Inpatient Facility Coding & Compliance Alert

Shift focus from chronicity to pathology identification.

 ICD-10 offers a variety of codes to choose from when reporting pancreatitis and its related conditions. You need not get overwhelmed by the number if you specifically follow the documentation of the pathology, or underlying cause.

Acute Pancreatitis: Seven Codes for Seven Causes

The ICD-9 code 577.0 (Acute pancreatitis) maps to seven codes in ICD-10. Depending on the cause, you’ll report specific codes such as B25.2 (Cytomegaloviral pancreatitis), K85.1 (Biliary acute pancreatitis), K85.2 (Alcohol induced acute pancreatitis), or K85.3 (Drug induced acute pancreatitis), respectively.

For other causes of acute pancreatitis, you’ll submit code K85.8 (Other acute pancreatitis). 

If the provider does not specify the cause of acute pancreatitis, the way out is to report code K85.9 (Acute pancreatitis, unspecified).However, if the provider is not able to determine a specific cause for acute pancreatitis report code K85.0 (Idiopathic acute pancreatitis).

So, how would the coder know that the MD didn’t determine the cause, versus not having a cause specified in the documentation? How do you know to submit K85.0 instead of K85.9?  What will happen is that coding staff will be making numerous queries to the physicians for additional detail.  Over time, the physicians will ‘learn’ when and how to provide more specific details.

Chronic Pancreatitis: Look for Alcohol Abuse

The single ICD-9 code 577.1 (Chronic pancreatitis) maps to two codes in ICD-10: K86.0 (Alcohol-induced chronic pancreatitis) and K86.1 (Other chronic pancreatitis). Thus, ICD-10 offers you a specific code for chronic pancreatitis caused by alcohol. 

Differentiate Cyst and Pseudocyst

ICD-9 offers a common code for pancreatic cysts and pseudocysts that is 577.2 (Cyst and pseudocyst of pancreas). ICD-10 has separate codes for cysts and pseudocysts, K86.2 (Cyst of pancreas) and K86.3 (Pseudocyst of pancreas).

Pancreatic cysts are accumulation of fluid within a cavity specially lined by cells. The pseudocysts look similar on radiological investigation, but they lack a clear cellular lining. They are surrounded by a fibrous tissue instead, and may contain digestive juices secreted by the pancreas.

Watch for Even More Options

On occasion, you may come across cases with other conditions of the pancreas like pancreatic fistula, pancreatic exocrine deficiency, and others. In these cases you have been resorting to the ICD-9 code 577.8 (Other specified diseases of pancreas). This ICD-9 code will map to the following three codes in ICD-10:

• K86.1, Other chronic pancreatitis
• K86.8, Other specified diseases of pancreas
• K87, Disorders of gallbladder, biliary tract and pancreas in diseases classified elsewhere.

Final choice: There may be times when your provider does not specify what disorder was diagnosed in the pancreas. ICD-9 offers code 577.9 (Unspecified disease of pancreas) for such conditions. The corresponding ICD-10 option is K86.9 (Disease of pancreas, unspecified).