ICD-10 Logo
ICDxICD-10 Medical Coding
ICD-10 Logo
ICDxICD-10 Medical Coding
ICD 10 CodesDiagnoses
ICD 10 CodesDiagnoses
ICD-10 Logo
ICDxICD-10 Medical Coding

Comprehensive ICD-10-CM code reference with AI-powered search capabilities.

© 2025 ICD Code Compass. All rights reserved.

Browse

  • All Chapters
  • All Categories
  • Diagnoses

Tools

  • AI Code Search
ICD-10-CM codes are maintained by the CDC and CMS. This tool is for reference purposes only.
v1.0.0
ICD-10 Guide
ICD-10 CodesK11.5

K11.5

Billable

Sialolithiasis

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

Code Description

ICD-10 K11.5 is a billable code used to indicate a diagnosis of sialolithiasis.

Key Diagnostic Point:

Sialolithiasis, commonly known as salivary gland stones, occurs when calcified deposits form in the salivary glands, leading to obstruction and inflammation. The condition primarily affects the submandibular glands, but can also involve the parotid and sublingual glands. Clinically, patients may present with symptoms such as unilateral swelling, pain during meals, dry mouth, and sometimes fever if infection occurs. The disease progression can lead to recurrent episodes of pain and swelling, potentially resulting in complications such as sialadenitis (infection of the salivary gland) or abscess formation. Diagnosis typically involves clinical evaluation, imaging studies such as ultrasound or CT scans, and sometimes sialography to visualize the stones. Treatment options range from conservative management, including hydration and massage, to more invasive procedures like sialendoscopy or surgical removal of the stones, depending on the size and location of the sialoliths. Accurate diagnosis and management are crucial to prevent complications and ensure patient comfort.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires imaging and clinical correlation.
  • Treatment complexity: Varies from conservative to surgical interventions.
  • Documentation requirements: Detailed clinical notes and imaging results needed.
  • Coding specificity: Requires precise coding based on the location and nature of the stones.

Audit Risk Factors

  • Common coding errors: Misidentifying the type of sialolithiasis or related conditions.
  • Documentation gaps: Incomplete clinical notes regarding symptoms and imaging.
  • Billing challenges: Denials may occur if documentation does not support the diagnosis or treatment provided.

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

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Sialolithiasis has significant clinical implications, as it can lead to recurrent infections and complications if not managed appropriately. The condition affects a notable portion of the population, particularly adults, and can influence healthcare utilization patterns due to the need for imaging and potential surgical interventions. Understanding the epidemiology of sialolithiasis can help healthcare providers implement preventive measures and improve patient outcomes.

ICD-9 vs ICD-10

Sialolithiasis has significant clinical implications, as it can lead to recurrent infections and complications if not managed appropriately. The condition affects a notable portion of the population, particularly adults, and can influence healthcare utilization patterns due to the need for imaging and potential surgical interventions. Understanding the epidemiology of sialolithiasis can help healthcare providers implement preventive measures and improve patient outcomes.

Reimbursement & Billing Impact

Reimbursement considerations may vary based on the complexity of treatment, with more invasive procedures typically yielding higher reimbursement rates. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity for procedures performed. Best practices include thorough documentation of the patient's symptoms, treatment rationale, and outcomes to support claims.

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 K11.5?

K11.5 specifically covers sialolithiasis, which includes the presence of calculi in the salivary glands leading to obstruction and potential infection. It does not cover sialadenitis or other salivary gland disorders unless they are directly related to the presence of stones.

When should K11.5 be used instead of related codes?

K11.5 should be used when there is a confirmed diagnosis of sialolithiasis, characterized by the presence of stones in the salivary glands. It should not be used for conditions like sialadenitis without stones or other salivary gland disorders.

What documentation supports K11.5?

Documentation should include clinical findings such as symptoms of swelling and pain, results from imaging studies confirming the presence of stones, and any treatment provided. Detailed notes on the patient's history and physical examination findings are essential.