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ICD-10 Guide
ICD-10 CodesK11.3

K11.3

Billable

Abscess of salivary gland

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

Code Description

ICD-10 K11.3 is a billable code used to indicate a diagnosis of abscess of salivary gland.

Key Diagnostic Point:

An abscess of the salivary gland, classified under ICD-10 code K11.3, is a localized collection of pus within the salivary gland tissue, often resulting from bacterial infection. The major salivary glands include the parotid, submandibular, and sublingual glands, each of which can be affected. Clinically, patients may present with swelling, pain, and tenderness in the affected area, along with possible fever and difficulty in swallowing or speaking. The disease progression can lead to complications such as the spread of infection or the formation of a fistula if not treated promptly. Diagnosis typically involves a thorough clinical examination, imaging studies like ultrasound or CT scans, and sometimes aspiration of the abscess for culture and sensitivity testing. Early diagnosis and management are crucial to prevent further complications and to ensure effective treatment, which may include antibiotics and surgical drainage of the abscess.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires clinical evaluation and imaging for confirmation.
  • Treatment complexity: May involve both medical and surgical interventions.
  • Documentation requirements: Detailed clinical notes and imaging reports are necessary.
  • Coding specificity: Requires accurate identification of the affected gland and any associated conditions.

Audit Risk Factors

  • Common coding errors: Misidentification of the type of salivary gland affected.
  • Documentation gaps: Incomplete clinical notes regarding symptoms and treatment.
  • Billing challenges: Difficulty in justifying surgical procedures without adequate documentation.

Specialty Focus

Medical Specialties

Primary medical specialty: 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

Secondary specialty: 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

The clinical significance of K11.3 lies in its potential to cause severe complications if left untreated, including systemic infection. Population health impact is notable, as abscesses can affect individuals of all ages, particularly those with underlying health conditions. Quality measures may include timely diagnosis and treatment, which can improve patient outcomes and reduce healthcare utilization patterns associated with complications.

ICD-9 vs ICD-10

The clinical significance of K11.3 lies in its potential to cause severe complications if left untreated, including systemic infection. Population health impact is notable, as abscesses can affect individuals of all ages, particularly those with underlying health conditions. Quality measures may include timely diagnosis and treatment, which can improve patient outcomes and reduce healthcare utilization patterns associated with complications.

Reimbursement & Billing Impact

Reimbursement considerations include the complexity of the procedure performed, such as drainage or surgical intervention. Common denials may arise from insufficient documentation or lack of medical necessity. Coders should ensure that all relevant clinical information is included in the medical record to support the billed services and to 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 K11.3?

K11.3 specifically covers abscesses of the salivary glands, which may arise from infections, duct obstructions, or trauma. It does not cover other salivary gland disorders such as sialolithiasis or benign tumors.

When should K11.3 be used instead of related codes?

K11.3 should be used when there is a confirmed diagnosis of an abscess in the salivary gland, particularly when there is evidence of pus formation. It should be differentiated from K11.2, which pertains to salivary stones without abscess formation.

What documentation supports K11.3?

Documentation should include clinical findings such as swelling, pain, and fever, imaging results confirming the abscess, and any treatment provided, including surgical notes if drainage was performed.