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K94.12 ICD-10-CM Code: Enterostomy infection

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

Coding at a Glance

Tabular directives
3 use-additional codes
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.

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for K94.12 in the official ICD-10-CM tabular list, quoted as published.

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

Use Additional Code

Supplementary codes the tabular list directs you to add.

  • Use additional code to specify type of infection, such as:
  • cellulitis of abdominal wall (L03.311)
  • sepsis (A40.-, A41.-)

Coder workflow for K94.12

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 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 K94.12(3 notes)

    Coding workflow: Check whether the documentation supports the additional code(s) the note names, and report them with K94.12 when it does. Where the instruction is conditional (“if applicable”, “if known”), it applies only when the record documents the condition.

    ReviewL03.311, A40, A41

    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 K94.12?

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).

ReviewL03.311, A40, A41

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 infection is a billable ICD-10-CM diagnosis code (K94.12).

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 (4)

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

  • 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 K94.12 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: 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 10 clinically related codes on its CMS exclusion list.

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 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.

K94.00 — Colostomy complication, unspecified, K94.01 — Colostomy hemorrhage, K94.02 — Colostomy infection, K94.03 — Colostomy malfunction, K94.09 — Other complications of colostomy, K94.10 — Enterostomy complication, unspecified, K94.11 — Enterostomy hemorrhage, K94.13 — Enterostomy malfunction, K94.19 — Other complications of enterostomy

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, K94.10 — Enterostomy complication, unspecified, K94.11 — Enterostomy hemorrhage, 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).

K91.872 — 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, K94.10 — Enterostomy complication, unspecified, K94.11 — Enterostomy hemorrhage, 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, +28 more

Same Index main term, other category

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

K61.5 — Supralevator abscess (supralevator), K63.0 — Abscess of intestine (fecal), K65.1 — Peritoneal abscess (omentum), K68.11 — Postprocedural retroperitoneal abscess (postoperative, retroperitoneal), K68.12 — Psoas muscle abscess (psoas muscle), K68.19 — Other retroperitoneal abscess (presacral), K6A.01 — Prevesical abscess (prevesical), K6A.09 — Other pelvic abscess (pelvis, pelvic), K75.0 — Abscess of liver (liver), K81.0 — Acute cholecystitis (gallbladder), L02.01 — Cutaneous abscess of face (face), L02.11 — Cutaneous abscess of neck (neck), L02.211 — Cutaneous abscess of abdominal wall (loin), L02.212 — Cutaneous abscess of back [any part, except buttock and flank] (back), L02.213 — Cutaneous abscess of chest wall (pectoral), L02.214 — Cutaneous abscess of groin (groin), L02.215 — Cutaneous abscess of perineum (mons pubis), L02.216 — Cutaneous abscess of umbilicus (navel), L02.217 — Cutaneous abscess of flank (flank), L02.219 — Cutaneous abscess of trunk, unspecified (trunk), +158 more

Contextual Map

Every relationship of K94.12 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 K94.12 with these 13 related codes in Claim Check

Hierarchy

Use Additional Code

  • A40 — Streptococcal sepsis[Use Additional Code]: “sepsis (A40.-, A41.-)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
  • A41 — Other sepsis[Use Additional Code]: “sepsis (A40.-, A41.-)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
  • L03.311 — Cellulitis of abdominal wall[Use Additional Code]: “cellulitis of abdominal wall (L03.311)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026

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

  • Abscess (connective tissue) (embolic) (fistulous) (infective) (metastatic) (multiple) (pernicious) (pyogenic) (septic), enterostomy[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Abscess (connective tissue) (embolic) (fistulous) (infective) (metastatic) (multiple) (pernicious) (pyogenic) (septic), ileostomy (bud)[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Complication (s) (from) (of), enterostomy (stoma), infection[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Infection, infected, infective (opportunistic), enterostomy[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

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. "K94.12 — Enterostomy infection." ICD-10-CM FY2026. https://medcoder.ai/icd10/code/k94.12-enterostomy-infection

Change history

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

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 K94.12 in its code family, with their registry titles.

View all codes in the K94 family