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K63.1 ICD-10-CM Code: Perforation of intestine (nontraumatic)

Compare with another code for K63.1Check 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
1 inclusion term · 2 Excludes1 · 1 Excludes2
Risk adjustment
CMS-HCC V28: 1 category · CMS-HCC V22 category 33

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, and is marked with where it comes from.

Excludes1Not reported with this code unless documented as unrelated
  • perforation (nontraumatic) of duodenum (K26.-)
  • perforation (nontraumatic) of intestine with diverticular disease (K57.0, K57.2, K57.4, K57.8)
Excludes2Not included here; may be reported together
  • perforation (nontraumatic) of appendix (K35.2-, K35.3-)
IncludesWhat this code covers
  • Perforation (nontraumatic) of rectum

Where it sits Source: CMS/NCHS

Under:Chapter 11: Diseases of the Digestive SystemK55-K64 Other diseases of intestinesK63 Other diseases of intestine

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 393 — OTHER DIGESTIVE SYSTEM DIAGNOSES WITH MCC (MDC 06)
  • MS-DRG 394 — OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC (MDC 06)
  • MS-DRG 395 — OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC (MDC 06)
  • MS-DRG 791 — PREMATURITY WITH MAJOR PROBLEMS (MDC 15)
  • MS-DRG 793 — FULL TERM NEONATE WITH MAJOR PROBLEMS (MDC 15)

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 78 — Intestinal Obstruction/Perforation

Other models: CMS-HCC V22 HCC 33

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 K63.1 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

Inclusion Terms

Alternative terms the tabular list files under this code.

  • Perforation (nontraumatic) of rectum

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).

Excludes2 — Not Included Here

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

Coder workflow for K63.1

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

Before you code K63.1

  1. Check the Excludes1 note: if the documentation supports a condition named there, do not simply proceed with K63.1. 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 documentation support a condition named in K63.1’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.

    ReviewK26, K57.0, K57.2, K57.4, K57.8

Consider K63.1. Then 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).

Official instructions as workflow

  • Excludes1 — check before selecting K63.1(2 notes)

    Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with K63.1: the two are not reported together. The one exception is when the record shows the two conditions are unrelated to each other.

    CompareK26, K57.0, K57.2, K57.4, K57.8

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

  • Excludes2 — not part of K63.1(1 note)

    Coding workflow: The conditions named in this note are not included in K63.1. When the record documents both, both may be reported; the note is a boundary, not a prohibition.

    CompareK35.2, K35.3

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

Coding decision scenarios

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

Documentation: Both the condition K63.1 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).

ReviewK26, K57.0, K57.2, K57.4, K57.8

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 K63.1 with…

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

The codes most likely to be picked instead of K63.1 — 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.

  • K26— 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 perforation (nontraumatic) of duodenum moves the case to K26; the two are not reported together unless documented as unrelated.

    Full comparison: K63.1 vs K26 →

  • K57.0— 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 perforation (nontraumatic) of intestine with diverticular disease moves the case to K57.0; the two are not reported together unless documented as unrelated.

    Full comparison: K63.1 vs K57.0 →

  • K57.2— 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 perforation (nontraumatic) of intestine with diverticular disease moves the case to K57.2; the two are not reported together unless documented as unrelated.

    Full comparison: K63.1 vs K57.2 →

  • K57.4— 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 perforation (nontraumatic) of intestine with diverticular disease moves the case to K57.4; the two are not reported together unless documented as unrelated.

    Full comparison: K63.1 vs K57.4 →

  • K57.8— 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 perforation (nontraumatic) of intestine with diverticular disease moves the case to K57.8; the two are not reported together unless documented as unrelated.

    Full comparison: K63.1 vs K57.8 →

  • K63.9— Specificity relationship (Review)

    Overlapping diagnoses in the same category.

    Overlapping codes in the same category — the documentation decides which is the more specific fit.

    What moves you there: A record that documents no more than “Disease of intestine, unspecified” takes K63.9; specificity in the record moves it back here.

    Full comparison: K63.1 vs K63.9 →

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

Perforation of intestine (nontraumatic) is a billable ICD-10-CM diagnosis code (K63.1).

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

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

Other codes that name K63.1 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 Excludes1 note: K63.3 — Ulcer of intestine.

These codes’ tabular lists mark this diagnosis as mutually exclusive — not reported together unless the conditions are documented as unrelated.

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 1 clinically related codes on its CMS exclusion list.

Named in the grouper logic of 5 MS-DRGs: DRG 393 (MDC 06), DRG 394 (MDC 06), DRG 395 (MDC 06), DRG 791 (MDC 15), DRG 793 (MDC 15).

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

Clinical classification (AHRQ CCSR):DIG006 — Gastrointestinal and biliary perforation (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 CMS-HCC risk category (V28)

CMS maps these diagnoses to the same Hierarchical Condition Category (Intestinal Obstruction/Perforation) for risk-adjusted payment.

K56.51 — Intestinal adhesions [bands], with partial obstruction, K56.52 — Intestinal adhesions [bands] with complete obstruction, K56.600 — Partial intestinal obstruction, unspecified as to cause, K56.601 — Complete intestinal obstruction, unspecified as to cause, K56.609 — Unspecified intestinal obstruction, unspecified as to partial versus complete obstruction, K56.690 — Other partial intestinal obstruction, K56.691 — Other complete intestinal obstruction, K56.699 — Other intestinal obstruction unspecified as to partial versus complete obstruction, K56.7 — Ileus, unspecified, K59.31 — Toxic megacolon, K65.0 — Generalized (acute) peritonitis, K65.1 — Peritoneal abscess, K65.2 — Spontaneous bacterial peritonitis, K65.3 — Choleperitonitis, K65.4 — Sclerosing mesenteritis, K65.8 — Other peritonitis, K65.9 — Peritonitis, unspecified, K67 — Disorders of peritoneum in infectious diseases classified elsewhere, K68.12 — Psoas muscle abscess, K68.19 — Other retroperitoneal abscess, +55 more

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.

Intestine Transplant Status/Complications

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical category (Gastrointestinal and biliary perforation).

K25.5 — Chronic or unspecified gastric ulcer with perforation, K26.1 — Acute duodenal ulcer with perforation, K26.5 — Chronic or unspecified duodenal ulcer with perforation, K27.1 — Acute peptic ulcer, site unspecified, with perforation, K27.5 — Chronic or unspecified peptic ulcer, site unspecified, with perforation, K28.1 — Acute gastrojejunal ulcer with perforation, K28.5 — Chronic or unspecified gastrojejunal ulcer with perforation, K35.32 — Acute appendicitis with perforation, localized peritonitis, and gangrene, without abscess, K35.33 — Acute appendicitis with perforation, localized peritonitis, and gangrene, with abscess, K57.00 — Diverticulitis of small intestine with perforation and abscess without bleeding, K57.01 — Diverticulitis of small intestine with perforation and abscess with bleeding, K57.20 — Diverticulitis of large intestine with perforation and abscess without bleeding, K57.21 — Diverticulitis of large intestine with perforation and abscess with bleeding, K57.40 — Diverticulitis of both small and large intestine with perforation and abscess without bleeding, K57.41 — Diverticulitis of both small and large intestine with perforation and abscess with bleeding, K57.80 — Diverticulitis of intestine, part unspecified, with perforation and abscess without bleeding, K57.81 — Diverticulitis of intestine, part unspecified, with perforation and abscess with bleeding, K82.2 — Perforation of gallbladder, K82.A2 — Perforation of gallbladder in cholecystitis, K83.2 — Perforation of bile duct, +2 more

Same Index main term, other category

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

K35.32 — Acute appendicitis with perforation, localized peritonitis, and gangrene, without abscess (appendix), K35.33 — Acute appendicitis with perforation, localized peritonitis, and gangrene, with abscess (cecum, with peritoneal abscess), K57.00 — Diverticulitis of small intestine with perforation and abscess without bleeding (diverticulum, small intestine), K57.01 — Diverticulitis of small intestine with perforation and abscess with bleeding (diverticulum, small intestine, with, bleeding), K57.20 — Diverticulitis of large intestine with perforation and abscess without bleeding (diverticulum, large intestine), K57.21 — Diverticulitis of large intestine with perforation and abscess with bleeding (diverticulum, large intestine, with, bleeding), K57.40 — Diverticulitis of both small and large intestine with perforation and abscess without bleeding (diverticulum, large intestine, with, small intestine), K57.41 — Diverticulitis of both small and large intestine with perforation and abscess with bleeding (diverticulum, large intestine, with, small intestine, with bleeding), K57.80 — Diverticulitis of intestine, part unspecified, with perforation and abscess without bleeding (diverticulum), K57.81 — Diverticulitis of intestine, part unspecified, with perforation and abscess with bleeding (diverticulum, with bleeding), K65.0 — Generalized (acute) peritonitis (cecum), K66.8 — Other specified disorders of peritoneum (mesentery), K82.2 — Perforation of gallbladder (gallbladder), K83.2 — Perforation of bile duct (bile duct), K86.89 — Other specified diseases of pancreas (pancreas), K92.2 — Gastrointestinal hemorrhage, unspecified (gastric, vessel), M27.51 — Perforation of root canal space due to endodontic treatment (root canal space due to endodontic treatment), M62.10 — Other rupture of muscle (nontraumatic), unspecified site (muscle, nontraumatic), M62.11 — Other rupture of muscle (nontraumatic), shoulder (muscle, nontraumatic, shoulder region), M62.12 — Other rupture of muscle (nontraumatic), upper arm (muscle, nontraumatic, upper arm), +203 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

Contextual Map

Every relationship of K63.1 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 K63.1 with these 8 related codes in Claim Check

Hierarchy

Excludes1

Excludes2

Referenced by Excludes1 notes

  • K63.3 — Ulcer of intestine[Excludes1]: “ulcer of intestine with perforation (K63.1)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2027

Clinical classification (CCSR)

Risk adjustment (CMS-HCC)

  • HCC 78 — Intestinal Obstruction/Perforation [CMS-HCC]— 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. 5,748 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2027
  • MDC 15 — Newborns and Other Neonates with Conditions Originating in Perinatal Period[MDC crossing]: “Newborns and Other Neonates with Conditions Originating in Perinatal Period — 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.”— CMS MS-DRG Definitions Manual · FY2027

Index entries (18)

  • Perforation, perforated (nontraumatic) (of), bowel[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2027
  • Perforation, perforated (nontraumatic) (of), colon[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2027
  • Perforation, perforated (nontraumatic) (of), ileum[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2027
  • Perforation, perforated (nontraumatic) (of), intestine NEC[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2027
  • Perforation, perforated (nontraumatic) (of), intestine NEC, ulcerative NEC[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2027
  • Perforation, perforated (nontraumatic) (of), jejunum, jejunal[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2027
  • Perforation, perforated (nontraumatic) (of), rectum[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2027
  • Perforation, perforated (nontraumatic) (of), sigmoid[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2027
  • and 10 more

Nearest codes (17)

Change history

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

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 (18)

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
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-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 28, 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. "K63.1 — Perforation of intestine (nontraumatic)." ICD-10-CM FY2027. https://medcoder.ai/icd10/code/k63.1-perforation-of-intestine-nontraumatic

Change history

  • FY2016 — October 1, 2015
    In the code set at ICD-10-CM adoption
    Perforation of intestine (nontraumatic)

No changes since FY2016 — additions, deletions, description changes and billable-status changes are tracked through FY2027, 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 K63.1 in its code family, with their registry titles.

View all codes in the K63 family