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ICD-10 Guide
ICD-10 CodesK85.81

K85.81

Billable

Other acute pancreatitis with uninfected necrosis

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

Code Description

ICD-10 K85.81 is a billable code used to indicate a diagnosis of other acute pancreatitis with uninfected necrosis.

Key Diagnostic Point:

K85.81 refers to 'Other acute pancreatitis with uninfected necrosis,' a serious condition characterized by inflammation of the pancreas accompanied by necrosis of pancreatic tissue without infection. Clinically, patients may present with severe abdominal pain, nausea, vomiting, and signs of systemic inflammatory response. The pancreas, located behind the stomach, plays a crucial role in digestion and glucose metabolism. In acute pancreatitis, the digestive enzymes become activated prematurely, leading to autodigestion of pancreatic tissue. Disease progression can vary; some patients may recover fully, while others may develop complications such as infected necrosis, pseudocysts, or systemic organ failure. Diagnosis typically involves clinical evaluation, imaging studies like CT scans, and laboratory tests to assess enzyme levels. It is essential to differentiate K85.81 from other forms of pancreatitis, particularly those with infected necrosis (K85.82), as management strategies differ significantly.

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

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

K85.81 has significant clinical implications, as acute pancreatitis can lead to severe complications and increased healthcare utilization. The condition affects a substantial portion of the population, with rising incidence rates linked to lifestyle factors such as alcohol consumption and obesity. Quality measures focus on timely diagnosis and management to prevent progression to infected necrosis or other severe outcomes, highlighting the importance of effective healthcare delivery in managing this condition.

ICD-9 vs ICD-10

K85.81 has significant clinical implications, as acute pancreatitis can lead to severe complications and increased healthcare utilization. The condition affects a substantial portion of the population, with rising incidence rates linked to lifestyle factors such as alcohol consumption and obesity. Quality measures focus on timely diagnosis and management to prevent progression to infected necrosis or other severe outcomes, highlighting the importance of effective healthcare delivery in managing this condition.

Reimbursement & Billing Impact

Reimbursement considerations include the severity of the condition and the complexity of care, including potential surgical interventions. Common denials may arise from insufficient documentation of the diagnosis or failure to demonstrate medical necessity for procedures performed. Best practices include maintaining detailed clinical notes, imaging reports, and laboratory results to support the coding and billing process.

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 K85.81?

K85.81 covers cases of acute pancreatitis where there is necrosis of pancreatic tissue that is not infected. This includes necrotizing pancreatitis that has not progressed to infection, which can complicate treatment and management.

When should K85.81 be used instead of related codes?

K85.81 should be used when there is clear evidence of acute pancreatitis with uninfected necrosis. It is crucial to differentiate it from K85.82, which indicates infected necrosis, as treatment protocols differ significantly.

What documentation supports K85.81?

Documentation should include clinical findings of acute pancreatitis, imaging results indicating necrosis without infection, laboratory results showing elevated pancreatic enzymes, and a clear treatment plan that reflects the management of uninfected necrosis.