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ICD-10 Guide
ICD-10 CodesK11.4

K11.4

Billable

Fistula of salivary gland

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

Code Description

ICD-10 K11.4 is a billable code used to indicate a diagnosis of fistula of salivary gland.

Key Diagnostic Point:

A fistula of the salivary gland is an abnormal connection between the salivary gland and the skin or another organ, often resulting from inflammation, infection, or trauma. Clinically, patients may present with swelling, pain, and drainage of saliva through the fistula, which can lead to complications such as dehydration and malnutrition if not addressed. The major salivary glands involved include the parotid, submandibular, and sublingual glands. Disease progression can vary; acute cases may resolve with conservative management, while chronic fistulas may require surgical intervention. Diagnostic considerations include imaging studies such as ultrasound or MRI to assess the extent of the fistula and rule out associated pathologies. A thorough clinical history and physical examination are essential for accurate diagnosis and treatment planning.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires imaging and clinical evaluation to confirm
  • Treatment complexity: May involve surgical repair or conservative management
  • Documentation requirements: Detailed clinical notes and imaging results needed
  • Coding specificity: Requires precise coding to differentiate from other salivary gland disorders

Audit Risk Factors

  • Common coding errors: Misidentification of the type of salivary gland disorder
  • Documentation gaps: Incomplete clinical notes regarding the fistula's characteristics
  • Billing challenges: Difficulty in justifying surgical procedures without adequate documentation

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

Oral and Maxillofacial Surgery

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

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Fistulas of the salivary gland can significantly impact patient quality of life, leading to complications such as chronic pain, infection, and nutritional deficiencies. Understanding the epidemiology of this condition is crucial for healthcare providers, as it can affect population health metrics and resource allocation. Quality measures related to timely diagnosis and effective treatment can improve patient outcomes and reduce healthcare utilization.

ICD-9 vs ICD-10

Fistulas of the salivary gland can significantly impact patient quality of life, leading to complications such as chronic pain, infection, and nutritional deficiencies. Understanding the epidemiology of this condition is crucial for healthcare providers, as it can affect population health metrics and resource allocation. Quality measures related to timely diagnosis and effective treatment can improve patient outcomes and reduce healthcare utilization.

Reimbursement & Billing Impact

Reimbursement may vary based on the complexity of the case and the interventions required. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity for surgical procedures. Coders should ensure that all relevant clinical information is included in the medical record to facilitate proper billing and reduce 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 K11.4?

K11.4 specifically covers fistulas resulting from salivary gland diseases, including those caused by infections, trauma, or surgical complications. It does not include conditions like salivary gland tumors or cysts.

When should K11.4 be used instead of related codes?

K11.4 should be used when there is a confirmed diagnosis of a fistula involving a salivary gland. It is distinct from codes for other salivary gland disorders, such as K11.3 for cysts or K11.5 for sialolithiasis.

What documentation supports K11.4?

Documentation should include clinical findings, imaging results, and treatment plans. Notes should detail the nature of the fistula, any associated symptoms, and the rationale for surgical intervention if applicable.