disorders (default); DIG021 — Gastrointestinal hemorrhage.

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 MCC — 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, I85.01 — Esophageal varices with bleeding, K20.81 — Other esophagitis with bleeding, K21.01 — Gastro-esophageal reflux disease with esophagitis, with bleeding, K21.9 — Gastro-esophageal reflux disease without esophagitis, K22.10 — Ulcer of esophagus without bleeding, K22.11 — Ulcer of esophagus with bleeding, K22.3 — Perforation of esophagus, K22.6 — Gastro-esophageal laceration-hemorrhage syndrome, K27.0 — Acute peptic ulcer, site unspecified, with hemorrhage, K27.1 — Acute peptic ulcer, site unspecified, with perforation, K27.2 — Acute peptic ulcer, site unspecified, with both hemorrhage and perforation, K27.3 — Acute peptic ulcer, site unspecified, without hemorrhage or perforation, K27.4 — Chronic or unspecified peptic ulcer, site unspecified, with hemorrhage, K27.5 — Chronic or unspecified peptic ulcer, site unspecified, with perforation, K27.6 — Chronic or unspecified peptic ulcer, site unspecified, with both hemorrhage and perforation, K27.7 — Chronic peptic ulcer, site unspecified, without hemorrhage or perforation, K27.9 — Peptic ulcer, site unspecified, unspecified as acute or chronic, without hemorrhage or perforation, K28.0 — Acute gastrojejunal ulcer with hemorrhage, K28.1 — Acute gastrojejunal ulcer with perforation, +17 more

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical categories (Esophageal disorders, Gastrointestinal hemorrhage).

B37.81 — Candidal esophagitis, B57.31 — Megaesophagus in Chagas' disease, I85.01 — Esophageal varices with bleeding, I85.11 — Secondary esophageal varices with bleeding, K20.0 — Eosinophilic esophagitis, K20.8 — Other esophagitis, K20.80 — Other esophagitis without bleeding, K20.81 — Other esophagitis with bleeding, K20.9 — Esophagitis, unspecified, K20.90 — Esophagitis, unspecified without bleeding, K21.0 — Gastro-esophageal reflux disease with esophagitis, K21.00 — Gastro-esophageal reflux disease with esophagitis, without bleeding, K21.01 — Gastro-esophageal reflux disease with esophagitis, with bleeding, K21.9 — Gastro-esophageal reflux disease without esophagitis, K22.0 — Achalasia of cardia, K22.10 — Ulcer of esophagus without bleeding, K22.11 — Ulcer of esophagus with bleeding, K22.2 — Esophageal obstruction, K22.3 — Perforation of esophagus, K22.4 — Dyskinesia of esophagus, +67 more

Same Index main term, other category

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

A18.83 — Tuberculosis of digestive tract organs, not elsewhere classified (tuberculous), B37.81 — Candidal esophagitis (candidal), K21.00 — Gastro-esophageal reflux disease with esophagitis, without bleeding (reflux), K21.01 — Gastro-esophageal reflux disease with esophagitis, with bleeding (reflux, with bleeding), K22.10 — Ulcer of esophagus without bleeding (ulcerative), K22.11 — Ulcer of esophagus with bleeding (ulcerative, with bleeding)

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)

Contextual Map

Every relationship of K20.91 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.

Hierarchy

Clinical classification (CCSR)

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. 5,748 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2027

Index entries

  • Esophagitis (acute) (alkaline) (chemical) (chronic) (infectional) (necrotic) (peptic) (postoperative) (without bleeding), with bleeding[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2027

Nearest codes

Change history

Reference

Index terms and tables, published questions and FAQ, every source behind this page with its release and checksum, the date-of-service check and the complete change history.

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.

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 FY2027 tabular list, index and tables, effective October 1, 2026 Release, file and checksum · Publisher’s page
Coding guidelines Official source data
ICD-10-CM Official Guidelines for Coding and Reporting (FY2027), quoted by section Release, file and checksum · Publisher’s page
Claim edits Official source data
CMS Definitions of Medicare Code Edits — v44.0 (October 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 — v44 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-derived 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 editorial 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.

Current data releases:ICD-10-CM FY2027 · ICD-10-PCS FY2027 · HCPCS October 2026 · MS-DRG v44 · Medicare Code Editor v44.0 · NCCI PTP Q4 2026 · MUE Q4 2026 · NCD code lists 2026-01 · LCD export September 20, 2026 · All releases and sources

Labels on this page: Official source data · MedCoder-derived relationship · MedCoder editorial explanation. How to read the labels · All data sources and release dates · CMS coding rules

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. "K20.91 — Esophagitis, unspecified with bleeding." ICD-10-CM FY2027. https://medcoder.ai/icd10/code/k20.91-esophagitis-unspecified-with-bleeding

Change history

  • FY2021 — October 1, 2020
    Added to the code set
    Esophagitis, unspecified with bleeding
    FY2021 changes

Nearest Codes in This Family

Official ICD-10-CM classifications closest to K20.91 in its code family, with their registry titles.

View all codes in the K20 family