ICD-10 K11.3
Billable / Specific CCAbscess of salivary gland
About ICD-10-CM K11.3
ICD-10-CM code K11.3 represents Abscess of salivary gland. This is a billable/specific code in the Digestive System chapter (block K11). The 2026 edition of ICD-10-CM K11.3 became effective on October 1, 2025.
Coding Tips for K11.3
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
K11.3 is designated CC for MS-DRG grouping. On inpatient claims, this code can shift the DRG to the with-CC variant when documented as a present-on-admission secondary diagnosis. Hospital CDI programs flag CC opportunities during chart review. Failure to capture this code may leave 30 to 80 percent of the inpatient stay revenue unrealized.
Inpatient DRG Impact, CC
codes Abscess of salivary gland. As a Complication/Comorbidity (CC), this contributes to DRG severity adjustment when documented alongside the principal diagnosis.
Medicare LCD Coverage for K11.3
Local Coverage Determinations (LCDs) from CMS MACs that list K11.3 as a covered diagnosis.
Showing top 10 of 35 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing K11.3.
2 Medicare
CPT Codes Commonly Billed with K11.3
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- 10081 CMS LCD: Billing and Coding: Incision and Drainage (I&D) of Abscess of Skin, Subcutaneous and Accessory Structures CMS LCD
- 10180 CMS LCD: Billing and Coding: Incision and Drainage (I&D) of Abscess of Skin, Subcutaneous and Accessory Structures CMS LCD
- 10080 CMS LCD: Billing and Coding: Incision and Drainage (I&D) of Abscess of Skin, Subcutaneous and Accessory Structures CMS LCD
- 10160 CMS LCD: Billing and Coding: Incision and Drainage (I&D) of Abscess of Skin, Subcutaneous and Accessory Structures CMS LCD
Convert K11.3 to ICD-9-CM
Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.
| ICD-10 | ICD-9 | Mapping Flags |
|---|---|---|
| K11.3 | 5273 | 00000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To K11.3
Other codes in section K00-K14 (Diseases of oral cavity and salivary glands).
ICD-10 K11.3, Billing FAQ
Is ICD-10 code K11.3 billable? +
Yes, K11.3 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
Is K11.3 a CC or MCC for inpatient DRG? +
Yes, this code is designated as CC. Documenting as a secondary diagnosis on inpatient claims can shift the DRG to a higher-weighted category.
What CPT codes are commonly billed with K11.3? +
Procedures frequently paired with K11.3 include: 10081, 10180, 10080, 10160.
What ICD-9 codes does K11.3 map to? +
Per CMS GEMs, K11.3 maps to ICD-9 codes: 5273. Useful for legacy data review and historical claim analysis.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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