Radiology Coding Alert

Make sure you distinguish cyst and pseudocyst.

You needn’t be perplexed by the ICD-10 options for pancreatitis. All you need to do is specifically look for documentation of the pathology. There are also options when the condition isn’t specifically documented by your physician. 

Check the Cause of Pancreatitis

When submitting codes for pancreatitis in ICD-9, you focused on chronicity of the condition. However, going further in ICD-10, your options will be guided by what was the underlying cause for the acute or chronic pancreatitis. “ICD-10 gives a lot more options for acute pancreatitis,” says Christy Hembree, CPC, Team Leader, Summit Radiology Services, Cartersville, GA. “You will need to know if the pancreatitis is idiopathic, biliary, alcohol induced, or drug induced. Choices are also given for other and unspecified.”

The ICD-9 code for acute pancreatitis is 577.0 (Acute pancreatitis). This code maps to seven codes in ICD-10. For viral (cytomegalovirus), biliary, alcohol-induced, and drug-induced acute pancreatitis, you report specific codes, i.e. B25.2 (Cytomegaloviral pancreatitis), K85.1 (Biliary acute pancreatitis), K85.2 (Alcohol induced acute pancreatitis), and K85.3 (Drug induced acute pancreatitis), respectively. For other causes of acute pancreatitis, you submit code K85.8 (Other acute pancreatitis). 

Your physician may not always specify the cause of acute pancreatitis. In this case, you report code K85.9 (Acute pancreatitis, unspecified). There will be instances when your physician will not be able to determine a specific cause for acute pancreatitis. In such idiopathic cases, you report code K85.0 (Idiopathic acute pancreatitis).

You will see a similar change in the coding for chronic pancreatitis. “In ICD-10 you need to know the cause of the chronic pancreatitis,” says Hembree. The single ICD-9 code 577.1 (Chronic pancreatitis) maps to two codes in ICD-10, i.e. K86.0 (Alcohol-induced chronic pancreatitis) and K86.1 (Other chronic pancreatitis). Thus, ICD-10 offers you a specific discrete code for chronic pancreatitis caused by alcohol. “If documentation supports chronic alcohol-induced pancreatitis, you are also instructed to use an additional code to identify alcohol abuse, F10.1x (Alcohol abuse) range, and dependence, F10.2x (Alcohol dependence) range,” Hembree says.

Differentiate Cyst and Pseudocyst

ICD-9 offers a common code for pancreatic cysts and pseudocysts. This single ICD-9 code is 577.2 (Cyst and pseudocyst of pancreas). ICD-10 however differentiates cysts and pseudocysts. The ICD-9 code 577.2 maps to the following two codes: 

• K86.2, Cyst of pancreas
• K86.3, Pseudocyst of pancreas

How is a pseudocyst different from a cyst? A typical cystic lesion is a fluid filled lesion that has a clear lining of cells. Pseudocysts, though similar in appearance to cysts on radiological evaluation, lack a clear cellular lining. Pseudocysts are collections of fluid surrounded by fibrous tissue. “A pseudocyst isn’t a true cyst, because the wall of the sac is not composed of a specific lining of cells characteristic of a true cyst,” Hembree says. “Pancreatic pseudocyst is a collection of pancreatic enzymes, necrotic pancreatic tissues, inflamed cells and blood that is enclosed within a fibrous capsule.”

Consider Some More Options

Besides cysts and pancreatitis, you may happen to report other conditions of pancreas, for example, pancreatic fistula, pancreatic exocrine deficiency, and others. In these cases, you submit ICD-9 code 577.8 (Other specified diseases of pancreas). This code maps 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.

You may come across clinical note where your physician 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).