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v1.0.0
ICD-10 Guide
ICD-10 CodesD86.9

D86.9

Billable

Sarcoidosis, unspecified

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/05/2025

Code Description

ICD-10 D86.9 is a billable code used to indicate a diagnosis of sarcoidosis, unspecified.

Key Diagnostic Point:

Sarcoidosis is a systemic granulomatous disease characterized by the formation of non-caseating granulomas in various organs. The etiology remains largely unknown, but it is believed to involve an abnormal immune response to environmental factors in genetically predisposed individuals. The condition can affect multiple organ systems, including the lungs, lymph nodes, skin, eyes, and heart. Symptoms may vary widely, ranging from asymptomatic to severe manifestations such as respiratory distress, skin lesions, or cardiac complications. Diagnosis typically involves a combination of clinical evaluation, imaging studies, and histological confirmation through biopsy. The unspecified designation indicates that the specific organ involvement or severity has not been documented, which can complicate treatment and management strategies. Given its potential to affect blood and blood-forming organs, sarcoidosis can lead to hematologic abnormalities such as anemia, leukopenia, or thrombocytopenia, necessitating careful monitoring and management of these complications.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in clinical presentation and organ involvement
  • Need for comprehensive documentation to specify organ systems affected
  • Potential for misdiagnosis with other granulomatous diseases
  • Lack of specific symptoms leading to delayed diagnosis

Audit Risk Factors

  • Inadequate documentation of organ involvement
  • Failure to provide biopsy results or imaging studies
  • Misclassification of sarcoidosis as another condition
  • Inconsistent coding practices across providers

Specialty Focus

Medical Specialties

Pulmonology

Documentation Requirements

Detailed pulmonary function tests, imaging results, and symptom descriptions.

Common Clinical Scenarios

Patients presenting with respiratory symptoms, abnormal chest X-rays, or lung function tests.

Billing Considerations

Ensure clear documentation of lung involvement and any associated complications.

Rheumatology

Documentation Requirements

Comprehensive assessment of systemic symptoms and organ involvement.

Common Clinical Scenarios

Patients with joint pain, skin lesions, or systemic symptoms suggestive of sarcoidosis.

Billing Considerations

Document any autoimmune markers or related conditions that may coexist.

Coding Guidelines

Inclusion Criteria

Use D86.9 When
  • Follow the official ICD
  • CM coding guidelines, ensuring accurate documentation of the patient's clinical status and any relevant diagnostic tests
  • Include any specific organ involvement when available, and use D86
  • 9 only when no further specification is documented

Exclusion Criteria

Do NOT use D86.9 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

71045CPT Code

Chest X-ray, 2 views

Clinical Scenario

Used to evaluate lung involvement in sarcoidosis.

Documentation Requirements

Document the reason for the X-ray and any findings related to sarcoidosis.

Specialty Considerations

Pulmonologists should ensure that imaging correlates with clinical findings.

88305CPT Code

Pathology examination, biopsy

Clinical Scenario

Used to confirm diagnosis through histological examination.

Documentation Requirements

Include biopsy results and correlation with clinical symptoms.

Specialty Considerations

Ensure that the pathology report is linked to the diagnosis of sarcoidosis.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of sarcoidosis, enabling better tracking of the disease's impact on various organ systems. However, the unspecified code D86.9 remains a common choice when documentation is lacking, which can lead to challenges in data accuracy and treatment planning.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of sarcoidosis, enabling better tracking of the disease's impact on various organ systems. However, the unspecified code D86.9 remains a common choice when documentation is lacking, which can lead to challenges in data accuracy and treatment planning.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of sarcoidosis, enabling better tracking of the disease's impact on various organ systems. However, the unspecified code D86.9 remains a common choice when documentation is lacking, which can lead to challenges in data accuracy and treatment planning.

Resources

Clinical References

  • •
    American Thoracic Society - Sarcoidosis

Coding & Billing References

  • •
    American Thoracic Society - Sarcoidosis

Frequently Asked Questions

What does D86.9 indicate?

D86.9 indicates sarcoidosis without specified organ involvement, requiring careful documentation to support its use.

When should I use D86.9 instead of more specific codes?

Use D86.9 when the documentation does not specify the organ systems affected by sarcoidosis.