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ICD-10 Guide
ICD-10 CodesK85.3

K85.3

Non-billable

Drug induced acute pancreatitis

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

Code Description

ICD-10 K85.3 is a used to indicate a diagnosis of drug induced acute pancreatitis.

Key Diagnostic Point:

Drug-induced acute pancreatitis is an inflammatory condition of the pancreas that occurs as a result of exposure to certain medications. Clinically, patients may present with severe abdominal pain, nausea, vomiting, and elevated serum amylase and lipase levels. The anatomy involved includes the pancreas, which is located in the retroperitoneal space and plays a crucial role in digestion and glucose metabolism. Disease progression can vary; in mild cases, symptoms may resolve with discontinuation of the offending drug, while severe cases can lead to complications such as necrotizing pancreatitis or systemic inflammatory response syndrome (SIRS). Diagnostic considerations include a thorough medication history, imaging studies such as ultrasound or CT scans to assess pancreatic inflammation, and laboratory tests to evaluate pancreatic enzyme levels. Identifying the specific drug responsible is essential for effective management and prevention of recurrence.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires careful assessment of medication history and clinical presentation.
  • Treatment complexity: Management may involve hospitalization, supportive care, and potential interventions.
  • Documentation requirements: Detailed documentation of drug history and clinical findings is necessary.
  • Coding specificity: Requires accurate identification of drug-related etiology.

Audit Risk Factors

  • Common coding errors: Misidentifying the cause of pancreatitis or failing to document drug history.
  • Documentation gaps: Incomplete medication records or lack of clinical correlation.
  • Billing challenges: Potential denials due to insufficient evidence linking the drug to the pancreatitis.

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

Drug-induced acute pancreatitis has significant clinical implications, as it can lead to severe morbidity and increased healthcare utilization. Understanding the epidemiology of drug reactions is essential for population health, as certain medications are more frequently associated with this condition. Quality measures may include monitoring adverse drug reactions and ensuring appropriate medication management to prevent recurrence.

ICD-9 vs ICD-10

Drug-induced acute pancreatitis has significant clinical implications, as it can lead to severe morbidity and increased healthcare utilization. Understanding the epidemiology of drug reactions is essential for population health, as certain medications are more frequently associated with this condition. Quality measures may include monitoring adverse drug reactions and ensuring appropriate medication management to prevent recurrence.

Reimbursement & Billing Impact

Reimbursement considerations include the severity of the condition and the need for hospitalization or outpatient management. Common denials may arise from insufficient documentation of the drug's role in the condition. Best practices include ensuring that all clinical notes, lab results, and imaging studies are complete and clearly indicate the diagnosis and treatment plan.

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 K85.3?

K85.3 specifically covers acute pancreatitis that is directly attributed to drug exposure. This includes reactions to medications such as certain antibiotics, diuretics, and immunosuppressants. The diagnosis requires a clear link between the drug and the onset of pancreatitis.

When should K85.3 be used instead of related codes?

K85.3 should be used when there is clear evidence that acute pancreatitis is caused by a specific drug. If pancreatitis is due to other factors such as alcohol use or gallstones, other codes like K85.0 or K85.2 should be used.

What documentation supports K85.3?

Documentation should include a comprehensive medication history, clinical findings consistent with acute pancreatitis, laboratory results showing elevated pancreatic enzymes, and imaging studies if performed. Clear notation of the suspected drug and the timeline of exposure is crucial.