I85.01

🧬 ICD-10 CM I85.01 — Esophageal varices with bleeding

Billable Code Confirmed

ICD-10 CM I85.01 is a valid, billable 5-character ICD-10-CM code for FY2025. All five characters are present: I85 (category) + .0 (esophageal varices) + 1 (with bleeding). No additional characters are required.

Non-Billable Parent Codes — Never Submit These

• ❌ I85 — 3-character header — missing etiology and bleeding specification.

• ❌ I85.0 — 4-character header — missing bleeding specification.

  Always submit a 5-character code when coding esophageal varices (e.g., I85.01 for bleeding, or I85.00 for without bleeding).

Clinical Context: Underlying Conditions & "Code First" Rules

Esophageal varices are typically a manifestation of an underlying liver condition or portal hypertension. ICD-10-CM guidelines often require the underlying condition to be sequenced first if the encounter is primarily directed at treating the etiology. However, if the patient is admitted for an acute life-threatening variceal hemorrhage, I85.01 may be the principal diagnosis. Common underlying conditions to document alongside this include Alcoholic cirrhosis (K70.30), Portal hypertension (K76.6), or Chronic hepatitis C. Note that “Secondary esophageal varices” uses a different subcategory (I85.1-).

🔍 Code Description

ICD-10 CM I85.01 classifies abnormally dilated veins in the lower part of the esophagus that have ruptured and are actively bleeding (or recently bled).

This is a life-threatening medical emergency typically caused by portal hypertension secondary to liver cirrhosis. The increased pressure in the portal vein causes blood to be shunted into the smaller, fragile vessels of the esophagus, which can balloon out (varices) and tear.

Note

To code I85.01, the provider must document “bleeding.” Symptoms typically include hematemesis (vomiting blood), melena (black, tarry stools), or signs of hemorrhagic shock. If the provider only documents “esophageal varices” without mentioning bleeding, you must default to I85.00 (Esophageal varices without bleeding).

🌳 Code Tree / Hierarchy

I85 Esophageal varices ❌ Non-billable
│  
├── I85.0 Esophageal varices ❌ Non-billable
│ │  
│ ├── I85.00 Esophageal varices without bleeding
│ └── I85.01 ESOPHAGEAL VARICES WITH BLEEDING ◀ THIS CODE ✅
│
└── I85.1 Secondary esophageal varices ❌ Non-billable
  │  
  ├── I85.10 Secondary esophageal varices without bleeding
  └── I85.11 Secondary esophageal varices with bleeding

✅ Includes

The following clinical scenarios and terms map to I85.01:

• Primary esophageal varices with bleeding

• Bleeding esophageal varices NOS

• Ruptured esophageal varices

❌ Excludes

Excludes1 — Cannot be coded together

The Excludes1 note dictates that the following conditions cannot be coded alongside I85.01:

• Esophageal varices in diseases classified elsewhere (I98.3) (For example, if the varices are explicitly linked to Schistosomiasis, use the specific etiology/manifestation combination.)

Excludes2 — Can be coded together if both are present

• Ulcer of esophagus with bleeding (K22.11) (Can be coded together if the patient has both bleeding varices and a bleeding esophageal ulcer.)

🛠️ CPT Procedural Crosswalk — wRVU & Assistant Payable Status

Patients presenting with bleeding esophageal varices require emergent stabilization, critical care, and typically an urgent upper endoscopy (EGD) for therapeutic intervention (banding or sclerotherapy).

CPT Code	Description	Global Period	wRVU (Facility)	Asst. Surgeon Payable?	Bundling & NCCI Edits
43244	Esophagogastroduodenoscopy, flexible, transoral; with band ligation of esophageal/gastric varices	000	5.86	No (Indicator 0)	Primary therapeutic procedure. Mutually exclusive with diagnostic EGD 43235 (bundles in).
43243	Esophagogastroduodenoscopy, flexible, transoral; with injection sclerosis of esophageal/gastric varices	000	4.88	No (Indicator 0)	Alternative or adjunct to banding. Cannot typically be billed with 43244 on the exact same lesion without modifier support.
99291	Critical care, evaluation and management of the critically ill; first 30-74 mins	XXX	4.50	No (Indicator 0)	Frequently reported for the initial hemodynamic stabilization. Modifier -25 required if billed on the same day as an EGD by the same provider.
37182	Insertion of transvenous intrahepatic portosystemic shunt(s) (TIPS)	090	~17.50	Yes (Indicator 2)	Major procedure for refractory bleeding. Bundles extensive vascular access and imaging.

Note: wRVU values are estimates based on the standard CMS Physician Fee Schedule. Check current year exact values.

💊 Coding Scenarios

Scenario 1 — ED Presentation and Emergent Banding

Clinical Vignette: A 55-year-old male with a history of alcoholic cirrhosis is brought to the ED with massive hematemesis. He is tachycardic and hypotensive. The ED physician aggressively resuscitates the patient with IV fluids and blood products (Critical care time: 45 minutes). The on-call gastroenterologist performs an emergent bedside EGD, identifying actively spurting esophageal varices. Four bands are successfully deployed to achieve hemostasis. The patient is admitted to the ICU.

CPT / HCPCS:

• 99291-25 — Critical care, first 30-74 mins (Billed by ED physician; Modifier -25 may apply depending on EGD timing/provider)

• 43244 — EGD with band ligation of varices (Billed by Gastroenterologist)

ICD-10-CM:

• I85.01 — Esophageal varices with bleeding (Principal diagnosis for the admission)

• K70.30 — Alcoholic cirrhosis of liver, without ascites (Underlying etiology)

• R57.1 — Hypovolemic shock (Capturing the severity of the acute blood loss)

Scenario 2 — CDI Query: “GI Bleed” vs. Specific Source

Clinical Vignette: The attending physician documents “Admitted for acute upper GI bleed. Patient has known liver cirrhosis. Underwent EGD showing varices.” The EGD report from the GI specialist clearly states: “Active oozing from large distal esophageal varices, treated with injection sclerosis.”

Action / Outcome:

If the coder strictly relies on the attending’s assessment, they might code K92.2 (Gastrointestinal hemorrhage, unspecified) and I85.00 (Esophageal varices without bleeding). This dramatically misrepresents the patient’s severity and loses DRG weight.

Coder Action: Send a Clinical Documentation Improvement (CDI) query to the attending physician: “Dr. Jones, the GI consult/EGD report indicates the source of the acute upper GI bleed was actively bleeding esophageal varices. Do you agree with this finding? If so, please update the discharge summary to reflect ‘bleeding esophageal varices’.” Once updated, code I85.01.

⚠️ Coding Pitfalls and Tips

	Pitfall or Tip
❌	Do not confuse with gastric varices: If the bleeding is coming from gastric varices (stomach), you must use I86.4 (Gastric varices), not I85.01. If the patient has both bleeding esophageal and bleeding gastric varices, code both.
❌	Do not use unspecified GI hemorrhage codes concurrently: If you know the bleeding is from the varices (I85.01), do not additionally code K92.2 (GI hemorrhage, unspecified) or K22.89 (Hemorrhage of esophagus). The bleeding is already captured in the combination code I85.01.
✅	Capture associated manifestations: Look for documentation of acute posthemorrhagic anemia (D62) resulting from the severe blood loss, as this is a common MCC that frequently accompanies I85.01.
✅	Check for “Secondary” Varices: Check the documentation to see if the varices are considered “primary/idiopathic” or “secondary” to an unrelated occlusion. The index default for “esophageal varices” is I85.0-. However, if it’s secondary to a specific identified process not related to cirrhosis, some pathways lead to I85.11 (Secondary esophageal varices with bleeding).

📚 Sources

1. CMS/NCHS. ICD-10-CM Official Guidelines for Coding and Reporting, FY2025. Tabular List — I85.01.

2. American Medical Association (AMA). CPT 2024/2025 Professional Edition.

3. CMS National Correct Coding Initiative (NCCI) Policy Manual for Medicare Services.