October 1 update. Our PDGM and ICD-10 tools now use the FY2027 code set: 190 codes added, 30 deleted, and no existing code changed clinical group.

See what changed

ICD-10 · PDGM grouping

I85 Esophageal varices

All 4 codes in the I85 family, with the PDGM clinical group, comorbidity subgroup and primary-position rule CMS assigns, read from the CMS grouper crosswalk v07.2.26 and the CDC FY2027 code file.

ICD-10-CM FY2027 · CMS grouper v07.2.26

Codes in family

4

Can lead a claim

2

Cannot lead a claim

2

What CMS assigns to I85

2 of the 4 codes group to MMTA - Cardiac and Circulatory; 2 are assigned no clinical group. 1 of the 4 counts toward the Varicose Veins and Lymphedema comorbidity subgroup; 3 are assigned none. 2 of the 4 can lead a claim. CMS attaches a code-first note to 2 of the 4.

  • Varicose Veins and Lymphedema: can award the low comorbidity tier as a secondary diagnosis.

Code first

CMS grouper convention 12, on I85.10, I85.11. Code first:

  • underlying disease

Every code in I85

Descriptions are CDC’s FY2027 wording; where CMS’s grouper abbreviates one, its form is shown beneath.

CodeDescriptionPrimary positionClinical groupComorbidity subgroup
I85.0 Esophageal varices
I85.00Esophageal varices without bleedingCan lead a claimHVaricose Veins and Lymphedema
I85.01Esophageal varices with bleedingCan lead a claimHNone
I85.1 Secondary esophageal varices
I85.10Secondary esophageal varices without bleedingCannot lead a claimPrincipal diagnosis not assigned to a clinical groupNoneNone
I85.11Secondary esophageal varices with bleedingCannot lead a claimPrincipal diagnosis not assigned to a clinical groupNoneNone

Sources: CMS HH PPS Grouper Software v07.2.26, effective 2026-10-01, for the clinical group, comorbidity subgroup, code-first conventions and primary-position flags; CDC NCHS ICD-10-CM FY2027 code descriptions for the family title and code wording. This is the crosswalk Medicare runs a claim through. Grouping also depends on admission source, timing, the OASIS functional items and the rest of the diagnosis list.

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