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K94.10 ICD-10-CM Code: Enterostomy complication, unspecified

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

Coding at a Glance

Risk adjustment
CMS-HCC V28: 1 category · CMS-HCC V22 category 188

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 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)

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 463 — Artificial Openings for Feeding or Elimination

Other models: CMS-HCC V22 HCC 188

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

Coder workflow for K94.10

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

Before you code K94.10

  1. Unspecified does not mean incorrect. When the record gives no greater specificity, K94.10 may be the appropriate code. Check the record for detail that supports a more specific sibling. 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).

    ReviewK94.11, K94.12, K94.13, K94.19

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

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 — K94.10 is appropriate when the documentation goes no further.

    ReviewK94.11, K94.12, K94.13, K94.19

Consider K94.10. 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).
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.

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 specific siblings in this subcategory and what each requires the record to state.

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).

ReviewK94.11, K94.12, K94.13, K94.19

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

Enterostomy complication, unspecified is a billable ICD-10-CM diagnosis code (K94.10).

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.

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

  • No Medicare Code Editor or MS-DRG Definitions Manual restrictions apply to this code.

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 K94.10 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 2 Excludes1 notes: Z43 — Encounter for attention to artificial openings (via K94.-), Z93 — Artificial opening status (via K94.-).

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

Referenced by 12 Excludes2 notes across 2 chapters: K62 — Other diseases of anus and rectum (via K94.1.-), K91 — Intraoperative and postprocedural complications and disorders of digestive system, not elsewhere classified (via K94.-), T80 — Complications following infusion, transfusion and therapeutic injection (via K94.-), T80-T88 — Complications of surgical and medical care, not elsewhere classified (T80-T88) (via K94.-), T81 — Complications of procedures, not elsewhere classified (via K94.-), T82 — Complications of cardiac and vascular prosthetic devices, implants and grafts (via K94.-), T83 — Complications of genitourinary prosthetic devices, implants and grafts (via K94.-), T84 — Complications of internal orthopedic prosthetic devices, implants and grafts (via K94.-), T85 — Complications of other internal prosthetic devices, implants and grafts (via K94.-), T86 — Complications of transplanted organs and tissue (via K94.-), T87 — Complications peculiar to reattachment and amputation (via K94.-), T88 — Other complications of surgical and medical care, not elsewhere classified (via K94.-).

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: not on the CMS CC/MCC list — as a secondary diagnosis this code does not change MS-DRG severity for that release.

Named in the grouper logic of 3 MS-DRGs: DRG 393 (MDC 06), DRG 394 (MDC 06), DRG 395 (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):DIG024 — Postprocedural or postoperative digestive system complication (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 (Artificial Openings for Feeding or Elimination) for risk-adjusted payment.

K91.850 — Pouchitis, K91.858 — Other complications of intestinal pouch, K94.00 — Colostomy complication, unspecified, K94.01 — Colostomy hemorrhage, K94.02 — Colostomy infection, K94.03 — Colostomy malfunction, K94.09 — Other complications of colostomy, K94.11 — Enterostomy hemorrhage, K94.12 — Enterostomy infection, K94.13 — Enterostomy malfunction, K94.19 — Other complications of enterostomy, K94.20 — Gastrostomy complication, unspecified, K94.21 — Gastrostomy hemorrhage, K94.22 — Gastrostomy infection, K94.23 — Gastrostomy malfunction, K94.29 — Other complications of gastrostomy, K94.30 — Esophagostomy complications, unspecified, K94.31 — Esophagostomy hemorrhage, K94.32 — Esophagostomy infection, K94.33 — Esophagostomy malfunction, +20 more

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical category (Postprocedural or postoperative digestive system complication).

K91.870 — Postprocedural hematoma of a digestive system organ or structure following a digestive system procedure, K91.871 — Postprocedural hematoma of a digestive system organ or structure following other procedure, K91.872 — Postprocedural seroma of a digestive system organ or structure following a digestive system procedure, K91.873 — Postprocedural seroma of a digestive system organ or structure following other procedure, K91.89 — Other postprocedural complications and disorders of digestive system, K94.00 — Colostomy complication, unspecified, K94.01 — Colostomy hemorrhage, K94.02 — Colostomy infection, K94.03 — Colostomy malfunction, K94.09 — Other complications of colostomy, K94.11 — Enterostomy hemorrhage, K94.12 — Enterostomy infection, K94.13 — Enterostomy malfunction, K94.19 — Other complications of enterostomy, K94.20 — Gastrostomy complication, unspecified, K94.21 — Gastrostomy hemorrhage, K94.22 — Gastrostomy infection, K94.23 — Gastrostomy malfunction, K94.29 — Other complications of gastrostomy, K94.30 — Esophagostomy complications, unspecified, +28 more

Contextual Map

Every relationship of K94.10 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 K94.10 with these 10 related codes in Claim Check

Hierarchy

Referenced by Excludes1 notes

Referenced by Excludes2 notes (12)

Clinical classification (CCSR)

Risk adjustment (CMS-HCC)

  • HCC 463 — Artificial Openings for Feeding or Elimination [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. 5,744 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2026

Index entries

  • Complication (s) (from) (of), enterostomy (stoma)[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026

Nearest codes (24)

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
Coding guidelines Official source data
ICD-10-CM Official Guidelines for Coding and Reporting (FY2026), quoted by section 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

Change history

  • FY2016 — October 1, 2015
    In the code set at ICD-10-CM adoption
    Enterostomy complication, unspecified

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 K94.10 in its code family, with their registry titles.

View all codes in the K94 family