ICD-10-CM 2019: Know the Documentation You’ll Need for New Gallbladder and Cholangitis Codes

If you code cholecystitis or cholangitis, you’ll want to know these new codes when ICD-10-CM 2019 kicks in on Oct. 1, 2018. Check out the helpful hints below to be sure you know how to apply the codes from the get-go.

Watch ‘Code First’ Note With New Cholecystitis Codes

ICD-10-CM 2019 adds new subcategory K82.A- (Disorders of gallbladder in diseases classified elsewhere).

There are two complete, reportable codes in the subcategory:

  • K82.A1 (Gangrene of gallbladder in cholecystitis)
  • K82.A2 (Perforation of gallbladder in cholecystitis).


Code first: For the codes that begin with K82.A-, be sure to apply the instruction to “code first the type of cholecystitis (K81.-), or cholelithiasis with cholecystitis (K80.00-K80.19, K80.40-K80.47, K80.60-K80.67).

Caution: One code you won’t be reporting with K82.A2 is K82.2 (Perforation of gallbladder). There is an Excludes1 note with K82.2 telling you not to report it at the same time as “perforation of gallbladder in cholecystitis (K82.A2).”

Documentation tips: Providers will need to document gangrene or perforation of the gallbladder to allow you to report these new codes correctly, but you’ll also need to know the type of cholecystitis or cholelithiasis so you can code that first. Based on the case, documentation may refer to calculus location, obstruction, and acute/chronic designation.

Answer This: Is the Cholangitis Primary AND Sclerosing?

In the 2018 ICD-10-CM code set, K83.0 (Cholangitis) is a complete, reportable code.

In the 2019 ICD-10-CM code set, K83.0- becomes a subcategory with two new reportable codes under it. The main benefit is being able to report primary sclerosing cholangitis with its own code, potentially supporting medical necessity for imaging and other services for this complex liver condition:

  • K83.01 (Primary sclerosing cholangitis)
  • K83.09 (Other cholangitis).

What’s ‘other’? In 2018, K83.0 has a long list of possible conditions listed under it. In 2019, they move to be under “other” code K83.09:

  • Ascending cholangitis
  • Cholangitis NOS
  • Primary cholangitis
  • Recurrent cholangitis
  • Sclerosing cholangitis
  • Secondary cholangitis
  • Stenosing cholangitis
  • Suppurative cholangitis.

Documentation tips: You may have noticed that the notes for K83.09 (other) include primary cholangitis and sclerosing cholangitis. Changes to the index support this, pointing to K83.09 for primary cholangitis and sclerosing cholangitis. You’ll use K83.01 when documentation shows “primary sclerosing,” not just one or the other.

Update Excludes notes: The 2018 code set had an Excludes1 note with K83.0 for “chronic nonsuppurative destructive cholangitis (K74.3).” The 2019 code set changes that to an Excludes2 note and adds some other possible conditions you may see documented that are coded to K74.3 (Primary biliary cirrhosis). The full note is below:

  • Excludes2:
    • chronic nonsuppurative destructive cholangitis (K74.3)
    • primary biliary cholangitis (K74.3)
    • primary biliary cirrhosis (K74.3).

What About You?

Does the documentation you code from provide this level of specificity for cholecystitis and cholangitis?

About 

Deborah works on a wide range of TCI SuperCoder projects, researching and writing about coding, as well as assisting with data updates and tool development for our online coding solutions. Since joining TCI in 2004, she’s covered the ins and outs of coding for radiology, cardiology, oncology and hematology, orthopedics, audiology, and more.

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