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ICD-10 Guide
ICD-10 CodesK11.21

K11.21

Billable

Acute sialoadenitis

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

Code Description

ICD-10 K11.21 is a billable code used to indicate a diagnosis of acute sialoadenitis.

Key Diagnostic Point:

Acute sialoadenitis is an inflammatory condition affecting the salivary glands, most commonly the parotid gland. Clinically, it presents with symptoms such as swelling, pain, and tenderness in the affected gland, often accompanied by fever and malaise. The condition can arise from various etiologies, including viral infections (e.g., mumps), bacterial infections due to duct obstruction, dehydration, or systemic diseases. The anatomy involved includes the major salivary glands: parotid, submandibular, and sublingual glands, with the parotid gland being the most frequently affected. Disease progression can lead to complications such as abscess formation or chronic sialadenitis if not treated promptly. Diagnostic considerations include clinical examination, imaging studies like ultrasound or CT scans, and laboratory tests to identify the causative organism. Early diagnosis and intervention are crucial to prevent complications and ensure effective management.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires clinical evaluation and possibly imaging or lab tests.
  • Treatment complexity: May involve antibiotics, hydration, and sometimes surgical intervention.
  • Documentation requirements: Detailed clinical notes and evidence of diagnosis are necessary.
  • Coding specificity: Requires accurate coding to differentiate from chronic sialoadenitis and other salivary gland disorders.

Audit Risk Factors

  • Common coding errors: Misclassification with chronic conditions or other salivary gland disorders.
  • Documentation gaps: Incomplete clinical notes or lack of diagnostic evidence.
  • Billing challenges: Potential denials if documentation does not support the acute 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

Dentistry

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

Acute sialoadenitis can significantly impact patient quality of life due to pain and discomfort, leading to increased healthcare utilization. It is essential to address this condition promptly to prevent complications such as abscess formation. Epidemiologically, the incidence may vary based on age, underlying health conditions, and access to healthcare, making awareness and early intervention crucial for population health.

ICD-9 vs ICD-10

Acute sialoadenitis can significantly impact patient quality of life due to pain and discomfort, leading to increased healthcare utilization. It is essential to address this condition promptly to prevent complications such as abscess formation. Epidemiologically, the incidence may vary based on age, underlying health conditions, and access to healthcare, making awareness and early intervention crucial for population health.

Reimbursement & Billing Impact

Reimbursement considerations include ensuring that the diagnosis is clearly supported by clinical evidence to avoid denials. Common denials may arise from insufficient documentation or misclassification of the condition. Best practices include using precise coding, maintaining detailed clinical notes, and ensuring that all services rendered are documented and justified in the medical record.

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 K11.21?

K11.21 covers acute sialoadenitis, primarily due to infectious causes, including viral and bacterial infections, as well as conditions leading to duct obstruction.

When should K11.21 be used instead of related codes?

K11.21 should be used when the condition is acute and presents with sudden onset symptoms. It should not be used for chronic conditions or other salivary gland disorders.

What documentation supports K11.21?

Documentation should include clinical findings, diagnostic imaging results, laboratory tests confirming infection, and treatment plans that reflect the acute nature of the condition.