I85.01: Esophageal varices with bleeding

Risk adjustment

I85.01 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:

• HCC 63 Chronic Liver Failure/End-Stage Liver Disorders0.962 RAF

Coefficient shown for the Community Non-dual Aged segment. A higher HCC in the same hierarchy will suppress this one, so capturing it does not always add score. Look up the whole chart to see which of its HCCs the hierarchy would zero.

Medicare coverage

I85.01 is named in 10 Medicare coverage policies: 10 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.

• A56389Billing and Coding: Upper Gastrointestinal Endoscopy and Visualization
• A56531Billing and Coding: Octreotide Acetate for Injectable Suspension (Sandostatin® LAR Depot)
• A56580Billing and Coding: Computerized Axial Tomography (CT), Thorax
• A56697Billing and Coding: Non-Invasive Vascular Studies