Learn about acalculous cholecystitis, also known as gallbladder inflammation without stones. This page covers diagnosis, clinical documentation, and medical coding for non-calculous cholecystitis, a serious condition requiring prompt medical attention. Find information relevant to healthcare professionals, including ICD-10 codes and best practices for accurate documentation.
Also known as
Acalculous cholecystitis
Inflammation of the gallbladder without gallstones.
Disorders of gallbladder, biliary tract
Includes various gallbladder and bile duct diseases.
Other specified diseases of gallbladder
Covers other specified gallbladder conditions.
Follow this step-by-step guide to choose the correct ICD-10 code.
Is the cholecystitis acalculous (without gallstones)?
Yes
Is it acute acalculous cholecystitis?
No
Code to the appropriate cholecystitis with gallstones (e.g., K80.00, K80.10, etc.)
When to use each related code
| Description |
|---|
| Gallbladder inflammation without stones |
| Gallbladder inflammation with stones |
| Gallbladder dysfunction without inflammation |
Coding K87.0 (acute) or K87.1 (chronic) without documented acalculous etiology risks inaccurate reimbursement.
Failing to document critical care services for severe acalculous cholecystitis can lead to lost revenue.
Discrepancies between physician notes and imaging reports regarding stone presence can create coding and billing errors.
Q: How can I differentiate acalculous cholecystitis from calculous cholecystitis in critically ill patients with vague abdominal pain?
A: Differentiating acalculous cholecystitis (gallbladder inflammation without stones) from calculous cholecystitis in critically ill patients can be challenging due to overlapping symptoms and the patients' often precarious state. While both present with right upper quadrant pain, fever, and leukocytosis, the absence of gallstones on imaging in acalculous cholecystitis is key. However, relying solely on imaging can be misleading. Consider incorporating bedside ultrasound to rapidly assess gallbladder wall thickening, pericholecystic fluid, and a positive sonographic Murphy's sign, especially in patients unable to undergo immediate CT or MRI. Furthermore, evaluating risk factors like recent surgery, trauma, prolonged fasting, total parenteral nutrition (TPN), or sepsis can increase suspicion for acalculous cholecystitis. Labs may show elevated alkaline phosphatase and bilirubin, although these aren't specific. Given the higher morbidity and mortality associated with acalculous cholecystitis in critically ill patients, early diagnosis and intervention are crucial. Explore how serial imaging and clinical assessments can improve diagnostic accuracy and guide appropriate management strategies like percutaneous cholecystostomy or, if feasible, cholecystectomy.
Q: What are the best imaging modalities for diagnosing acalculous cholecystitis, and how should I interpret the findings in a patient with suspected gallbladder inflammation without stones?
A: Ultrasound, CT, and hepatobiliary iminodiacetic acid (HIDA) scans are the primary imaging modalities for diagnosing acalculous cholecystitis (gallbladder inflammation without stones). Ultrasound can demonstrate gallbladder wall thickening (>4mm), pericholecystic fluid, and a positive sonographic Murphy's sign, suggestive of inflammation. However, its sensitivity can be limited in critically ill patients. CT scans can reveal gallbladder wall edema, distension, and pericholecystic fluid or abscesses, offering a more comprehensive view of the surrounding structures. HIDA scans are particularly useful when ultrasound and CT findings are equivocal. Non-visualization of the gallbladder on HIDA scan, suggesting cystic duct obstruction, is highly suggestive of acalculous cholecystitis. Interpreting these findings requires careful correlation with the patient's clinical picture, including risk factors like recent surgery, trauma, or sepsis. Consider implementing a multi-modal imaging approach for a more accurate diagnosis and to rule out other differential diagnoses like acute hepatitis or pancreatitis. Learn more about the sensitivity and specificity of different imaging modalities in the context of acalculous cholecystitis.
Patient presents with signs and symptoms suggestive of acalculous cholecystitis, a diagnosis of gallbladder inflammation without gallstones. The patient reports right upper quadrant pain, which may be described as sharp, cramping, or dull and aching. Fever, nausea, vomiting, and anorexia are also noted. Physical examination reveals tenderness in the right upper quadrant, and Murphy's sign may be positive. Laboratory findings may indicate elevated white blood cell count, C-reactive protein, and liver function tests. Imaging studies, such as abdominal ultrasound or CT scan of the abdomen and pelvis, are essential for diagnosis and may reveal gallbladder wall thickening, pericholecystic fluid, or distension. Differential diagnoses include biliary colic, acute pancreatitis, and peptic ulcer disease. Given the clinical presentation and absence of gallstones on imaging, the diagnosis of acalculous cholecystitis is suspected. Treatment for acalculous cholecystitis typically involves supportive care, including intravenous fluids, pain management, and antibiotics. Cholecystectomy, either laparoscopic or open, may be necessary if the patient's condition does not improve with conservative management or if complications arise. The patient's clinical status will be closely monitored for signs of improvement or potential complications such as gallbladder perforation or gangrene.