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ICD-10 Guide
ICD-10 CodesK11.20

K11.20

Billable

Sialoadenitis, unspecified

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

Code Description

ICD-10 K11.20 is a billable code used to indicate a diagnosis of sialoadenitis, unspecified.

Key Diagnostic Point:

Sialoadenitis, unspecified, refers to the inflammation of the salivary glands without a specified cause. Clinically, patients may present with swelling, pain, and tenderness in the affected gland, often accompanied by dry mouth or difficulty swallowing. The condition can affect any of the major salivary glands, including the parotid, submandibular, or sublingual glands. Disease progression may vary; acute sialoadenitis can arise suddenly, often due to infection, dehydration, or obstruction, while chronic forms may develop from recurrent episodes or autoimmune conditions. Diagnostic considerations include clinical examination, imaging studies (such as ultrasound or CT scans), and laboratory tests to identify potential infectious agents or underlying systemic diseases. A thorough patient history is essential to determine risk factors, such as recent dehydration, medication use, or systemic diseases like Sjögren's syndrome.

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

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

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

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

Sialoadenitis can significantly affect patients' quality of life, leading to discomfort and difficulties in eating and speaking. Understanding its prevalence and management is crucial for improving population health outcomes. Effective coding and documentation can enhance healthcare utilization patterns, ensuring that patients receive appropriate care and resources are allocated efficiently. Epidemiologically, awareness of sialoadenitis can lead to better preventive measures and treatment protocols.

ICD-9 vs ICD-10

Sialoadenitis can significantly affect patients' quality of life, leading to discomfort and difficulties in eating and speaking. Understanding its prevalence and management is crucial for improving population health outcomes. Effective coding and documentation can enhance healthcare utilization patterns, ensuring that patients receive appropriate care and resources are allocated efficiently. Epidemiologically, awareness of sialoadenitis can lead to better preventive measures and treatment protocols.

Reimbursement & Billing Impact

Reimbursement considerations include the necessity of the visit and any procedures performed. Common denials may arise from insufficient documentation or lack of specificity in the diagnosis. Coders should ensure that the medical necessity for the evaluation and management services is clearly documented, and that the treatment plan aligns with the diagnosis to avoid 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 K11.20?

K11.20 covers unspecified sialoadenitis, which may include cases of acute or chronic inflammation of the salivary glands without a clear etiology. It does not specify whether the cause is infectious, obstructive, or autoimmune.

When should K11.20 be used instead of related codes?

K11.20 should be used when the specific cause of sialoadenitis is unknown or not documented. If the cause is identified, such as obstruction or infection, the corresponding specific code should be utilized.

What documentation supports K11.20?

Documentation should include clinical findings, patient history, and any imaging or laboratory results that indicate inflammation of the salivary glands without a specified cause. Clear notes on symptoms and treatment plans are also essential.