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2025 ICD-10-CM code K86.1

Other chronic pancreatitis.This includes chronic pancreatitis NOS, infectious, recurrent, and relapsing.

Code K86.1 should not be used with codes for conditions explicitly excluded in the ICD-10-CM guidelines, such as cystic fibrosis (E84.-) or pancreatic steatorrhea (K90.3), unless both conditions are present.If exocrine pancreatic insufficiency is present, it can be coded with K86.81 in addition to K86.1.

Medical necessity for treatment related to K86.1 is established by the presence of signs, symptoms, and objective findings consistent with chronic pancreatitis. This may include documentation of pain, malabsorption, or other complications requiring intervention. Treatment may involve pain management, pancreatic enzyme replacement, and management of related complications like diabetes or pseudocysts.

Clinicians responsible for diagnosing and managing K86.1 include gastroenterologists, internists, and potentially infectious disease specialists depending on the underlying cause.Management often involves pain control, enzyme replacement for exocrine insufficiency, and addressing any underlying infections or other contributing factors.

In simple words: This code refers to a long-term inflammation of the pancreas that is not caused by alcohol or other known factors.It can be due to various reasons, including infections or recurring episodes of inflammation.

Other chronic pancreatitis. This includes chronic pancreatitis that is not otherwise specified (NOS), infectious chronic pancreatitis, recurrent chronic pancreatitis, and relapsing chronic pancreatitis.This code also encompasses exocrine pancreatic insufficiency (K86.81).

Example 1: A patient presents with recurrent episodes of severe abdominal pain, elevated pancreatic enzymes, and imaging findings consistent with chronic pancreatitis. No history of alcohol abuse or other clear etiology is identified, leading to a diagnosis of other chronic pancreatitis (K86.1)., A patient with cystic fibrosis develops chronic pancreatitis due to thickened pancreatic secretions blocking the ducts. This is coded as K86.1, as cystic fibrosis itself is coded separately (E84.-)., A patient develops chronic pancreatitis following a severe viral infection affecting the pancreas. This is considered infectious chronic pancreatitis and coded as K86.1.

Documentation should include clinical findings (abdominal pain, steatorrhea, weight loss), laboratory results (elevated pancreatic enzymes, abnormal fecal fat), imaging studies (CT, MRI, MRCP) showing pancreatic changes, and exclusion of other causes of chronic pancreatitis (alcohol, gallstones, medications).If an infectious etiology is suspected, documentation of the infection and its relationship to the pancreatitis is crucial.

** For accurate coding and reimbursement, always refer to the current ICD-10-CM coding guidelines and any payer-specific requirements.

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