ICD-10 K86.0
Billable / Specific HCC v28: 34 CCAlcohol-induced chronic pancreatitis
About ICD-10-CM K86.0
ICD-10-CM code K86.0 represents Alcohol-induced chronic pancreatitis. This is a billable/specific code in the Digestive System chapter (block K86). The 2026 edition of ICD-10-CM K86.0 became effective on October 1, 2025.
Coding Tips for K86.0
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
K86.0 is a CMS-HCC v28 risk-adjustment code (category 34). To count for the patient Risk Adjustment Factor (RAF), document the diagnosis with MEAT language each calendar year: Monitored, Evaluated, Assessed, Treated. A diagnosis on the problem list alone does not satisfy CMS RADV audit standards. Include the diagnosis in the assessment with current status and current treatment plan.
K86.0 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.
Type 2 Excludes
Not included here, the excluded code is not part of K86.0, but a patient may have both conditions at the same time. Both codes may be coded together when applicable.
- alcohol induced acute pancreatitis (K85.2-)
Use Additional Code
When coding K86.0, also report these additional codes when applicable.
- code to identify:
- alcohol abuse and dependence (F10.-)
Coding Notes
Code Also
- exocrine pancreatic insufficiency (K86.81)
Medicare Advantage HCC Impact
Capture this diagnosis annually for accurate risk adjustment. Missed HCC captures are the #1 revenue leak in Medicare Advantage risk programs.
Inpatient DRG Impact, CC
codes Alcohol-induced chronic pancreatitis. As a Complication/Comorbidity (CC), this contributes to DRG severity adjustment when documented alongside the principal diagnosis.
Medicare LCD Coverage for K86.0
Local Coverage Determinations (LCDs) from CMS MACs that list K86.0 as a covered diagnosis.
Showing top 10 of 222 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing K86.0.
1 Cigna
5 Medicare
2 Aetna
Convert K86.0 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 |
|---|---|---|
| K86.0 | 5771 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To K86.0
Other codes in section K80-K87 (Disorders of gallbladder, biliary tract and pancreas).
ICD-10 K86.0, Billing FAQ
Is ICD-10 code K86.0 billable? +
Yes, K86.0 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
What codes are Type 2 Excludes for K86.0? +
Type 2 Excludes (may be coded together when both conditions exist): alcohol induced acute pancreatitis (K85.2-)
Does K86.0 affect Medicare Advantage HCC risk adjustment? +
Yes. K86.0 maps to CMS-HCC v28 category 34. Capture this diagnosis annually for accurate Medicare Advantage risk score.
Is K86.0 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 K86.0? +
Procedures frequently paired with K86.0 include: J3420, J3425.
What ICD-9 codes does K86.0 map to? +
Per CMS GEMs, K86.0 maps to ICD-9 codes: 5771. 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 July 16, 2026.
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