ICD-10 Coding for Exocrine Pancreatic Insufficiency(K86.81)
Complete ICD-10-CM coding and documentation guide for Exocrine Pancreatic Insufficiency. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Exocrine Pancreatic Insufficiency
K86-K87Primary Range
Diseases of the pancreas
This range includes codes for pancreatic diseases, including exocrine pancreatic insufficiency.
Key Information: ICD-10 code for exocrine pancreatic insufficiency
Essential facts and insights about Exocrine Pancreatic Insufficiency
Primary ICD-10-CM Code for exocrine pancreatic insufficiency
Decision Criteria
clinical Criteria
- Presence of steatorrhea and weight loss unresponsive to dietary changes.
Applicable To
- EPI due to chronic pancreatitis
- EPI due to cystic fibrosis
Excludes
- Celiac disease (K90.0)
Clinical Validation Requirements
- Fecal elastase-1 <200 µg/g stool
- 72-hour fecal fat >7g/24hr
Code-Specific Risks
- Failure to document underlying etiology can lead to incorrect coding.
Coding Notes
- Ensure to document the specific underlying condition causing EPI.
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.
Celiac disease
K90.0Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Exocrine Pancreatic Insufficiency to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code K86.81.
Impact
Clinical: Leads to misdiagnosis., Regulatory: Non-compliance with coding standards., Financial: Potential loss of reimbursement.
Mitigation Strategy
Use specific terms like 'EPI confirmed by fecal elastase-1 <200 µg/g'.
Impact
Reimbursement: Incorrect DRG assignment can affect reimbursement., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Always code K86.81 with chronic pancreatitis if EPI is present.
Impact
Missing documentation of underlying conditions.
Mitigation Strategy
Ensure all relevant conditions are documented and coded.
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 Exocrine Pancreatic Insufficiency, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Exocrine Pancreatic Insufficiency
Use these documentation templates to ensure complete and accurate documentation for Exocrine Pancreatic Insufficiency. These templates include all required elements for proper coding and billing.
Chronic pancreatitis with EPI
Specialty: GastroenterologyRequired Elements
- Symptoms: Steatorrhea, weight loss
- Test results: Fecal elastase-1
- Treatment: PERT
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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