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ICD-10 Guide
ICD-10 CodesChapter 11: Diseases of the digestive systemK11

K11

Non-billable

Diseases of salivary glands

Chapter 11:Diseases of the digestive system

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

Code Description

ICD-10 K11 is a used to indicate a diagnosis of diseases of salivary glands.

Key Diagnostic Point:

Diseases of the salivary glands encompass a variety of conditions affecting the glands responsible for saliva production, which are crucial for digestion and oral health. The major salivary glands include the parotid, submandibular, and sublingual glands. Common diseases include sialadenitis (inflammation), sialolithiasis (salivary stones), and tumors (benign or malignant). Clinical presentations often involve swelling, pain, dry mouth (xerostomia), and difficulty swallowing. Disease progression can lead to complications such as abscess formation or systemic infections if left untreated. Diagnostic considerations include imaging studies (ultrasound, CT scans), sialography, and biopsy when neoplasms are suspected. A thorough patient history and physical examination are essential for accurate diagnosis and management of these conditions, which can significantly impact a patient's quality of life and nutritional intake.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Moderate, as differential diagnoses may include various conditions affecting the oral cavity and neck.
  • Treatment complexity: Varies from conservative management (hydration, massage) to surgical interventions (stone removal, gland excision).
  • Documentation requirements: Requires detailed clinical notes, imaging results, and treatment plans.
  • Coding specificity: Moderate, as it requires precise coding based on the specific disease and its manifestations.

Audit Risk Factors

  • Common coding errors: Misclassification of the type of salivary gland disease.
  • Documentation gaps: Incomplete patient history or lack of imaging results.
  • Billing challenges: Denials may arise from insufficient documentation supporting the diagnosis or treatment provided.

Specialty Focus

Medical Specialties

Primary medical specialty: Otolaryngology

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

Secondary specialty: Dentistry

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 CPT Codes

CPT Code

Clinical Scenario

Documentation Requirements

CPT Code

Clinical Scenario

Documentation Requirements

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Diseases of the salivary glands can significantly affect a patient's quality of life, leading to difficulties in eating, speaking, and maintaining oral hygiene. The prevalence of conditions like sialolithiasis and sialadenitis highlights the need for awareness and timely intervention. Understanding these diseases contributes to better population health outcomes, as they can lead to complications if untreated, increasing healthcare utilization and costs.

ICD-9 vs ICD-10

Diseases of the salivary glands can significantly affect a patient's quality of life, leading to difficulties in eating, speaking, and maintaining oral hygiene. The prevalence of conditions like sialolithiasis and sialadenitis highlights the need for awareness and timely intervention. Understanding these diseases contributes to better population health outcomes, as they can lead to complications if untreated, increasing healthcare utilization and costs.

Reimbursement & Billing Impact

Reimbursement considerations include the complexity of the condition and the interventions performed. Common denials may arise from lack of supporting documentation or failure to meet medical necessity criteria. Best practices include ensuring that all clinical notes are thorough, that imaging studies are documented, and that the rationale for any surgical procedures is clearly articulated in the patient's medical record.

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 K11?

K11 covers conditions such as sialadenitis, sialolithiasis, benign and malignant tumors of the salivary glands, and xerostomia. Each condition has specific diagnostic criteria, including clinical symptoms and imaging findings.

When should K11 be used instead of related codes?

K11 should be used when the primary diagnosis involves a disease specifically affecting the salivary glands. It is important to differentiate it from codes related to oral mucosal diseases or other gastrointestinal conditions.

What documentation supports K11?

Documentation should include a detailed clinical evaluation, imaging studies (if performed), treatment plans, and follow-up notes. Specific symptoms and their duration, as well as any interventions undertaken, should be clearly recorded.