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v1.0.0
ICD-10 Guide
ICD-10 CodesK83.5

K83.5

Billable

Biliary cyst

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

Code Description

ICD-10 K83.5 is a billable code used to indicate a diagnosis of biliary cyst.

Key Diagnostic Point:

Biliary cysts, classified under ICD-10 code K83.5, are fluid-filled sacs that develop in the biliary system, which includes the bile ducts and gallbladder. These cysts can vary in size and may be congenital or acquired. Clinically, patients may present with abdominal pain, jaundice, or biliary obstruction, although many cases are asymptomatic and discovered incidentally during imaging studies. The anatomy involved primarily includes the liver, bile ducts, and gallbladder, where these cysts can disrupt normal bile flow. Disease progression can lead to complications such as infection, rupture, or malignancy, particularly in larger cysts. Diagnostic considerations typically involve imaging modalities such as ultrasound, CT scans, or MRCP (Magnetic Resonance Cholangiopancreatography) to visualize the cysts and assess their characteristics. In some cases, endoscopic retrograde cholangiopancreatography (ERCP) may be employed for therapeutic intervention or further evaluation.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires imaging and differential diagnosis to rule out other biliary conditions.
  • Treatment complexity: Management may involve surgical intervention, especially for symptomatic cysts.
  • Documentation requirements: Detailed clinical notes and imaging reports are essential for accurate coding.
  • Coding specificity: Requires precise coding to differentiate from other biliary disorders.

Audit Risk Factors

  • Common coding errors: Misclassification with other biliary disorders.
  • Documentation gaps: Inadequate imaging reports or clinical notes.
  • Billing challenges: Denials due to lack of supporting documentation for surgical procedures.

Specialty Focus

Medical Specialties

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

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

Biliary cysts, while often asymptomatic, can significantly impact patient quality of life if complications arise. They are relatively rare, but their management can lead to increased healthcare utilization, particularly in surgical cases. Understanding the epidemiology of biliary cysts is essential for population health, as timely diagnosis and treatment can prevent serious complications and improve patient outcomes.

ICD-9 vs ICD-10

Biliary cysts, while often asymptomatic, can significantly impact patient quality of life if complications arise. They are relatively rare, but their management can lead to increased healthcare utilization, particularly in surgical cases. Understanding the epidemiology of biliary cysts is essential for population health, as timely diagnosis and treatment can prevent serious complications and improve patient outcomes.

Reimbursement & Billing Impact

Reimbursement considerations include the necessity of imaging studies and potential surgical interventions. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity for procedures. Best practices include ensuring all clinical notes are thorough and that imaging results are clearly linked to the diagnosis of biliary cysts.

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 K83.5?

K83.5 specifically covers biliary cysts, which may include choledochal cysts and other cystic lesions of the biliary tree. It does not cover other biliary disorders such as cholangitis or cholecystitis.

When should K83.5 be used instead of related codes?

K83.5 should be used when a biliary cyst is diagnosed, particularly when imaging confirms the presence of a cystic lesion in the biliary system, differentiating it from other conditions like K83.0 or K83.1.

What documentation supports K83.5?

Documentation should include imaging reports that confirm the presence of a biliary cyst, clinical notes detailing symptoms, and any relevant surgical reports if intervention is performed.