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Gastrointestinal HCCs in CMS-HCC V28 (HCC 77-81)

The gastrointestinal group of the CMS-HCC V28 model holds 5 payment categories (HCC 77, 78, 79, 80, 81): intestine transplant, obstruction, pancreatitis and inflammatory bowel disease. 161 ICD-10-CM codes map to them in the payment year 2027 initial mapping. Community, non-dual, aged factors run from 0.244 (HCC 81) to 1.172 (HCC 77). Inside the group, HCC 77 drops 78, 80 and 81; HCC 80 drops 81. HCC 78 does not drop, and is not dropped by, HCC 80 or 81, so a member coded for both is paid for both unless a higher-ranked category is also documented.

Compiled from CMS files by the QuickIntell RCM Editorial Team · Data effective · Method: reference methodology · Report a data correction

Data currency: ICD-10-CM to HCC mapping: PY2027 initial ICD-10-CM mappings (dates of service 2026) (payment year 2027); CMS-HCC V28 model software: CMS-HCC V28 software V2826.115.T2 (PY2027 initial) (payment year 2027). Next CMS release: PY2028 advance notice (February 2027) and the PY2027 midyear final mapping (spring 2027).

Payment categories
5
Mapped ICD-10-CM codes
161
Factor range (CNA)
0.244 to 1.172
Hierarchies in the group
1
CMS hierarchy group "GI"

Categories and relative factors

Each factor is added to the member's demographic factors when the category is documented in the data collection year. Community, non-dual, aged (CNA) is the largest segment; the disabled (CND) and long-term institutional (INS) segments are estimated separately, which is why the same category is worth a different amount for each.

CMS-HCC V28 gastrointestinal categories with relative factors
HCCCategoryCodesCNACNDINS
HCC 77Intestine Transplant Status/Complications61.1726.3015.089
HCC 78Intestinal Obstruction/Perforation760.3260.5340.380
HCC 79Chronic Pancreatitis20.3570.5740.218
HCC 80Crohn's Disease (Regional Enteritis)280.5500.6350.374
HCC 81Ulcerative Colitis490.2440.2850.258

Hierarchy inside the group

The V28 hierarchy macro ranks related categories so that a member with codes in several of them is paid only for the higher-ranked one. Each category drops only the categories its own macro entry lists.

HCC 77, 78, 80, 81 do not form a single chain: the ranking branches, so each category's own drop list from the macro is shown instead.

HCC 78 does not drop, and is not dropped by, HCC 80 or 81, so a member coded for both is paid for both unless a higher-ranked category is also documented.

ICD-10-CM code families

Where the mapped codes concentrate. A family with many codes is usually where specificity matters most: the category only counts when the documented diagnosis supports the exact code reported.

Three-character ICD-10-CM categories with the most codes in the gastrointestinal group
ICD-10-CM categoryMapped codes
K5156
K5032
K5616
K657
Q426
Q415
T865
K254

Where these codes sat in V24

The payment year 2025 mapping lists the V24 and V28 category for the same codes. 20 codes in this group had no V24 payment category. The main V24 sources are below; the crosswalk report covers every category.

V24 categories behind the gastrointestinal V28 categories (PY2025 mapping)
V24 HCCV24 categoryCodes
35Inflammatory Bowel Disease88
33Intestinal Obstruction/Perforation67
186Major Organ Transplant or Replacement Status6
34Chronic Pancreatitis2

The CMS-HCC V24 vs V28 crosswalk shows the codes that lost or gained payment status across all categories.

Inpatient MS-DRGs that use these diagnoses

Appendix B of the v44 MS-DRG Definitions Manual names the DRGs whose logic uses each diagnosis. The same documentation supports the inpatient group and, for Medicare Advantage members, the risk score.

MS-DRGs whose logic lists the most gastrointestinal HCC codes
MS-DRGTitleShared codes
DRG 385Inflammatory Bowel Disease with MCC88
DRG 386Inflammatory Bowel Disease with CC88
DRG 387Inflammatory Bowel Disease without CC/MCC77
DRG 791Prematurity with Major Problems28
DRG 793Full Term Neonate with Major Problems28
DRG 393Other Digestive System Diagnoses with MCC19
DRG 394Other Digestive System Diagnoses with CC19
DRG 395Other Digestive System Diagnoses without CC/MCC19

FY2027 code changes in this group

The October 1, 2026 ICD-10-CM update deleted 0 codes mapped to this group and created 3 replacement codes whose predecessors map here. CMS has not mapped the new codes yet; each category page lists them as pending. The FY2027 code changes report lists every new and deleted code.

Where QuickIntell fits for gastrointestinal HCCs

An HCC counts only when the visit note supports it. QuickScribe captures the encounter documentation, and QuickCode supports qualified coder review and documentation clarification before diagnoses are submitted.

See QuickScribe for visit documentationSee QuickCode for coder reviewBook a meeting

Frequently asked questions

Which HCCs are in the V28 gastrointestinal group?

HCC 77 (Intestine Transplant Status/Complications, 6 codes, factor 1.172); HCC 78 (Intestinal Obstruction/Perforation, 76 codes, factor 0.326); HCC 79 (Chronic Pancreatitis, 2 codes, factor 0.357); HCC 80 (Crohn's Disease (Regional Enteritis), 28 codes, factor 0.550); HCC 81 (Ulcerative Colitis, 49 codes, factor 0.244).

Which gastrointestinal HCC has the most mapped ICD-10-CM codes?

HCC 78, Intestinal Obstruction/Perforation, with 76 codes in the PY2027 initial mapping; across the group the largest code families are K51 (56), K50 (32), K56 (16), K65 (7).

Where did the gastrointestinal codes sit in the V24 model?

In the PY2025 mapping, which carries both models, 161 code-to-category links point to this group; 20 of those codes had no V24 payment category. The main V24 sources were HCC 35 (Inflammatory Bowel Disease, 88), HCC 33 (Intestinal Obstruction/Perforation, 67), HCC 186 (Major Organ Transplant or Replacement Status, 6).

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.

Disclaimer

Factors, hierarchies and mappings are reproduced from the CMS risk adjustment model files as an operational reference. The group is a navigation aid built from the V28 hierarchy; CMS pays categories, not groups. Payment depends on the plan's base rate, normalization, the coding intensity adjustment and the enrollee's segment. Not legal, clinical or billing advice.

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