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v1.0.0
ICD-10 Guide
ICD-10 CodesK85.90

K85.90

Billable

Acute pancreatitis without necrosis or infection, unspecified

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

Code Description

ICD-10 K85.90 is a billable code used to indicate a diagnosis of acute pancreatitis without necrosis or infection, unspecified.

Key Diagnostic Point:

Acute pancreatitis is characterized by the sudden inflammation of the pancreas, which can lead to severe abdominal pain, nausea, vomiting, and digestive disturbances. The pancreas, located behind the stomach, plays a crucial role in digestion and blood sugar regulation. In cases classified under K85.90, the acute pancreatitis occurs without necrosis or infection, indicating that while the pancreas is inflamed, there is no tissue death or bacterial involvement. The clinical presentation typically includes epigastric pain that may radiate to the back, elevated serum amylase and lipase levels, and potential complications such as fluid collections or pseudocysts. Diagnosis is often confirmed through imaging studies like ultrasound or CT scans. Disease progression can vary, with some patients recovering fully while others may develop chronic pancreatitis or other complications. Early recognition and management are essential to prevent further complications and to address underlying causes such as gallstones or alcohol use.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

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

Audit Risk Factors

  • Common coding errors
  • Documentation gaps
  • Billing challenges

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 significantly impacts population health, with rising incidence rates linked to lifestyle factors such as alcohol consumption and obesity. Quality measures focus on timely diagnosis and management to reduce hospitalizations and complications. Understanding epidemiological trends helps healthcare providers allocate resources effectively and improve patient outcomes in managing this condition.

ICD-9 vs ICD-10

Acute pancreatitis significantly impacts population health, with rising incidence rates linked to lifestyle factors such as alcohol consumption and obesity. Quality measures focus on timely diagnosis and management to reduce hospitalizations and complications. Understanding epidemiological trends helps healthcare providers allocate resources effectively and improve patient outcomes in managing this condition.

Reimbursement & Billing Impact

Reimbursement considerations include the need for clear evidence of acute pancreatitis without complications. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity for treatments. Best practices include ensuring that all clinical findings are well-documented and that the coding accurately reflects the patient's condition to avoid audits and ensure proper reimbursement.

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 K85.90?

K85.90 covers cases of acute pancreatitis that do not involve necrosis or infection. This includes idiopathic pancreatitis and cases where the cause is not specified, such as mild to moderate inflammation without complications.

When should K85.90 be used instead of related codes?

K85.90 should be used when acute pancreatitis is diagnosed without any evidence of necrosis or infection. If there are signs of tissue death or infection, codes K85.00 or K85.01 should be considered.

What documentation supports K85.90?

Documentation should include clinical findings such as symptoms, laboratory results indicating elevated pancreatic enzymes, imaging studies confirming inflammation, and a clear statement of the diagnosis without necrosis or infection.