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ICD-10 Guide
ICD-10 CodesK85.02

K85.02

Billable

Idiopathic acute pancreatitis with infected necrosis

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

Code Description

ICD-10 K85.02 is a billable code used to indicate a diagnosis of idiopathic acute pancreatitis with infected necrosis.

Key Diagnostic Point:

K85.02 refers to idiopathic acute pancreatitis with infected necrosis, a severe form of pancreatitis characterized by inflammation of the pancreas that leads to necrosis of pancreatic tissue. The condition is termed 'idiopathic' when the exact cause remains unknown, although it can be associated with factors such as alcohol consumption, gallstones, and certain medications. Clinically, patients may present with severe abdominal pain, nausea, vomiting, and fever. The anatomy involved includes the pancreas, which is located behind the stomach and plays a crucial role in digestion and glucose metabolism. Disease progression can lead to complications such as infected necrosis, where necrotic pancreatic tissue becomes infected, necessitating surgical intervention. Diagnostic considerations include imaging studies such as CT scans or MRIs to assess the extent of necrosis and infection, along with laboratory tests to evaluate pancreatic enzyme levels. Early diagnosis and management are critical to prevent further complications and improve patient outcomes.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

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

Audit Risk Factors

  • Common coding errors include misidentifying the type of pancreatitis.
  • Documentation gaps may arise if the extent of necrosis and infection is not clearly documented.
  • Billing challenges can occur if the treatment plan is not adequately 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

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

K85.02 has significant clinical implications, as infected necrosis can lead to severe morbidity and mortality if not promptly addressed. The condition impacts population health by contributing to hospitalizations and increased healthcare utilization. Quality measures focus on timely diagnosis and management to improve patient outcomes. Epidemiologically, the incidence of acute pancreatitis is rising, necessitating awareness and effective management strategies among healthcare providers.

ICD-9 vs ICD-10

K85.02 has significant clinical implications, as infected necrosis can lead to severe morbidity and mortality if not promptly addressed. The condition impacts population health by contributing to hospitalizations and increased healthcare utilization. Quality measures focus on timely diagnosis and management to improve patient outcomes. Epidemiologically, the incidence of acute pancreatitis is rising, necessitating awareness and effective management strategies among healthcare providers.

Reimbursement & Billing Impact

Reimbursement considerations include the severity of the condition and the complexity of treatment provided. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity for procedures performed. Coding best practices include ensuring that all relevant clinical information is captured in the medical record and that the treatment plan aligns with the diagnosis.

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 K85.02?

K85.02 covers idiopathic acute pancreatitis with infected necrosis, which is characterized by pancreatic inflammation and necrosis that becomes infected. It is essential to differentiate this from other forms of pancreatitis, such as those caused by gallstones or alcohol.

When should K85.02 be used instead of related codes?

K85.02 should be used when there is clear documentation of acute pancreatitis with infected necrosis and no identifiable cause. It is crucial to differentiate it from K85.00 and K85.01, which do not involve necrosis.

What documentation supports K85.02?

Documentation should include clinical findings of acute pancreatitis, imaging results showing necrosis, and evidence of infection. Detailed notes on the patient's history, physical examination, and treatment plan are also necessary.