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ICD-10 Guide
ICD-10 CodesK85.10

K85.10

Billable

Biliary acute pancreatitis without necrosis or infection

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

Code Description

ICD-10 K85.10 is a billable code used to indicate a diagnosis of biliary acute pancreatitis without necrosis or infection.

Key Diagnostic Point:

Biliary acute pancreatitis without necrosis or infection is a condition characterized by inflammation of the pancreas, primarily triggered by gallstones or biliary obstruction. Clinically, patients may present with severe abdominal pain, often radiating to the back, nausea, vomiting, and elevated serum amylase and lipase levels. The anatomy involved includes the pancreas, bile ducts, and gallbladder, with the pathophysiology often linked to the obstruction of the pancreatic duct due to gallstones. Disease progression can lead to complications such as necrotizing pancreatitis or infection if not managed promptly. Diagnosis typically involves imaging studies such as ultrasound or CT scans to assess for gallstones and evaluate the pancreas. Laboratory tests are crucial for confirming elevated enzyme levels indicative of pancreatitis. Early recognition and management are vital to prevent further complications, making accurate coding essential for appropriate treatment and reimbursement.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires differentiation from other types of pancreatitis and conditions.
  • Treatment complexity: Management may involve hospitalization, pain management, and potential surgical intervention.
  • Documentation requirements: Detailed clinical notes and imaging results are necessary for accurate coding.
  • Coding specificity: Requires precise coding to distinguish from other pancreatitis types.

Audit Risk Factors

  • Common coding errors: Misclassification of the type of pancreatitis.
  • Documentation gaps: Insufficient clinical details regarding the absence of necrosis or infection.
  • Billing challenges: Potential denials if documentation does not clearly support the diagnosis.

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

General 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

Biliary acute pancreatitis significantly impacts clinical outcomes and healthcare utilization, often leading to hospitalization and surgical interventions. It is a common condition that can affect a substantial portion of the population, particularly those with gallstone disease. Quality measures focus on timely diagnosis and management to reduce complications and improve patient outcomes. Understanding the epidemiology of this condition is crucial for healthcare providers to implement effective prevention strategies and optimize resource allocation.

ICD-9 vs ICD-10

Biliary acute pancreatitis significantly impacts clinical outcomes and healthcare utilization, often leading to hospitalization and surgical interventions. It is a common condition that can affect a substantial portion of the population, particularly those with gallstone disease. Quality measures focus on timely diagnosis and management to reduce complications and improve patient outcomes. Understanding the epidemiology of this condition is crucial for healthcare providers to implement effective prevention strategies and optimize resource allocation.

Reimbursement & Billing Impact

Reimbursement considerations should also include the potential for inpatient admission based on the severity of the condition.

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 K85.10?

K85.10 specifically covers biliary acute pancreatitis that is not complicated by necrosis or infection. It is primarily associated with gallstone disease and biliary obstruction, leading to inflammation of the pancreas.

When should K85.10 be used instead of related codes?

K85.10 should be used when the patient presents with acute pancreatitis due to biliary causes without any evidence of necrosis or infection. If necrosis or infection is present, K85.11 or K85.12 should be considered.

What documentation supports K85.10?

Documentation should include clinical findings, imaging results showing gallstones or biliary obstruction, and laboratory results indicating elevated pancreatic enzymes. Clear notes on the absence of necrosis or infection are essential.