2025 ICD-10-CM code K85.3
(Active) Effective Date: N/A Revision Date: N/A Diseases of the digestive system - Acute pancreatitis Diseases of the digestive system Feed
Drug-induced acute pancreatitis.Use additional codes for adverse effects and drug identification.
Modifiers may be used to indicate the type of service provided (e.g., professional component, technical component), or for other specific circumstances, as appropriate for the circumstances. Refer to the most current CPT and HCPCS guidelines.
Medical necessity is established by the presence of acute pancreatitis confirmed by laboratory findings (elevated amylase and lipase) and clinical symptoms (severe abdominal pain, nausea, vomiting).The causal relationship between the medication and the pancreatitis must be documented.
Diagnosis and management of acute pancreatitis, including pain management, fluid resuscitation, and supportive care.If surgical intervention is needed, the surgeon will also be involved.Further investigation into the drug causing the pancreatitis may be necessary.The physician may need to adjust or discontinue medications.
In simple words: This code means the patient has a severe inflammation of the pancreas caused by medication.The doctor will also use other codes to specify the exact medicine that caused the problem and whether the patient misused or was dependent on the drug.
Drug-induced acute pancreatitis is an acute inflammatory process causing pancreatic parenchyma necrosis.It's characterized by severe abdominal pain, nausea, vomiting, diarrhea, fever, and potentially shock. This specific code, K85.3, indicates that the pancreatitis is caused by medication. Additional codes from categories T36-T50 (with 5th or 6th character 5) should be used to specify the drug causing the adverse effect.Further, codes F11.-F17.- should be used if drug abuse or dependence is involved.
Example 1: A 60-year-old female patient presents with severe abdominal pain, nausea, and vomiting after starting a new medication for high cholesterol. Labs reveal elevated lipase and amylase levels, confirming acute pancreatitis.Code K85.3 is used, along with the appropriate code for the medication (T36-T50, 5th/6th character 5)., A 45-year-old male with a history of alcohol abuse and pancreatitis is admitted for acute pancreatitis.He is currently taking opioid medication for pain management.K85.3 is used to indicate drug-induced pancreatitis, along with appropriate codes for opioid use (F11.-F17.-)., A 72-year-old female with a history of diabetes is hospitalized for severe abdominal pain and is diagnosed with acute pancreatitis.She is taking multiple medications, and further investigation reveals that a recent change in her diuretic medication triggered the pancreatitis.K85.3 is used along with the appropriate medication code (T36-T50, 5th/6th character 5).
Detailed history and physical examination, including medication list, onset and duration of symptoms.Laboratory results (amylase, lipase, blood count, electrolytes), imaging studies (CT scan, MRI), and potentially endoscopic procedures.Documentation to support medical necessity, such as severity of symptoms, treatment plan, and response to therapy.
** This code should only be used when a clear causal relationship exists between the medication and the pancreatitis.It is crucial to thoroughly document the case to support medical necessity and accurate billing.
- Payment Status: Active
- Modifier TC rule: The application of a technical component modifier (TC) depends on the services performed and must be determined based on current CPT and HCPCS guidelines.Consult payer-specific guidelines.
- Specialties:Gastroenterology, Internal Medicine, Surgery
- Place of Service:Inpatient Hospital, Emergency Room - Hospital, Outpatient Hospital