ICD-10 Coding for Symptomatic Cholelithiasis(K80.20, K80.10, K80.61)
Complete ICD-10-CM coding and documentation guide for Symptomatic Cholelithiasis. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Symptomatic Cholelithiasis
K80-K87Primary Range
Diseases of gallbladder, biliary tract, and pancreas
This range includes codes for gallstones and their complications, such as cholecystitis and obstruction.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| K80.20 | Calculus of gallbladder without cholecystitis or obstruction | Use when gallstones are present with symptoms but without cholecystitis or obstruction. |
|
| K80.10 | Calculus of gallbladder with acute cholecystitis | Use when gallstones are present with acute cholecystitis confirmed by clinical and imaging findings. |
|
| K80.61 | Calculus of bile duct with obstruction | Use when gallstones cause bile duct obstruction confirmed by imaging. |
|
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 symptomatic cholelithiasis
Essential facts and insights about Symptomatic Cholelithiasis
Primary ICD-10-CM Codes for symptomatic cholelithiasis
Decision Criteria
clinical Criteria
- Patient presents with symptomatic gallstones without signs of inflammation or obstruction.
Applicable To
- Symptomatic gallstones without inflammation
Clinical Validation Requirements
- Right upper quadrant pain
- Ultrasound confirmation of gallstones
Code-Specific Risks
- Misclassification if cholecystitis is present
Coding Notes
- Ensure documentation specifies absence of cholecystitis or obstruction.
K80.10 - Calculus of gallbladder with acute cholecystitis
Use when gallstones are present with acute cholecystitis confirmed by clinical and imaging findings.
Applicable To
- Gallstones with acute inflammation
Excludes
- Chronic cholecystitis (K81.1)
Clinical Validation Requirements
- Severe RUQ pain >6 hours
- Murphy’s sign
- WBC >11k
- Ultrasound showing gallbladder wall thickening
Coding Notes
Document acute symptoms and imaging findings clearly.
K80.61 - Calculus of bile duct with obstruction
Use when gallstones cause bile duct obstruction confirmed by imaging.
Applicable To
- Gallstones causing bile duct obstruction
Excludes
- Cholangitis (K83.0)
Clinical Validation Requirements
- Elevated LFTs
- Imaging showing CBD stone
Coding Notes
Ensure obstruction is confirmed by imaging.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Symptomatic Cholelithiasis to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code K80.20.
Impact
Clinical: May lead to misdiagnosis., Regulatory: Increases risk of non-compliance., Financial: Potential for denied claims.
Mitigation Strategy
Always include imaging results in the documentation.
Impact
Reimbursement: May lead to lower reimbursement rates., Compliance: Increases risk of audit failures., Data Quality: Reduces accuracy of clinical data.
Mitigation Strategy
Use specific codes like K80.10 or K80.20 based on clinical documentation.
Impact
High risk of audit if unspecified codes are used when specific conditions are documented.
Mitigation Strategy
Use specific codes based on detailed clinical documentation.
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 Symptomatic Cholelithiasis, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Symptomatic Cholelithiasis
Use these documentation templates to ensure complete and accurate documentation for Symptomatic Cholelithiasis. These templates include all required elements for proper coding and billing.
Acute cholecystitis with gallstones
Specialty: GastroenterologyRequired Elements
- Patient history
- Physical examination findings
- Laboratory results
- Imaging studies
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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