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K80.20
ICD-10-CM
Symptomatic Cholelithiasis

Find information on symptomatic cholelithiasis diagnosis, including clinical documentation, medical coding, ICD-10 codes (K80), biliary colic, gallstones, cholecystitis, and ultrasound findings. Learn about healthcare best practices for documenting and coding symptomatic gallbladder disease for accurate reimbursement and patient care. This resource provides guidance for physicians, clinicians, and medical coders on properly documenting and coding symptomatic cholelithiasis.

Also known as

Gallstones with symptoms
Biliary colic

Diagnosis Snapshot

Key Facts
  • Definition : Gallstones causing symptoms like biliary colic (pain in the upper right abdomen).
  • Clinical Signs : Abdominal pain, nausea, vomiting, fever, jaundice, pain after fatty meals.
  • Common Settings : Outpatient clinic, emergency room, surgery center, gastroenterology office.

Related ICD-10 Code Ranges

Complete code families applicable to AAPC K80.20 Coding
K80-K87

Diseases of the biliary tract

Covers gallbladder, bile duct, and other biliary conditions.

R10-R19

Symptoms and signs involving the abdomen and pelvis

Includes abdominal pain, nausea, and other related symptoms.

K70-K77

Diseases of liver

Liver conditions that may be associated with biliary issues.

Code-Specific Guidance

Decision Tree for

Follow this step-by-step guide to choose the correct ICD-10 code.

With cholecystitis?

Code Comparison

Related Codes Comparison

When to use each related code

Description
Gallstones with symptoms
Asymptomatic gallstones
Biliary colic

Documentation Best Practices

Documentation Checklist
  • Document patient's reported symptoms (e.g., biliary colic, nausea, vomiting)
  • Physical exam findings supporting cholelithiasis diagnosis
  • Imaging confirmation of gallstones (e.g., ultrasound, CT)
  • Correlation of symptoms with gallstone presence
  • Specify symptomatic nature to distinguish from asymptomatic cholelithiasis

Coding and Audit Risks

Common Risks
  • Unspecified Cholelithiasis

    Coding K80.0 (Cholelithiasis without cholecystitis) when documentation supports symptomatic cholelithiasis (K80.2) leads to undercoding and lost revenue.

  • Missed Complicating Diagnoses

    Failing to capture complicating diagnoses like acute cholecystitis (K81.0) or biliary colic (K80.8) with symptomatic cholelithiasis impacts reimbursement and severity.

  • Lack of Supporting Documentation

    Insufficient documentation of symptoms related to gallstones can lead to denials for K80.2. CDI can query for symptom clarification.

Mitigation Tips

Best Practices
  • Document gallstone location, size for accurate ICD-10-CM coding (K80.-)
  • Capture cholelithiasis symptoms, severity for E/M coding, CDI compliance
  • Order/document imaging (ultrasound) confirming symptomatic cholelithiasis
  • Correlate symptoms with cholelithiasis for HCC medical necessity reviews
  • Ensure complete HPI for HCC risk adjustment, accurate RAF scores

Clinical Decision Support

Checklist
  • Verify RUQ pain, nausea/vomiting documented
  • Confirm Murphy's sign or sonographic findings
  • Check for biliary colic, fever, or jaundice
  • Correlate labs (e.g., LFTs, WBC) with symptoms
  • Document cholelithiasis diagnosis and plan

Reimbursement and Quality Metrics

Impact Summary
  • **Reimbursement and Quality Metrics Impact Summary: Symptomatic Cholelithiasis**
  • **Keywords:** Cholelithiasis ICD-10, Gallstones billing, Medical coding HCC, Quality reporting, Case Mix Index CMI, Reimbursement impact, Hospital finance, Denials management
  • **Impacts:**
  • Increased CMI due to higher resource utilization.
  • Potential denials if documentation lacks symptom specificity.
  • HCC coding impacts risk adjustment and future reimbursements.
  • Quality metrics related to pain management and surgical outcomes are affected.

Streamline Your Medical Coding

Let S10.AI help you select the most accurate ICD-10 codes. Our AI-powered assistant ensures compliance and reduces coding errors.

Quick Tips

Practical Coding Tips
  • Code K80.00 for unspecified cholelithiasis with symptoms
  • Document symptom specifics for K80.0-K80.2
  • Query physician if documentation lacks symptom clarity
  • Cholecystitis (K81.0-K81.9) needs infection documented
  • Biliary colic without cholecystitis? Code K80.8

Documentation Templates

Patient presents with symptomatic cholelithiasis, confirmed by abdominal ultrasound demonstrating the presence of gallstones within the gallbladder.  The patient reports classic biliary colic, characterized by episodic, intense right upper quadrant or epigastric pain, often radiating to the right shoulder or back.  Pain episodes are typically triggered by fatty meals and may be accompanied by nausea, vomiting, and dyspepsia.  Physical examination reveals tenderness in the right upper quadrant upon palpation.  Differential diagnoses considered include acute cholecystitis, biliary dyskinesia, peptic ulcer disease, and pancreatitis.  Laboratory findings, including liver function tests and complete blood count, are within normal limits, ruling out acute cholecystitis and other complications.  The patient's current symptoms warrant a cholecystectomy, which has been discussed with the patient, including risks and benefits.  Surgical consultation has been obtained and the procedure is scheduled.  Patient education provided on postoperative care and dietary modifications.  ICD-10 code K80.20 (Calculus of gallbladder without cholecystitis) is assigned.  The patient's prognosis is excellent with surgical intervention.