I had some engine work done on my 2003 f350 6.0 Powerstroke and i am getting a kam memory code on my programmer and my truck runs like crap on any tune other than my 50hp tow tune could i have a failing ecm?

You’ll get a kam code anytime the batteries are unhooked or the ecm is reflagged.

Does is show up again after clearing it?

Have you done a VGT relearn yet? That will typically need to be done when the batteries are unhooked or the ecm flashed.
03 trucks have some odd issues that others don’t.

Is is it a generic SCT or custom tunes?

it has been happening for over a year off and on I can do a kam reset and it does not help the code will go away for a while and then come back. It runs bad on my preloaded tunes and custom. I thought it was my programmer but I installed it on my friends 05 and it ran fine. My injection control pressure will go over 3600 psi on my tow tune but on any higher tune it will max out at about 3000 psi and start running rough.could it be my icp sensor?

Do you have access to a scan tool with enhanced PIDs?