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ICD-10 Guide
ICD-10 CodesK86.2

K86.2

Billable

Cyst of pancreas

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

Code Description

ICD-10 K86.2 is a billable code used to indicate a diagnosis of cyst of pancreas.

Key Diagnostic Point:

K86.2 refers to a cyst of the pancreas, which is a fluid-filled sac that can develop in the pancreas. These cysts can be classified as either true cysts, which are lined by epithelium, or pseudocysts, which are not lined by epithelium and are often a result of pancreatitis. Clinically, patients may present with abdominal pain, nausea, vomiting, or may be asymptomatic. 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 vary; while some cysts may resolve spontaneously, others can lead to complications such as infection, rupture, or obstruction of the pancreatic duct. Diagnostic considerations include imaging studies such as ultrasound, CT scans, or MRI, which can help differentiate between cyst types and assess for complications. Endoscopic ultrasound may also be utilized for further evaluation and management.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires imaging and possibly biopsy for accurate diagnosis.
  • Treatment complexity: Management may involve observation, drainage, or surgical intervention depending on symptoms and complications.
  • Documentation requirements: Detailed clinical notes and imaging reports are necessary to support diagnosis.
  • Coding specificity: Requires precise coding to differentiate between types of cysts and associated conditions.

Audit Risk Factors

  • Common coding errors: Misclassification between true cysts and pseudocysts.
  • Documentation gaps: Insufficient clinical details regarding symptoms and imaging 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

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

The clinical significance of pancreatic cysts lies in their potential to cause complications such as infection or malignancy. Population health impact includes the need for increased surveillance in patients with a history of pancreatitis or other risk factors. Quality measures may focus on timely diagnosis and appropriate management of pancreatic cysts to prevent adverse outcomes. Healthcare utilization patterns may reflect an increase in imaging studies and specialist consultations for patients presenting with abdominal symptoms.

ICD-9 vs ICD-10

The clinical significance of pancreatic cysts lies in their potential to cause complications such as infection or malignancy. Population health impact includes the need for increased surveillance in patients with a history of pancreatitis or other risk factors. Quality measures may focus on timely diagnosis and appropriate management of pancreatic cysts to prevent adverse outcomes. Healthcare utilization patterns may reflect an increase in imaging studies and specialist consultations for patients presenting with abdominal symptoms.

Reimbursement & Billing Impact

Reimbursement considerations include the complexity of the case and whether the cyst is symptomatic. Common denials may arise if the documentation does not adequately support the diagnosis or if there is a lack of clinical evidence for the necessity of procedures. Best practices include ensuring that all imaging studies and clinical evaluations are thoroughly documented and that coding accurately reflects the patient's condition.

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 K86.2?

K86.2 covers pancreatic cysts, including both true cysts and pseudocysts. It is important to differentiate these from other pancreatic conditions such as pancreatitis or pancreatic tumors.

When should K86.2 be used instead of related codes?

K86.2 should be used when a patient is diagnosed with a cyst of the pancreas, particularly when imaging confirms the presence of a cystic lesion. It is essential to use this code when the cyst is symptomatic or requires intervention.

What documentation supports K86.2?

Documentation should include imaging reports that confirm the presence of a cyst, clinical notes detailing symptoms, and any relevant laboratory results. It is also important to document the clinical decision-making process regarding management.