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ICD-10 Guide
ICD-10 CodesK85.80

K85.80

Billable

Other acute pancreatitis without necrosis or infection

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

Code Description

ICD-10 K85.80 is a billable code used to indicate a diagnosis of other acute pancreatitis without necrosis or infection.

Key Diagnostic Point:

K85.80 refers to 'Other acute pancreatitis without necrosis or infection,' a condition characterized by the sudden onset of inflammation of the pancreas. Clinically, patients may present with severe abdominal pain, nausea, vomiting, and elevated serum amylase and lipase levels. The pancreas, located behind the stomach, plays a crucial role in digestion and glucose metabolism. Acute pancreatitis can arise from various etiologies, including gallstones, alcohol consumption, and certain medications. In cases classified under K85.80, the inflammation does not involve necrosis (tissue death) or infection, distinguishing it from more severe forms of pancreatitis. Disease progression can vary, with some patients recovering fully while others may experience complications. Diagnostic considerations include imaging studies such as abdominal ultrasound or CT scans to assess pancreatic inflammation and rule out complications. Accurate diagnosis is essential for appropriate management and treatment, which may include supportive care, dietary modifications, and addressing underlying causes.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity
  • Treatment complexity
  • Documentation requirements
  • Coding specificity

Audit Risk Factors

  • Common coding errors include misclassification of the type of pancreatitis.
  • Documentation gaps may arise if the clinical notes do not clearly specify the absence of necrosis or infection.
  • Billing challenges can occur if the diagnosis is not well-supported by clinical evidence.

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

Acute pancreatitis, including cases classified under K85.80, has significant clinical implications, affecting patient quality of life and healthcare utilization. It can lead to increased hospital admissions and healthcare costs. Understanding the epidemiology of acute pancreatitis is crucial, as it can vary by population and is influenced by factors such as alcohol use and gallstone prevalence. Quality measures related to the management of acute pancreatitis focus on timely diagnosis and appropriate treatment to reduce complications and improve outcomes.

ICD-9 vs ICD-10

Acute pancreatitis, including cases classified under K85.80, has significant clinical implications, affecting patient quality of life and healthcare utilization. It can lead to increased hospital admissions and healthcare costs. Understanding the epidemiology of acute pancreatitis is crucial, as it can vary by population and is influenced by factors such as alcohol use and gallstone prevalence. Quality measures related to the management of acute pancreatitis focus on timely diagnosis and appropriate treatment to reduce complications and improve outcomes.

Reimbursement & Billing Impact

Reimbursement considerations include ensuring that the clinical notes detail the patient's symptoms, diagnostic tests performed, and treatment provided. Common denials may arise from insufficient documentation or failure to meet medical necessity criteria. Coding best practices involve using the most specific code available and ensuring that the diagnosis aligns with the services billed to avoid audits and denials.

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 K85.80?

K85.80 covers cases of acute pancreatitis that do not involve necrosis or infection. This includes inflammation due to non-specific causes, such as idiopathic pancreatitis or cases where the etiology is not clearly defined.

When should K85.80 be used instead of related codes?

K85.80 should be used when acute pancreatitis is diagnosed without evidence of necrosis or infection. It is essential to differentiate it from K85.81 and K85.89 based on clinical findings and imaging results.

What documentation supports K85.80?

Documentation should include clinical findings such as abdominal pain, laboratory results showing elevated pancreatic enzymes, and imaging studies that confirm the diagnosis of acute pancreatitis without necrosis or infection.