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ICD-10 Guide
ICD-10 CodesK85.31

K85.31

Billable

Drug induced acute pancreatitis with uninfected necrosis

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

Code Description

ICD-10 K85.31 is a billable code used to indicate a diagnosis of drug induced acute pancreatitis with uninfected necrosis.

Key Diagnostic Point:

Drug-induced acute pancreatitis with uninfected necrosis is a severe condition characterized by inflammation of the pancreas due to the adverse effects of certain medications. Clinically, patients may present with severe abdominal pain, nausea, vomiting, and elevated serum amylase and lipase levels. The anatomy involved includes the pancreas, which is located behind the stomach and plays a crucial role in digestion and glucose metabolism. Disease progression can lead to necrosis of pancreatic tissue, which, if uninfected, may not show signs of secondary infection but can still result in significant morbidity. Diagnostic considerations include imaging studies such as CT scans or MRIs to assess the extent of necrosis and rule out complications like infected necrosis or abscess formation. A thorough medication history is essential to identify potential drug triggers, which may include certain antibiotics, diuretics, and immunosuppressants. Early recognition and management are critical to prevent further complications and improve patient outcomes.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires comprehensive evaluation of symptoms and imaging studies.
  • Treatment complexity: Management may involve hospitalization, supportive care, and potential surgical intervention.
  • Documentation requirements: Detailed documentation of drug history and clinical findings is necessary.
  • Coding specificity: Requires precise identification of the cause (drug-induced) and the condition (acute pancreatitis with necrosis).

Audit Risk Factors

  • Common coding errors: Misidentification of the cause of pancreatitis or failure to document drug history.
  • Documentation gaps: Incomplete medical records regarding medication use or clinical findings.
  • Billing challenges: Potential denials due to lack of specificity or insufficient documentation.

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

Internal Medicine

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 K85.31 lies in its potential to lead to serious complications, including systemic inflammatory response syndrome and multi-organ failure. Population health impact is notable, as drug-induced pancreatitis can affect a wide range of patients, particularly those on polypharmacy regimens. Quality measures may focus on the timely identification and management of this condition to reduce hospitalizations and improve patient outcomes. Epidemiologically, understanding the prevalence of drug-induced pancreatitis can inform healthcare utilization patterns and guide safer prescribing practices.

ICD-9 vs ICD-10

The clinical significance of K85.31 lies in its potential to lead to serious complications, including systemic inflammatory response syndrome and multi-organ failure. Population health impact is notable, as drug-induced pancreatitis can affect a wide range of patients, particularly those on polypharmacy regimens. Quality measures may focus on the timely identification and management of this condition to reduce hospitalizations and improve patient outcomes. Epidemiologically, understanding the prevalence of drug-induced pancreatitis can inform healthcare utilization patterns and guide safer prescribing practices.

Reimbursement & Billing Impact

Reimbursement considerations may vary based on the severity of the condition and the treatment provided. Common denials may occur if the documentation does not clearly establish the drug causation or if the coding lacks specificity. Best practices include thorough documentation of the patient's clinical presentation and a clear link between the medication and the pancreatitis.

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 K85.31?

K85.31 specifically covers acute pancreatitis that is induced by drugs, characterized by necrosis of pancreatic tissue without infection. This includes cases where the patient has a history of medication use that is known to cause pancreatitis.

When should K85.31 be used instead of related codes?

K85.31 should be used when there is clear evidence that acute pancreatitis is caused by a drug, and the patient exhibits necrosis without signs of infection. If the pancreatitis is due to other causes, such as alcohol or gallstones, different codes should be selected.

What documentation supports K85.31?

Documentation should include a detailed medication history, clinical findings consistent with acute pancreatitis, imaging results showing necrosis, and a clear statement linking the drug to the condition.