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 CodesK85.11

K85.11

Billable

Biliary acute pancreatitis with uninfected necrosis

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

Code Description

ICD-10 K85.11 is a billable code used to indicate a diagnosis of biliary acute pancreatitis with uninfected necrosis.

Key Diagnostic Point:

Biliary acute pancreatitis with uninfected necrosis is a severe form of pancreatitis characterized by inflammation of the pancreas due to biliary obstruction, often from gallstones. Clinically, patients may present with severe abdominal pain, nausea, vomiting, and elevated serum amylase and lipase levels. The anatomy involved includes the pancreas, bile ducts, and gallbladder. In this condition, necrosis of pancreatic tissue occurs without secondary infection, which differentiates it from infected necrotizing pancreatitis. Disease progression can lead to complications such as abscess formation, systemic inflammatory response syndrome (SIRS), and multi-organ failure if not managed promptly. Diagnostic considerations include imaging studies like ultrasound or CT scans to assess the extent of necrosis and rule out other causes of abdominal pain. Early recognition and management are crucial to prevent further complications and improve patient outcomes.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires imaging and laboratory tests to confirm diagnosis.
  • Treatment complexity: May involve hospitalization, fluid management, and potential surgical intervention.
  • Documentation requirements: Detailed clinical notes and imaging results are essential.
  • Coding specificity: Requires precise coding to differentiate from other types of pancreatitis.

Audit Risk Factors

  • Common coding errors: Misclassification of the type of pancreatitis.
  • Documentation gaps: Incomplete clinical notes regarding the extent of necrosis.
  • Billing challenges: Potential denials if documentation does not support the severity of the condition.

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

The clinical significance of K85.11 lies in its potential to lead to severe complications if not treated promptly. It affects a substantial portion of the population, particularly those with gallbladder disease. Understanding this condition is crucial for improving quality measures and healthcare utilization patterns, as timely intervention can reduce hospital stays and improve patient outcomes. Epidemiologically, the incidence of acute pancreatitis is rising, making awareness and accurate coding essential for effective healthcare management.

ICD-9 vs ICD-10

The clinical significance of K85.11 lies in its potential to lead to severe complications if not treated promptly. It affects a substantial portion of the population, particularly those with gallbladder disease. Understanding this condition is crucial for improving quality measures and healthcare utilization patterns, as timely intervention can reduce hospital stays and improve patient outcomes. Epidemiologically, the incidence of acute pancreatitis is rising, making awareness and accurate coding essential for effective healthcare management.

Reimbursement & Billing Impact

Reimbursement considerations include the severity of the condition and the complexity of treatment provided. Common denials may arise from insufficient documentation or failure to demonstrate the necessity of surgical interventions. Adhering to coding best practices, such as using the most specific codes and ensuring accurate clinical documentation, can mitigate billing challenges.

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 K85.11?

K85.11 specifically covers biliary acute pancreatitis with uninfected necrosis, which occurs when bile duct obstruction leads to pancreatic inflammation and necrosis without infection.

When should K85.11 be used instead of related codes?

K85.11 should be used when there is clear evidence of biliary obstruction causing acute pancreatitis with necrosis, and no signs of infection are present. It is important to differentiate it from K85.10 and K85.12.

What documentation supports K85.11?

Documentation should include clinical findings, imaging results showing necrosis, laboratory tests indicating elevated pancreatic enzymes, and a clear assessment of the absence of infection.