Coding Acute Pancreatitis and Chronic Pancreatitis (Fall Coding Seminar - Jeopardy Game Clarification)

During the Coding Jeopardy Game at OHIMA’s recent Fall Coding Seminar (September 14, 2018), there was much discussion after an answer was revealed.  The question was: "ICD-10-CM code assignment for acute and chronic pancreatitis."  The correct answers were:

K85.90 for the acute pancreatitis
K86.1 for the chronic pancreatitis
K86.81 for exocrine pancreatic insufficiency

Here is the rationale for the codes...

Official Coding Guideline I.B.8 states:

Acute and Chronic Conditions - If the same condition is described as both acute (subacute) and chronic, and separate subentries exist in the Alphabetic Index at the same indentation level, code both and sequence the acute (subacute) code first.

Therefore, both K85.90 and K86.1 are correct and sequenced appropriately.

Now comes the part that raised discussion.  Under K86.1, there is a “Code also” note stating to assign K86.81 for the exocrine pancreatic insufficiency.  This note is also found under K90.0 for celiac disease, K86.0 for alcohol-induced chronic pancreatitis, the C25 category for cancer of the pancreas, and the category E84 for cystic fibrosis.  This “Code also” note does not indicate the phrase “if applicable” as other “Code also” notes do.  See the difference in the type of “Code also” note by comparing with the one at K74 for fibrosis and cirrhosis of the liver which states “Code also, if applicable, viral hepatitis”.  In the case of K86.81, coders are being directed to add the K86.81 for the conditions listed above. 

4th Qtr. 2016 Coding Clinic weighed in on exocrine pancreatic insufficiency (EPI) by stating that chronic pancreatitis is the most common cause of EPI, and listing several other etiologies including cystic fibrosis, pancreatic duct obstructions, and pancreatic cancer.  That would be consistent with the “Code also” note coders see under those conditions indicating the need to assign the code.

Hopefully, this fully clarifies the rationale behind the code assignments listed as correct in the game.

 

About the Author 

Dianna Foley, RHIA, CHPS, CCS  is OHIMA's Coding Education Coordinator. Dianna has been an HIM professional for 20 years. She progressed through the ranks of coder, department supervisor, and department director, to her current role as a coding consultant. 

She recently served as the program director for Medical Coding and HIT at Eastern Gateway Community College. Dianna earned her bachelor's degree from the University of Cincinnati subsequently achieving her RHIA, CHPS, and CCS certifications. She is an AHIMA Approved ICD-10-CM/PCS Trainer and a a presenter at regional HIM meetings and the OHIMA Annual Meeting.