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K11.5 ICD-10-CM Code: Sialolithiasis

Billing Status: YES. This is a valid, specific, and billable ICD-10-CM reference.

Coding at a Glance

Tabular directives
2 inclusion terms · 8 use-additional codes

Inpatient Payment Groups (MS-DRG)

Potential MS-DRG participation — not a DRG assignment.

MS-DRGs this diagnosis helps define, as principal or secondary, per the CMS ICD-10-CM/PCS MS-DRG Definitions Manual v43, Appendix B.

  • MS-DRG 011 — TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH MCC (MDC PRE)
  • MS-DRG 012 — TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH CC (MDC PRE)
  • MS-DRG 013 — TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITHOUT CC/MCC (MDC PRE)
  • MS-DRG 154 — OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH MCC (MDC 03)
  • MS-DRG 155 — OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH CC (MDC 03)
  • MS-DRG 156 — OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITHOUT CC/MCC (MDC 03)

A diagnosis appearing in a group's logic does not by itself determine the DRG assigned to a stay; the grouper uses the full claim.

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for K11.5 in the official ICD-10-CM tabular list, quoted as published.

Source: CMS/CDC — ICD-10-CM Tabular ListRelease: FY2026Effective: October 1, 2025

Notes without a marker are published on K11.5 itself; “inherited from” names the category or block whose note applies here.

Inclusion Terms

Alternative terms the tabular list files under this code.

  • Calculus of salivary gland or duct
  • Stone of salivary gland or duct

Use Additional Code

Supplementary codes the tabular list directs you to add.

  • Use additional code to identify:
  • alcohol abuse and dependence (F10.-)
  • exposure to environmental tobacco smoke (Z77.22)
  • exposure to tobacco smoke in the perinatal period (P96.81)
  • history of tobacco dependence (Z87.891)
  • occupational exposure to environmental tobacco smoke (Z57.31)
  • tobacco dependence (F17.-)
  • tobacco use (Z72.0)

Source: inherited from K11

Coder workflow for K11.5

MedCoder structured workflow — derived from this code’s own official record

Documentation check

The provider’s diagnostic statement
Codes are assigned from the provider’s documented diagnosis, not from clinical criteria, test values or a medication list (Guidelines I.A.19).
The conditions the Use Additional Code note names
Reported with this code when documented; a conditional instruction (“if applicable”, “if known”) applies only when the record supports it.

Official instructions as workflow

  • Use Additional Code — after identifying K11.5(8 notes)

    Coding workflow: Check whether the documentation supports the additional code(s) the note names, and report them with K11.5 when it does. Where the instruction is conditional (“if applicable”, “if known”), it applies only when the record documents the condition.

    ReviewF10, Z77.22, P96.81, Z87.891, Z57.31, F17

    See the official tabular notes · Guidelines I.A.13

Coding decision scenarios

Pattern scenarios for this code’s structure — decision rules, not clinical cases

Documentation: A condition the Use Additional Code note names is documented.

Coding question: Is a second code reported with K11.5?

Path: Review the Use Additional Code note and the code it names.

Reason: The additional code is reported when the record documents the condition; a conditional instruction applies only when its condition is met (Guidelines I.A.13).

ReviewF10, Z77.22, P96.81, Z87.891, Z57.31, F17

Every row is derived from this code’s own record — its title, tabular notes, 7th-character family and same-category siblings — with fixed MedCoder wording; nothing is inferred about a patient. The official notes and guideline text are in the sections each row links to, and they control.

Code Overview

Sialolithiasis is a billable ICD-10-CM diagnosis code (K11.5).

MedCoder summary Summary composed by MedCoder from this code's official ICD-10-CM record. The tabular instructional notes themselves appear verbatim below.

Indexed Clinical Terms (14)

Official source data — entries quoted as published, in the Index’s own lookup phrasing

Clinical term phrases from the official ICD-10-CM Index to Diseases and Injuries that map to this code. These are alphabetic-index entries shown as the Index writes them — lookup phrasing, not necessarily the wording of a final diagnosis.

Official Coding Guidelines

No excerpt in the ICD-10-CM Official Guidelines names this code specifically. Its chapter carries only this chapter-wide note:

Chapter 11: Diseases of the Digestive System (K00-K95)

Reserved for future guideline expansion

Verify Before Coding

  • No Medicare Code Editor or MS-DRG Definitions Manual restrictions apply to this code.

From the code registry, the Medicare Code Editor, and the MS-DRG Definitions Manual. Check it against a full claim in Claim Check.

Relationships & Classification

MedCoder structured relationships — computed from published CMS and AHRQ datasets

MS-DRG Grouper Relationships (FY2026)

Potential MS-DRG participation — not a DRG assignment.

FY2026 MS-DRG: not on the CMS CC/MCC list — as a secondary diagnosis this code does not change MS-DRG severity for that release.

Named in the grouper logic of 6 MS-DRGs: DRG 011 (MDC PRE), DRG 012 (MDC PRE), DRG 013 (MDC PRE), DRG 154 (MDC 03), DRG 155 (MDC 03), DRG 156 (MDC 03).

From the CMS MS-DRG Definitions Manual (Appendices B and C). Actual DRG assignment depends on the complete claim.

Clinical classification (AHRQ CCSR):DIG003 — Diseases of mouth; excluding dental (default); DEN001 — Any dental condition including traumatic injury; DEN002 — Nontraumatic dental conditions.

Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses. Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.

Related Codes

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical categories (Diseases of mouth; excluding dental, Any dental condition including traumatic injury, Nontraumatic dental conditions).

K09.8 — Other cysts of oral region, not elsewhere classified, K09.9 — Cyst of oral region, unspecified, K11.0 — Atrophy of salivary gland, K11.1 — Hypertrophy of salivary gland, K11.20 — Sialoadenitis, unspecified, K11.21 — Acute sialoadenitis, K11.22 — Acute recurrent sialoadenitis, K11.23 — Chronic sialoadenitis, K11.3 — Abscess of salivary gland, K11.4 — Fistula of salivary gland, K11.6 — Mucocele of salivary gland, K11.7 — Disturbances of salivary secretion, K11.8 — Other diseases of salivary glands, K11.9 — Disease of salivary gland, unspecified, K12.0 — Recurrent oral aphthae, K12.1 — Other forms of stomatitis, K12.2 — Cellulitis and abscess of mouth, K12.30 — Oral mucositis (ulcerative), unspecified, K12.31 — Oral mucositis (ulcerative) due to antineoplastic therapy, K12.32 — Oral mucositis (ulcerative) due to other drugs, +613 more

Same Index main term, other category

The ICD-10-CM Index to Diseases and Injuries files this code under the main terms “Obstruction, obstructed, obstructive”, “Calculus, calculi, calculous”, “Concretion”, …; these codes share that main term but sit in a different category of the Tabular List.

J47.1 — Bronchiectasis with (acute) exacerbation (airway, with, bronchiectasis, with, exacerbation), J47.9 — Bronchiectasis, uncomplicated (airway, with, bronchiectasis), J67.9 — Hypersensitivity pneumonitis due to unspecified organic dust (airway, with, allergic alveolitis), J68.9 — Unspecified respiratory condition due to chemicals, gases, fumes and vapors (airway, due to, inhalation of fumes or vapors), J95.03 — Malfunction of tracheostomy stoma (tracheostomy airway), J98.09 — Other diseases of bronchus, not elsewhere classified (bronchus), J98.4 — Other disorders of lung (lung), J98.8 — Other specified respiratory disorders (airway), K03.6 — Deposits [accretions] on teeth (dental), K04.2 — Pulp degeneration (pulpal), K22.2 — Esophageal obstruction (cardia), K31.0 — Acute dilatation of stomach (stomach NEC, acute), K31.1 — Adult hypertrophic pyloric stenosis (gastric outlet), K31.3 — Pylorospasm, not elsewhere classified (stomach NEC, due to pylorospasm), K31.5 — Obstruction of duodenum (duodenum), K31.89 — Other diseases of stomach and duodenum (stomach), K38.1 — Appendicular concretions (appendicular), K56.0 — Paralytic ileus (intestine, reflex), K56.2 — Volvulus (intestine, volvulus), K56.3 — Gallstone ileus (intestine, by gallstone), +163 more

Contextual Map

Every relationship of K11.5 in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.

Hierarchy

Clinical classification (CCSR)

MS-DRG Grouper

MDC crossing

  • Pre-MDC[MDC crossing]: “Pre-MDC — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs. 153 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2026
  • MDC 03 — Diseases and Disorders of the Ear, Nose, Mouth and Throat[MDC crossing]: “Diseases and Disorders of the Ear, Nose, Mouth and Throat — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs. 5,147 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2026

Index entries (14)

  • Calculus, calculi, calculous, parotid duct or gland[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Calculus, calculi, calculous, salivary (duct) (gland)[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Calculus, calculi, calculous, Stensen's duct[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Calculus, calculi, calculous, sublingual duct or gland[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Calculus, calculi, calculous, submandibular duct, gland or region[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Calculus, calculi, calculous, submaxillary duct, gland or region[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Calculus, calculi, calculous, Wharton's duct[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Concretion, salivary gland (any)[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • and 6 more

Nearest codes (14)

Change history

  • FY2016 — In the code set at ICD-10-CM adoption [Change history]— CMS release files (code change ledger) · icd10cm-fy2016

Sources for this page

Codes, titles, notes, index terms and mappings on this page are transcribed from the datasets below. Relationships MedCoder computed and text MedCoder wrote are labelled where they appear.

Code, title, tabular notes and index terms Official source data
CMS/CDC ICD-10-CM FY2026 tabular list, index and tables, effective October 1, 2025 Release, file and checksum · Publisher’s page
Coding guidelines Official source data
ICD-10-CM Official Guidelines for Coding and Reporting (FY2026), quoted by section Release, file and checksum · Publisher’s page
Claim edits Official source data
CMS Definitions of Medicare Code Edits — v43.1 (April 2026) Release, file and checksum · Publisher’s page
Inpatient payment groups Official source data
CMS MS-DRG Definitions Manual (incl. Appendix B diagnosis index, Appendix C CC/MCC list, Appendix E procedure index) and IPPS Final Rule tables — v43 Release, file and checksum · Publisher’s page
Change history and date-of-service validity Official source data
CMS ICD-10-CM release addenda, ingested release by release into the change ledger Release, file and checksum · Publisher’s page
Comparisons, relationships and the contextual map MedCoder structured relationship
Computed by MedCoder from the tabular notes and tables above; every derived relationship is marked as derived where it appears
Summary and FAQ answers MedCoder explanation
Written by MedCoder to explain the sources above: drafted with AI assistance, checked by a person against the release files, and labelled as MedCoder text where it appears. Not official text.

Labels on this page: Official source data · MedCoder structured relationship · MedCoder explanation. How to read the labels · All data sources and release dates

Change history

  • FY2016 — October 1, 2015
    In the code set at ICD-10-CM adoption
    Sialolithiasis

No changes since FY2016 — additions, deletions, description changes and billable-status changes are tracked through FY2027 (effective October 1, 2026), and none are recorded for this code. Note changes are tracked from FY2027 only.

Nearest Codes in This Family

Official ICD-10-CM classifications closest to K11.5 in its code family, with their registry titles.

View all codes in the K11 family