ICD Code K86.1

ICD code K86.1 is a classification used to identify "Other chronic pancreatitis," which refers to a long-standing inflammation of the pancreas that is not specified under other categories. This condition can lead to permanent damage to the pancreas, affecting its ability to function properly, and may result in symptoms such as abdominal pain, digestive issues, and diabetes. The code is used by healthcare providers to document and track this specific type of chronic pancreatitis for billing, treatment, and statistical purposes.

1. Recurrent Abdominal Pain: Persistent or recurring pain in the upper abdomen, often radiating to the back, which may be exacerbated by eating or drinking.

2. Pancreatic Insufficiency: Evidence of malabsorption and maldigestion due to insufficient production of pancreatic enzymes, often leading to symptoms such as steatorrhea (fatty stools) and weight loss.

3. Diabetes Mellitus: Onset of diabetes as a result of impaired insulin production due to chronic damage to the pancreatic tissue.

4. Imaging Findings: Radiological evidence from CT, MRI, or ultrasound showing changes in the pancreatic structure, such as calcifications, ductal irregularities, or atrophy.

5. History of Alcohol Use: A documented history of significant alcohol consumption, which is a common etiological factor in chronic pancreatitis.

6. Genetic Factors: Presence of genetic mutations known to predispose individuals to chronic pancreatitis, such as mutations in the PRSS1, SPINK1, or CFTR genes.

7. Autoimmune Indicators: Laboratory findings or clinical evidence suggestive of autoimmune pancreatitis, such as elevated serum IgG4 levels or other autoimmune markers.

8. Recurrent Episodes of Acute Pancreatitis: A history of multiple episodes of acute pancreatitis, which may have led to chronic changes in the pancreas over time.

9. Endoscopic Findings: Results from endoscopic procedures, such as ERCP, showing ductal changes consistent with chronic pancreatitis, including strictures or stones.

10. Exclusion of Other Causes: Ruling out other potential causes of the symptoms and imaging findings, such as pancreatic cancer or other gastrointestinal disorders.

For the ICD code K86.1 (Other chronic pancreatitis), the relevant CPT codes that may be applicable for treatment and management include:

1. CPT 43260 - Endoscopic retrograde cholangiopancreatography (ERCP); diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure).

2. CPT 43261 - ERCP with biopsy, single or multiple.

3. CPT 43262 - ERCP with sphincterotomy/papillotomy.

4. CPT 43263 - ERCP with removal of foreign body or stent.

5. CPT 43264 - ERCP with endoscopic retrograde removal of stone(s) from biliary/pancreatic duct(s).

6. CPT 43265 - ERCP with destruction of calculi, any method (e.g., mechanical, electrohydraulic, lithotripsy).

7. CPT 43266 - ERCP with dilation of biliary/pancreatic duct(s) strictures(s) with or without collection of specimen(s) by brushing or washing (includes pre- and post-dilation ductal lavage).

8. CPT 43267 - ERCP with insertion of tube or stent into bile or pancreatic duct.

9. CPT 43268 - ERCP with endoscopic retrograde insertion of nasobiliary or nasopancreatic drainage tube.

10. CPT 43269 - ERCP with endoscopic ultrasound (EUS) for diagnostic purposes.

11. CPT 48100 - Pancreatectomy, total.

12. CPT 48105 - Pancreatectomy, partial distal.

13. CPT 48120 - Pancreatectomy, distal, with or without splenectomy.

14. CPT 48140 - Pancreatectomy, proximal subtotal with splenectomy, including distal pancreatectomy, partial gastrectomy, choledochoenterostomy, pancreaticojejunostomy, or pancreaticogastrostomy, splenectomy, and gastrojejunostomy (Whipple-type procedure).

15. CPT 48145 - Pancreatectomy, radical, with total gastrectomy, including resection of portion of esophagus (e.g., for carcinoma); with pancreaticojejunostomy, pancreaticogastrostomy, or other anastomosis.

These CPT codes are examples of procedures that may be performed in the management of chronic pancreatitis, but the specific codes used will depend on the individual patient's condition and the treatment plan determined by the healthcare provider. Always consult the latest CPT code manual or a certified coding professional for the most accurate and up-to-date coding information.

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