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ICD-10 Guide
ICD-10 CodesK11.1

K11.1

Billable

Hypertrophy of salivary gland

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/06/2025

Code Description

ICD-10 K11.1 is a billable code used to indicate a diagnosis of hypertrophy of salivary gland.

Key Diagnostic Point:

Hypertrophy of the salivary gland refers to the abnormal enlargement of one or more salivary glands, which can occur due to various underlying conditions such as chronic inflammation, obstruction, or systemic diseases. The major salivary glands include the parotid, submandibular, and sublingual glands, all of which play crucial roles in the digestive process by producing saliva that aids in digestion and oral health. Clinically, patients may present with swelling in the affected area, discomfort, dry mouth, or difficulty swallowing. Disease progression can vary; hypertrophy may be transient or chronic, depending on the underlying cause. Diagnostic considerations include imaging studies such as ultrasound or MRI to assess gland size and structure, as well as laboratory tests to rule out infections or autoimmune disorders. A thorough patient history and physical examination are essential for accurate diagnosis and management.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires differential diagnosis to rule out other conditions such as tumors or infections.
  • Treatment complexity: Management may involve medical therapy, surgical intervention, or monitoring.
  • Documentation requirements: Detailed clinical notes and imaging results are necessary for accurate coding.
  • Coding specificity: Requires precise coding to differentiate from other salivary gland disorders.

Audit Risk Factors

  • Common coding errors: Misclassification with other salivary gland disorders.
  • Documentation gaps: Incomplete clinical notes may lead to incorrect coding.
  • Billing challenges: Potential for denials if documentation does not support the diagnosis.

Specialty Focus

Medical Specialties

Otolaryngology

Documentation Requirements

Standard ICD-10-CM documentation requirements apply

Common Clinical Scenarios

Various clinical presentations within this specialty area

Billing Considerations

Follow specialty-specific billing guidelines

Gastroenterology

Documentation Requirements

Standard ICD-10-CM documentation requirements apply

Common Clinical Scenarios

Various clinical presentations within this specialty area

Billing Considerations

Follow specialty-specific billing guidelines

Related ICD-10 Codes

Related CPT Codes

CPT Code

Clinical Scenario

Documentation Requirements

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Hypertrophy of the salivary gland can significantly impact patient quality of life, leading to discomfort and difficulties in eating and speaking. Understanding this condition is crucial for healthcare providers, as it can indicate underlying systemic issues. Population health impact includes the need for effective management strategies to reduce complications and improve patient outcomes. Monitoring trends in salivary gland disorders can inform healthcare utilization patterns and guide preventive measures.

ICD-9 vs ICD-10

Hypertrophy of the salivary gland can significantly impact patient quality of life, leading to discomfort and difficulties in eating and speaking. Understanding this condition is crucial for healthcare providers, as it can indicate underlying systemic issues. Population health impact includes the need for effective management strategies to reduce complications and improve patient outcomes. Monitoring trends in salivary gland disorders can inform healthcare utilization patterns and guide preventive measures.

Reimbursement & Billing Impact

Reimbursement may vary based on the complexity of the case and the treatment provided. Common denials can occur if the documentation does not clearly support the diagnosis or if the procedure codes do not align with the diagnosis. It is essential to ensure that all relevant clinical information is included in the medical record to facilitate proper billing and minimize the risk of audits.

Resources

Clinical References

  • •
    ICD-10 Official Guidelines for K00-K99
  • •
    Clinical Documentation Requirements

Coding & Billing References

  • •
    ICD-10 Official Guidelines for K00-K99
  • •
    Clinical Documentation Requirements

Frequently Asked Questions

What specific conditions are covered by K11.1?

K11.1 covers hypertrophy of salivary glands, which may be due to conditions such as chronic sialadenitis, duct obstruction, or systemic diseases like Sjögren's syndrome.

When should K11.1 be used instead of related codes?

K11.1 should be used when there is a confirmed diagnosis of hypertrophy without the presence of stones or neoplasms, which would require different codes.

What documentation supports K11.1?

Documentation should include clinical findings, imaging results, and any relevant laboratory tests that support the diagnosis of hypertrophy of the salivary gland.