2025 ICD-10-CM code K85.9
(Active) Effective Date: N/A Revision Date: N/A Diseases of the digestive system - Acute pancreatitis Diseases of the digestive system Feed
Acute pancreatitis, unspecified; this code represents acute inflammation of the pancreas without further specification of the cause or characteristics.
Modifiers may be applicable depending on the circumstances of the encounter and services provided.Consult the relevant coding guidelines and payer-specific rules.
Medical necessity for evaluation and treatment of acute pancreatitis (K85.9) is established by the presence of clinical findings suggestive of the condition.This is typically supported by elevated serum amylase and lipase levels and confirmed through imaging techniques.The severity of symptoms, potential complications, and the need for hospital admission, pain management, or surgical intervention dictate the level of medical necessity.
The clinical responsibility for a patient with K85.9 involves a thorough evaluation to establish the diagnosis of acute pancreatitis through clinical examination, laboratory tests (amylase, lipase levels), and imaging studies (abdominal CT scan or ultrasound). Treatment is focused on managing pain, preventing complications, and investigating and treating any underlying cause if identified.This may involve admission to the hospital, intravenous fluids, pain management, and potentially surgical intervention.
In simple words: This code means the patient has sudden inflammation of their pancreas, but doctors don't yet know the exact reason why.
K85.9, Acute pancreatitis, unspecified, is an ICD-10-CM code that classifies acute inflammation of the pancreas without specifying the underlying cause or any associated complications like necrosis or infection.It encompasses cases where the etiology of the pancreatitis remains undetermined after a thorough clinical evaluation.This code is used when more specific codes (K85.0-K85.8) are not applicable. The diagnosis requires clinical findings suggestive of acute pancreatitis, such as abdominal pain, elevated serum amylase and/or lipase levels, and characteristic imaging findings.
Example 1: A 55-year-old male presents to the emergency department with severe epigastric pain radiating to the back, nausea, and vomiting.Laboratory tests reveal markedly elevated serum amylase and lipase levels.An abdominal CT scan shows features consistent with acute pancreatitis.No specific etiology is identified despite a thorough investigation.K85.9 is coded., A 32-year-old female is admitted to the hospital with acute abdominal pain, fever, and leukocytosis. Imaging studies reveal an inflamed pancreas, consistent with acute pancreatitis, and a small gallstone. However, the physician cannot conclusively determine if the gallstone is the direct cause of the pancreatitis, so K85.9 is used., A 70-year-old male with a history of alcohol abuse is hospitalized for acute pancreatitis.Although alcohol is suspected as a contributing factor, the investigation does not confirm a direct causal link between alcohol consumption and the pancreatitis. Hence, K85.9 is used instead of the more specific alcohol-induced acute pancreatitis (K85.2) code.
Documentation should include the patient's history (including risk factors), physical examination findings (abdominal tenderness, guarding), laboratory results (amylase, lipase, complete blood count, electrolyte panel), and imaging studies (abdominal CT scan or ultrasound). The clinical rationale for selecting K85.9 should be clearly documented if more specific codes are not used. Diagnostic certainty indicators (A, G, V, Z) might be added in some settings.
** K85.9 is a non-billable/non-specific code.More specific codes should be used whenever possible for accurate billing. Always refer to the latest official ICD-10-CM coding guidelines for the most up-to-date information and any revisions to the code or its usage.
- Payment Status: Active
- Specialties:Gastroenterology, Surgery
- Place of Service:Inpatient Hospital, Emergency Room - Hospital, Office