C16.1

Documentation support

General coding-documentation guidance — not a substitute for payer-specific requirements or professional coding judgment.

• •As a general rule, code to the highest level of specificity supported by the documentation in the medical record.

ICD-9-CM equivalent

Informational only — GEM mappings are approximate, not guaranteed one-to-one equivalents. Verify before use in billing.

• 1513

Associated MS-DRGs

C16.1 can serve as the principal diagnosis for these Medicare Severity Diagnosis-Related Groups.

Informational only — actual DRG assignment also depends on procedures, complications/comorbidities (CC/MCC), discharge status, and payer-specific rules not reflected here.

• DRG 314Other Circulatory System Diagnoses with MCC
• DRG 315Other Circulatory System Diagnoses with CC
• DRG 316Other Circulatory System Diagnoses without CC/MCC
• DRG 374Digestive Malignancy with MCC
• DRG 375Digestive Malignancy with CC
• DRG 376Digestive Malignancy without CC/MCC