ICD-10 Coding for Pancreatic Lesion(K86.2, C25.9, D13.6)
Complete ICD-10-CM coding and documentation guide for Pancreatic Lesion. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Pancreatic Lesion
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| K86.2 | Cyst of pancreas | For non-neoplastic pancreatic cysts confirmed by imaging. |
|
| C25.9 | Malignant neoplasm of pancreas, unspecified | For confirmed malignant neoplasms when specific type is not identified. |
|
| D13.6 | Benign neoplasm of pancreas | For benign pancreatic lesions confirmed by imaging and histology. |
|
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 pancreatic cyst
Essential facts and insights about Pancreatic Lesion
Primary ICD-10-CM Codes for pancreatic lesion
Decision Criteria
clinical Criteria
- Presence of a fluid-filled sac without solid components.
Applicable To
- Pancreatic pseudocyst
Excludes
- Cystic fibrosis (E84.-)
Clinical Validation Requirements
- Imaging showing unilocular cyst <3 cm
- No septations or mural nodules
Code-Specific Risks
- Confusion with neoplastic cysts if not properly documented.
Coding Notes
- Ensure imaging reports are detailed to differentiate from neoplastic lesions.
C25.9 - Malignant neoplasm of pancreas, unspecified
For confirmed malignant neoplasms when specific type is not identified.
Excludes
- Benign neoplasm of pancreas (D13.6)
Clinical Validation Requirements
- CA19-9 >37 U/mL
- Ill-defined mass on CT
Coding Notes
Histological confirmation is crucial for accurate coding.
D13.6 - Benign neoplasm of pancreas
For benign pancreatic lesions confirmed by imaging and histology.
Applicable To
- Benign pancreatic tumor
Excludes
- Malignant neoplasm of pancreas (C25.-)
Clinical Validation Requirements
- MRI showing well-demarcated lesion
- Normal tumor markers
Coding Notes
Ensure histological reports confirm benign nature.
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 Pancreatic Lesion to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code K86.2.
Impact
Clinical: Misrepresentation of the patient's condition., Regulatory: Non-compliance with coding guidelines., Financial: Potential for claim denials.
Mitigation Strategy
Verify lesion type with imaging and histology., Use specific codes for benign lesions.
Impact
Reimbursement: Incorrect coding can lead to denied claims., Compliance: Non-compliance with coding standards., Data Quality: Impacts accuracy of clinical data.
Mitigation Strategy
Ensure detailed imaging and histological reports are included.
Impact
Lack of histological confirmation for malignant codes.
Mitigation Strategy
Ensure biopsy results are documented before coding.
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 Pancreatic Lesion, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Pancreatic Lesion
Use these documentation templates to ensure complete and accurate documentation for Pancreatic Lesion. These templates include all required elements for proper coding and billing.
Pancreatic cyst evaluation
Specialty: GastroenterologyRequired Elements
- Imaging findings
- Cyst characteristics
- Laboratory results
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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