ICD-10 Coding for Chronic Pancreatitis(K86.0, K86.1, K86.81)
Complete ICD-10-CM coding and documentation guide for Chronic Pancreatitis. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Chronic Pancreatitis
K86.0-K86.1Primary Range
Chronic Pancreatitis Codes
These codes cover chronic pancreatitis, including alcohol-induced and other specified types.
Exocrine Pancreatic Insufficiency
This code is used to specify exocrine pancreatic insufficiency, often associated with chronic pancreatitis.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| K86.0 | Alcohol-induced chronic pancreatitis | Use when chronic pancreatitis is explicitly linked to alcohol use. |
|
| K86.1 | Other chronic pancreatitis | Use when chronic pancreatitis is due to non-alcoholic causes. |
|
| K86.81 | Exocrine pancreatic insufficiency | Use when there is documented pancreatic enzyme deficiency. |
|
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 chronic pancreatitis
Essential facts and insights about Chronic Pancreatitis
Primary ICD-10-CM Codes for chronic pancreatitis
Decision Criteria
clinical Criteria
- History of alcohol use and chronic pancreatic changes
Applicable To
- Chronic pancreatitis due to alcohol use
Excludes
- Acute pancreatitis (K85.-)
Clinical Validation Requirements
- Documented history of alcohol use
- Imaging showing pancreatic changes consistent with chronic pancreatitis
Code-Specific Risks
- Misclassification if alcohol use is not documented
Coding Notes
- Ensure alcohol use is documented to support this code.
K86.1 - Other chronic pancreatitis
Use when chronic pancreatitis is due to non-alcoholic causes.
Applicable To
- Idiopathic chronic pancreatitis
Excludes
- Acute pancreatitis (K85.-)
Clinical Validation Requirements
- Imaging showing chronic pancreatic changes
- Absence of alcohol use history
Coding Notes
Document specific etiology if known.
K86.81 - Exocrine pancreatic insufficiency
Use when there is documented pancreatic enzyme deficiency.
Applicable To
- Pancreatic enzyme deficiency
Excludes
- Cystic fibrosis with pancreatic insufficiency (E84.1)
Clinical Validation Requirements
- Low fecal elastase levels
- Symptoms of malabsorption
Coding Notes
Ensure enzyme deficiency is documented.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Chronic Pancreatitis to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code K86.0.
Impact
Clinical: May lead to inadequate treatment planning., Regulatory: Non-compliance with coding standards., Financial: Potential loss of reimbursement for enzyme replacement therapy.
Mitigation Strategy
Review enzyme levels and symptoms., Ensure documentation supports insufficiency.
Impact
Reimbursement: Incorrect coding may affect DRG assignment., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Verify and document alcohol use to use K86.0 instead.
Impact
Failure to document the cause of chronic pancreatitis.
Mitigation Strategy
Implement mandatory fields for etiology in EHR templates.
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 Chronic Pancreatitis, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Chronic Pancreatitis
Use these documentation templates to ensure complete and accurate documentation for Chronic Pancreatitis. These templates include all required elements for proper coding and billing.
Chronic pancreatitis with alcohol use
Specialty: GastroenterologyRequired Elements
- History of alcohol use
- Imaging findings
- Symptoms of malabsorption
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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