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ICD-10 Guide
ICD-10 CodesK81.1

K81.1

Billable

Chronic cholecystitis

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

Code Description

ICD-10 K81.1 is a billable code used to indicate a diagnosis of chronic cholecystitis.

Key Diagnostic Point:

Chronic cholecystitis is a long-standing inflammation of the gallbladder, often resulting from repeated episodes of acute cholecystitis or prolonged irritation due to gallstones. Clinically, patients may present with intermittent abdominal pain, particularly in the right upper quadrant, nausea, and dyspepsia. The gallbladder, a small organ located beneath the liver, plays a crucial role in the digestion of fats by storing bile. Over time, chronic inflammation can lead to fibrosis and thickening of the gallbladder wall, potentially resulting in complications such as gallbladder perforation or the development of gallbladder cancer. Diagnosis typically involves imaging studies such as ultrasound or CT scans, which can reveal gallstones and gallbladder wall abnormalities. Laboratory tests may show elevated liver enzymes or bilirubin levels, indicating possible complications. A definitive diagnosis often requires a combination of clinical evaluation, imaging, and sometimes histopathological examination following cholecystectomy.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires imaging and clinical correlation.
  • Treatment complexity: May involve surgical intervention (cholecystectomy).
  • Documentation requirements: Detailed clinical history and imaging results needed.
  • Coding specificity: Requires accurate identification of chronic versus acute conditions.

Audit Risk Factors

  • Common coding errors: Misclassification between acute and chronic cholecystitis.
  • Documentation gaps: Incomplete clinical history or lack of imaging results.
  • Billing challenges: Denials due to insufficient documentation or incorrect coding.

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

General Surgery

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

Chronic cholecystitis has significant clinical implications, affecting patient quality of life and healthcare utilization. It can lead to increased hospital admissions and surgical interventions, impacting population health. Understanding the epidemiology of this condition is crucial, as it is prevalent in populations with high rates of obesity and gallstone disease. Quality measures related to the management of gallbladder diseases can help improve patient outcomes and reduce healthcare costs.

ICD-9 vs ICD-10

Chronic cholecystitis has significant clinical implications, affecting patient quality of life and healthcare utilization. It can lead to increased hospital admissions and surgical interventions, impacting population health. Understanding the epidemiology of this condition is crucial, as it is prevalent in populations with high rates of obesity and gallstone disease. Quality measures related to the management of gallbladder diseases can help improve patient outcomes and reduce healthcare costs.

Reimbursement & Billing Impact

Reimbursement considerations include ensuring that the diagnosis is clearly linked to the services provided, particularly if surgery is involved. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity for the procedure. Coders should ensure that all relevant codes are used to reflect the complexity of the condition and any associated procedures accurately.

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 K81.1?

K81.1 specifically covers chronic cholecystitis, characterized by persistent inflammation of the gallbladder, often due to gallstones. It may also encompass conditions leading to chronic irritation of the gallbladder wall.

When should K81.1 be used instead of related codes?

K81.1 should be used when there is clear evidence of chronic inflammation of the gallbladder, as opposed to acute cholecystitis (K81.0), which is characterized by sudden onset and may require immediate surgical intervention.

What documentation supports K81.1?

Documentation for K81.1 should include a detailed clinical history of symptoms, imaging studies confirming chronic changes in the gallbladder, and any relevant laboratory findings that support the diagnosis.