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ICD-10 Guide
ICD-10 CodesK85.30

K85.30

Billable

Drug induced acute pancreatitis without necrosis or infection

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

Code Description

ICD-10 K85.30 is a billable code used to indicate a diagnosis of drug induced acute pancreatitis without necrosis or infection.

Key Diagnostic Point:

K85.30 refers to drug-induced acute pancreatitis without necrosis or infection. This condition arises when certain medications trigger inflammation of the pancreas, leading to acute symptoms such as severe abdominal pain, nausea, vomiting, and elevated pancreatic enzymes. The pancreas, located behind the stomach, plays a crucial role in digestion and blood sugar regulation. In drug-induced cases, the inflammation is typically reversible upon discontinuation of the offending agent. The disease progression can vary, with some patients experiencing mild symptoms that resolve quickly, while others may develop more severe manifestations requiring hospitalization. Diagnostic considerations include a thorough patient history to identify potential drug exposures, laboratory tests to assess pancreatic enzyme levels, and imaging studies to rule out other causes of abdominal pain. Clinicians must also consider the timing of symptom onset in relation to medication use, as this can aid in establishing a causal link.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires careful evaluation of medication history and symptom correlation.
  • Treatment complexity: Management involves discontinuation of the drug and supportive care, which may vary based on severity.
  • Documentation requirements: Detailed documentation of drug history and clinical findings is essential.
  • Coding specificity: Requires precise coding to differentiate from other types of pancreatitis.

Audit Risk Factors

  • Common coding errors: Misidentification of the cause of pancreatitis or failure to document drug history.
  • Documentation gaps: Incomplete records regarding medication use or clinical findings.
  • Billing challenges: Potential denials if documentation does not clearly support the diagnosis.

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

The clinical significance of K85.30 lies in its potential to cause significant morbidity if not recognized and managed promptly. Drug-induced acute pancreatitis can lead to increased healthcare utilization, including hospital admissions and prolonged stays. Understanding the epidemiology of this condition is crucial, as it can inform preventive measures and improve patient outcomes. Quality measures may focus on timely diagnosis and management, reducing the incidence of drug-induced cases through better medication monitoring.

ICD-9 vs ICD-10

The clinical significance of K85.30 lies in its potential to cause significant morbidity if not recognized and managed promptly. Drug-induced acute pancreatitis can lead to increased healthcare utilization, including hospital admissions and prolonged stays. Understanding the epidemiology of this condition is crucial, as it can inform preventive measures and improve patient outcomes. Quality measures may focus on timely diagnosis and management, reducing the incidence of drug-induced cases through better medication monitoring.

Reimbursement & Billing Impact

Reimbursement considerations include ensuring that the diagnosis is supported by laboratory findings and imaging studies. Common denials may arise from insufficient documentation linking the drug to the acute pancreatitis. Coders should ensure that all relevant clinical information is included in the medical record to support the diagnosis and avoid billing challenges. Best practices include regular audits of documentation and coding accuracy to minimize errors.

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 K85.30?

K85.30 covers acute pancreatitis specifically induced by drugs, excluding cases with necrosis or infection. Common drugs associated include certain diuretics, antiepileptics, and antibiotics.

When should K85.30 be used instead of related codes?

K85.30 should be used when acute pancreatitis is directly linked to drug exposure without evidence of necrosis or infection, differentiating it from idiopathic or alcohol-induced cases.

What documentation supports K85.30?

Documentation should include a comprehensive medication history, clinical presentation details, laboratory results indicating elevated pancreatic enzymes, and imaging studies that exclude other causes.