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2025 ICD-10-CM code K85.1

Biliary acute pancreatitis, also known as gallstone pancreatitis.

Follow current ICD-10-CM coding guidelines.Use additional codes to specify any associated complications or comorbidities.

Medical necessity for K85.1 is established by the presence of clinical symptoms and diagnostic imaging findings consistent with acute pancreatitis secondary to gallstones.Treatment may involve conservative management or surgical/endoscopic intervention depending on the severity of the condition.

Diagnosis and management of acute pancreatitis, including pain management, fluid resuscitation, and treatment of complications such as infection or organ failure.May involve surgical intervention for gallstone removal (cholecystectomy) or other procedures to relieve the biliary obstruction.

IMPORTANT:May be used in conjunction with codes indicating the presence of gallstones or other biliary tract disorders.

In simple words: This code means the pancreas is inflamed because of gallstones blocking the bile duct.Gallstones are small, hard deposits that form in the gallbladder.This blockage causes the pancreas to swell and become painful.

K85.1, Biliary acute pancreatitis, is an ICD-10-CM code that signifies acute inflammation of the pancreas caused by gallstones obstructing the bile duct. This obstruction leads to a backup of pancreatic enzymes, resulting in autodigestion of the pancreatic tissue.The condition is characterized by sudden onset of severe abdominal pain, often radiating to the back, accompanied by nausea, vomiting, and fever.Diagnosis often involves imaging studies such as ultrasound, CT scan, or MRI to visualize the gallstones and pancreatic inflammation.

Example 1: A 55-year-old female presents to the emergency department with severe epigastric pain radiating to the back, nausea, vomiting, and fever.An abdominal ultrasound reveals gallstones and evidence of acute pancreatitis.The patient is diagnosed with K85.1 and admitted for intravenous fluids, pain management, and subsequent cholecystectomy., A 60-year-old male with a history of gallstones is admitted to the hospital with symptoms consistent with acute pancreatitis.CT scan confirms the diagnosis of K85.1.He undergoes endoscopic retrograde cholangiopancreatography (ERCP) to remove the gallstones and relieve the biliary obstruction., A 70-year-old female is found to have elevated pancreatic enzymes during a routine check-up.Further imaging reveals gallstones and mild inflammation of the pancreas, consistent with K85.1. She is managed conservatively with pain medication and close monitoring.

Detailed history of present illness, including onset, character, location, and radiation of pain; physical examination findings; relevant laboratory data (amylase, lipase); imaging studies (ultrasound, CT, MRI); and any surgical or endoscopic procedures performed.

** K85.1 should be used to code biliary acute pancreatitis only when gallstones are the confirmed cause. If the etiology of acute pancreatitis is not gallstones, use other K85 codes as appropriate.Always code to the highest level of specificity.

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