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ICD-10 Coding for Acute Pancreatitis(K85.0, K85.2)

Complete ICD-10-CM coding and documentation guide for Acute Pancreatitis. Includes clinical validation requirements, documentation requirements, and coding pitfalls.

Also known as:

APSudden PancreatitisAcute Inflammation of the Pancreas

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Related ICD-10 Code Ranges

Complete code families applicable to Acute Pancreatitis

K85.0-K85.9Primary Range

Acute pancreatitis and its specific etiologies

This range covers all forms of acute pancreatitis, including specific causes like alcohol-induced and biliary.

Code Comparison: When to Use Each Code

Compare key differences between these codes to ensure accurate selection

CodeDescriptionWhen to UseKey Documentation
K85.0Idiopathic acute pancreatitisWhen the cause of acute pancreatitis is unknown after thorough investigation.
  • Abdominal pain consistent with acute pancreatitis
  • Lipase or amylase levels ≥3x ULN
  • Imaging findings consistent with acute pancreatitis
K85.2Alcohol-induced acute pancreatitisWhen acute pancreatitis is directly linked to alcohol consumption.
  • Documented history of significant alcohol consumption
  • Abdominal pain and elevated lipase levels
  • Imaging findings consistent with acute pancreatitis

Clinical Decision Support

Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.

Key Information: ICD-10 code for acute pancreatitis

Essential facts and insights about Acute Pancreatitis

The ICD-10 code for acute pancreatitis depends on the cause: K85.0 for idiopathic, K85.1 for biliary, K85.2 for alcohol-induced.

Primary ICD-10-CM Codes for acute pancreatitis

K85.0
Idiopathic acute pancreatitis
Non-billable Code

Decision Criteria

clinical Criteria

  • No identifiable cause after diagnostic workup.

Applicable To

  • Acute pancreatitis of unknown cause

Excludes

  • Chronic pancreatitis (K86.1)

Clinical Validation Requirements

  • Abdominal pain consistent with acute pancreatitis
  • Lipase or amylase levels ≥3x ULN
  • Imaging findings consistent with acute pancreatitis

Code-Specific Risks

  • Risk of using unspecified codes if etiology is not documented.

Coding Notes

  • Ensure documentation specifies the absence of known causes before using this code.
View Full Code Details

Ancillary Codes

Additional codes that should be used in conjunction with the main diagnosis codes when applicable.

Abdominal tenderness

R10.819
Use when abdominal tenderness is documented but not specific to a quadrant.

Alcohol use disorder

F10.10
Use to document alcohol use disorder when applicable.

Differential Codes

Alternative codes to consider when ruling out similar conditions to the primary diagnosis.

Biliary acute pancreatitis

K85.1
Presence of gallstones or biliary obstruction confirmed by imaging.

Documentation & Coding Risks

Avoid these common documentation and coding issues when documenting Acute Pancreatitis to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code K85.0.

Impact

Clinical: May lead to inappropriate treatment plans., Regulatory: Non-compliance with documentation standards., Financial: Potential for reduced reimbursement.

Mitigation Strategy

Ensure detailed social history is taken., Quantify alcohol use in terms of daily intake.

Impact

Reimbursement: May result in lower reimbursement rates., Compliance: Non-compliance with coding guidelines., Data Quality: Reduces the accuracy of clinical data.

Mitigation Strategy

Always document and code the specific cause of pancreatitis if known.

Impact

Failure to document specific causes of pancreatitis can lead to audit issues.

Mitigation Strategy

Implement thorough documentation practices for etiology.

Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.

Frequently Asked Questions

Common questions about ICD-10 coding for Acute Pancreatitis, with expert answers to help guide accurate code selection and documentation.

Documentation Templates for Acute Pancreatitis

Use these documentation templates to ensure complete and accurate documentation for Acute Pancreatitis. These templates include all required elements for proper coding and billing.

Emergency Department Admission

Specialty: Gastroenterology

Required Elements

  • Onset and character of abdominal pain
  • Alcohol consumption history
  • Laboratory results including lipase levels
  • Imaging findings

Example Documentation

Patient presents with sudden epigastric pain, vomiting, lipase 1200 U/L, CT shows pancreatic edema. Assessment: Acute alcohol-induced pancreatitis.

Examples: Poor vs. Good Documentation

Poor Documentation Example
Patient has pancreatitis.
Good Documentation Example
Patient presents with sudden epigastric pain radiating to back, vomiting, lipase 950 U/L, CT shows pancreatic edema. Assessment: Acute idiopathic pancreatitis.
Explanation
The good example provides specific symptoms, lab results, and imaging findings, allowing for accurate coding.

Need help with ICD-10 coding for Acute Pancreatitis? Ask your questions below.

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