ICD-10 Coding for Gallstone Pancreatitis(K85.1)
Complete ICD-10-CM coding and documentation guide for Gallstone Pancreatitis. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Gallstone Pancreatitis
K85-K86Primary Range
Diseases of the pancreas
This range includes codes for acute and chronic pancreatitis, including those caused by gallstones.
Cholelithiasis and cholecystitis
This range includes codes for gallstones and related gallbladder conditions, which may be relevant if there is a separate gallbladder pathology.
Key Information: ICD-10 code for gallstone pancreatitis
Essential facts and insights about Gallstone Pancreatitis
Primary ICD-10-CM Code for gallstone pancreatitis
Decision Criteria
clinical Criteria
- Presence of gallstones on imaging and elevated ALT.
documentation Criteria
- Documented evidence of gallstones and pancreatitis symptoms.
Applicable To
- Gallstone pancreatitis
- Biliary pancreatitis
Excludes
- Chronic pancreatitis (K86.1)
Clinical Validation Requirements
- Elevated lipase/amylase ≥3x ULN
- ALT > 150 U/L
- Gallstones on imaging (US/CT/MRCP)
Code-Specific Risks
- Incorrectly sequencing gallstones as principal diagnosis when admission is for pancreatitis.
Coding Notes
- Ensure documentation specifies 'biliary' or 'gallstone' pancreatitis to use K85.1.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Cholelithiasis
K80.XXDocumentation & Coding Risks
Avoid these common documentation and coding issues when documenting Gallstone Pancreatitis to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code K85.1.
Impact
Clinical: Misdiagnosis of pancreatitis etiology., Regulatory: Non-compliance with documentation standards., Financial: Potential denial of claims.
Mitigation Strategy
Ensure imaging is performed and results are documented., Review documentation for completeness before submission.
Impact
Reimbursement: Incorrect coding can lead to lower reimbursement., Compliance: Non-compliance with ICD-10 guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Use K85.1 when gallstones are the confirmed cause.
Impact
Sequencing gallstones as principal diagnosis instead of pancreatitis.
Mitigation Strategy
Educate coding staff on proper sequencing rules.
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 Gallstone Pancreatitis, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Gallstone Pancreatitis
Use these documentation templates to ensure complete and accurate documentation for Gallstone Pancreatitis. These templates include all required elements for proper coding and billing.
Emergency Department Admission
Specialty: GastroenterologyRequired Elements
- History of present illness
- Imaging results
- Lab results
- Assessment and plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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