K86.1 ICD-10-CM Code: Other chronic pancreatitis

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for K86.1 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 K86.1 itself; “inherited from” names the category or block whose note applies here.

Coder workflow for K86.1

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

Before you code K86.1

1. “Other” (NEC) means the condition is specified in the record but no dedicated code captures it. Confirm the documented form is not one a sibling code names before settling on K86.1; if the record states no specifics at all, the unspecified sibling applies instead. “Other” codes are for documented conditions the classification gives no specific code; “unspecified” codes are for records lacking the detail (Guidelines I.A.9.a, I.A.9.b).

   ReviewK86.0, K86.2, K86.3

   See the relationships section · Guide: Other vs unspecified (NEC vs NOS) →

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).

Acuity

Acute or chronic as documented; when both are documented and separate codes exist, both are reported with the acute code first (Guidelines I.B.8).

Any detail beyond this code’s title

What the record states that a more specific sibling code would capture — or its absence, which itself supports the unspecified code.

Official instructions as workflow

• Excludes2 — not part of K86.1(3 notes)

  Coding workflow: The conditions named in this note are not included in K86.1. When the record documents both, both may be reported; the note is a boundary, not a prohibition.

  CompareE84, D13.7, K90.3

  See the official tabular notes · Guidelines I.A.12.b

• Code Also — related condition(1 note)

  Coding workflow: Review the related condition when both are documented and the instruction applies. A Code Also note does not fix sequencing; the order follows the circumstances of the encounter.

  ReviewK86.81

  See the official tabular notes · Guidelines I.A.17

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.

Indexed Clinical Terms (9)

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.

• Hypertension, hypertensive (accelerated) (benign) (essential) (idiopathic) (malignant) (systemic), pancreatic duct - code to underlying condition, with chronic pancreatitis
• Pancreatitis (annular) (apoplectic) (calcareous) (edematous) (hemorrhagic) (malignant) (subacute) (suppurative), chronic (infectious)
• Pancreatitis (annular) (apoplectic) (calcareous) (edematous) (hemorrhagic) (malignant) (subacute) (suppurative), chronic (infectious), recurrent
• Pancreatitis (annular) (apoplectic) (calcareous) (edematous) (hemorrhagic) (malignant) (subacute) (suppurative), chronic (infectious), relapsing
• Pancreatitis (annular) (apoplectic) (calcareous) (edematous) (hemorrhagic) (malignant) (subacute) (suppurative), cystic (chronic)
• Pancreatitis (annular) (apoplectic) (calcareous) (edematous) (hemorrhagic) (malignant) (subacute) (suppurative), fibrous (chronic)
• Pancreatitis (annular) (apoplectic) (calcareous) (edematous) (hemorrhagic) (malignant) (subacute) (suppurative), interstitial (chronic)
• Pancreatitis (annular) (apoplectic) (calcareous) (edematous) (hemorrhagic) (malignant) (subacute) (suppurative), recurrent, chronic
• Pancreatitis (annular) (apoplectic) (calcareous) (edematous) (hemorrhagic) (malignant) (subacute) (suppurative), relapsing, chronic

Official Coding Guidelines

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

Don’t confuse K86.1 with…

MedCoder analysis — pairs from this code’s official notes, distinctions written by MedCoder

The codes most likely to be picked instead of K86.1 — named in its own official notes, or sharing its laterality or encounter family — with what separates them and which documentation moves the case. Each links to the full comparison.

• K86.9— Specificity relationship (Review)

  Overlapping diagnoses in the same category.

  Overlapping codes in the same category — the documentation decides which is the more specific fit.

  What moves you there: A record that documents no more than “Disease of pancreas, unspecified” takes K86.9; specificity in the record moves it back here.

  Full comparison: K86.1 vs K86.9 →

• E84— Excludes2 relationship (Informational)

  Distinct conditions — both may be reported.

  A distinct condition — both may be reported when both are documented.

  What moves you there: Documentation of fibrocystic disease of pancreas adds E84; it is not part of this code and both may be reported when both are documented.

  Full comparison: K86.1 vs E84 →

• D13.7— Excludes2 relationship (Informational)

  Distinct conditions — both may be reported.

  A distinct condition — both may be reported when both are documented.

  What moves you there: Documentation of islet cell tumor (of pancreas) adds D13.7; it is not part of this code and both may be reported when both are documented.

  Full comparison: K86.1 vs D13.7 →

• K90.3— Excludes2 relationship (Informational)

  Distinct conditions — both may be reported.

  A distinct condition — both may be reported when both are documented.

  What moves you there: Documentation of pancreatic steatorrhea adds K90.3; it is not part of this code and both may be reported when both are documented.

  Full comparison: K86.1 vs K90.3 →

Relationships are read from this code's own official notes, its laterality siblings and its encounter family; the wording of each distinction is MedCoder editorial, and the documentation named in each “what moves you there” line is the official note phrase or sibling title itself. Source: CMS ICD-10-CM tabular instructional notes; ICD-10-CM Official Guidelines, Section I.A.12.a.

Verify Before Coding

• CC as a secondary diagnosis (FY2026). Can raise the stay's MS-DRG severity tier.

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

Other codes that name K86.1 or its code family, from the CMS ICD-10-CM tabular instructional notes. Tabular-note edges are stored at the code family level that carries each note.

Referenced by 1 Code First instruction: E08 — Diabetes mellitus due to underlying condition (via K86.-).

Each of these codes carries a Code First note naming this condition — when that code is reported, THIS code is sequenced first, ahead of it.

MS-DRG Grouper Relationships (FY2026)

Potential MS-DRG participation — not a DRG assignment.

FY2026 MS-DRG: CC — Complication or Comorbidity. Reported as a secondary diagnosis, this code raises the stay's MS-DRG severity tier — except when the principal diagnosis is one of 27 clinically related codes on its CMS exclusion list.

Named in the grouper logic of 3 MS-DRGs: DRG 438 (MDC 07), DRG 439 (MDC 07), DRG 440 (MDC 07).

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

Clinical classification (AHRQ CCSR):DIG020 — Pancreatic disorders (excluding diabetes) (default).

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 process (MS-DRG)

Acts as CC — raises the severity of other admissions. CMS groups these diagnoses into one MS-DRG principal-diagnosis exclusion process — a CC/MCC on this list never raises severity when the principal diagnosis is also on it.

K85.11 — Biliary acute pancreatitis with uninfected necrosis, K85.12 — Biliary acute pancreatitis with infected necrosis, K85.20 — Alcohol induced acute pancreatitis without necrosis or infection, K85.21 — Alcohol induced acute pancreatitis with uninfected necrosis, K85.22 — Alcohol induced acute pancreatitis with infected necrosis, K85.30 — Drug induced acute pancreatitis without necrosis or infection, K85.31 — Drug induced acute pancreatitis with uninfected necrosis, K85.32 — Drug induced acute pancreatitis with infected necrosis, K85.80 — Other acute pancreatitis without necrosis or infection, K85.81 — Other acute pancreatitis with uninfected necrosis, K85.82 — Other acute pancreatitis with infected necrosis, K85.90 — Acute pancreatitis without necrosis or infection, unspecified, K85.91 — Acute pancreatitis with uninfected necrosis, unspecified, K85.92 — Acute pancreatitis with infected necrosis, unspecified, K86.0 — Alcohol-induced chronic pancreatitis, K86.2 — Cyst of pancreas, K86.3 — Pseudocyst of pancreas, K86.81 — Exocrine pancreatic insufficiency, K86.89 — Other specified diseases of pancreas, K86.9 — Disease of pancreas, unspecified, +6 more

Same CMS-HCC risk category (V28)

CMS maps these diagnoses to the same Hierarchical Condition Category (Chronic Pancreatitis) for risk-adjusted payment.

K86.0 — Alcohol-induced chronic pancreatitis

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical category (Pancreatic disorders (excluding diabetes)).

K85.3 — Drug induced acute pancreatitis, K85.30 — Drug induced acute pancreatitis without necrosis or infection, K85.31 — Drug induced acute pancreatitis with uninfected necrosis, K85.32 — Drug induced acute pancreatitis with infected necrosis, K85.8 — Other acute pancreatitis, K85.80 — Other acute pancreatitis without necrosis or infection, K85.81 — Other acute pancreatitis with uninfected necrosis, K85.82 — Other acute pancreatitis with infected necrosis, K85.9 — Acute pancreatitis, unspecified, K85.90 — Acute pancreatitis without necrosis or infection, unspecified, K85.91 — Acute pancreatitis with uninfected necrosis, unspecified, K85.92 — Acute pancreatitis with infected necrosis, unspecified, K86.0 — Alcohol-induced chronic pancreatitis, K86.2 — Cyst of pancreas, K86.3 — Pseudocyst of pancreas, K86.8 — Other specified diseases of pancreas, K86.81 — Exocrine pancreatic insufficiency, K86.89 — Other specified diseases of pancreas, K86.9 — Disease of pancreas, unspecified, K90.3 — Pancreatic steatorrhea, +14 more

Same Index main term, other category

The ICD-10-CM Index to Diseases and Injuries files this code under the main terms “Hypertension, hypertensive”, “Pancreatitis”; these codes share that main term but sit in a different category of the Tabular List.

K85.22 — Alcohol induced acute pancreatitis with infected necrosis (acute, alcohol induced, with necrosis, infected), K85.30 — Drug induced acute pancreatitis without necrosis or infection (acute, drug induced), K85.31 — Drug induced acute pancreatitis with uninfected necrosis (acute, drug induced, with necrosis), K85.32 — Drug induced acute pancreatitis with infected necrosis (acute, drug induced, with necrosis, infected), K85.80 — Other acute pancreatitis without necrosis or infection (interstitial, acute), K85.81 — Other acute pancreatitis with uninfected necrosis (acute, specified NEC, with necrosis), K85.82 — Other acute pancreatitis with infected necrosis (acute, specified NEC, with necrosis, infected), K85.90 — Acute pancreatitis without necrosis or infection, unspecified, K85.91 — Acute pancreatitis with uninfected necrosis, unspecified (with necrosis), K85.92 — Acute pancreatitis with infected necrosis, unspecified (with necrosis, infected), O10.01 — Pre-existing essential hypertension complicating pregnancy (complicating, pregnancy, pre-existing, essential), O10.02 — Pre-existing essential hypertension complicating childbirth (complicating, childbirth, pre-existing, essential), O10.03 — Pre-existing essential hypertension complicating the puerperium (complicating, puerperium, pre-existing, pre-existing, essential), O10.11 — Pre-existing hypertensive heart disease complicating pregnancy (complicating, pregnancy, pre-existing, with, heart disease), O10.12 — Pre-existing hypertensive heart disease complicating childbirth (complicating, childbirth, pre-existing, with, heart disease), O10.13 — Pre-existing hypertensive heart disease complicating the puerperium (complicating, puerperium, pre-existing, pre-existing, with, heart disease), O10.21 — Pre-existing hypertensive chronic kidney disease complicating pregnancy (complicating, pregnancy, pre-existing, with, renal disease), O10.22 — Pre-existing hypertensive chronic kidney disease complicating childbirth (complicating, childbirth, pre-existing, with, renal disease), O10.23 — Pre-existing hypertensive chronic kidney disease complicating the puerperium (complicating, puerperium, pre-existing, pre-existing, with, renal disease), O10.31 — Pre-existing hypertensive heart and chronic kidney disease complicating pregnancy (complicating, pregnancy, pre-existing, with, heart disease, with renal disease), +75 more

Lab tests where this diagnosis supports Medicare coverage (NCD)

Medicare's National Coverage Determination (NCD) program lists this diagnosis as medical justification for these lab tests.

HbA1c Test (Glycated Hemoglobin), Blood Glucose Test, Fecal Occult Blood Test (FOBT), Lipid Panel

Contextual Map

Every relationship of K86.1 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.

Run K86.1 with these 2 related codes in Claim Check

Hierarchy

• K00-K95 — Chapter 11: Diseases of the Digestive System (K00-K95) (K00-K95)[Hierarchy]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• K80-K87 — Disorders of gallbladder, biliary tract and pancreas[Hierarchy]— CMS ICD-10-CM tabular structure · icd10cm-fy2026

Code Also

• K86.81 — Exocrine pancreatic insufficiency[Code Also]: “exocrine pancreatic insufficiency (K86.81)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026

Referenced by Code First instructions

• E08 — Diabetes mellitus due to underlying condition[Code First](via K86.-): “pancreatitis and other diseases of the pancreas (K85-K86.-)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026

Clinical classification (CCSR)

• DIG020 — Pancreatic disorders (excluding diabetes)[CCSR]— AHRQ CCSR for ICD-10-CM Diagnoses (HCUP)

Risk adjustment (CMS-HCC)

• HCC 79 — Chronic Pancreatitis [CMS-HCC]— CMS-HCC V28 · 2026

MS-DRG Grouper

• CC — Complication or Comorbidity [MS-DRG severity]: “As a secondary diagnosis this code can raise the stay's MS-DRG severity tier (CC).”— CMS MS-DRG Definitions Manual (Appendix C) · FY2026
• DRG 438 — DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC[MS-DRG]: “DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC (MDC 07)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2026
• DRG 439 — DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC[MS-DRG]: “DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC (MDC 07)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2026
• DRG 440 — DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CC/MCC[MS-DRG]: “DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CC/MCC (MDC 07)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2026

MDC crossing

• MDC 07 — Diseases and Disorders of the Hepatobiliary System and Pancreas[MDC crossing]: “Diseases and Disorders of the Hepatobiliary System and Pancreas — 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. 2,481 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2026

Index entries (9)

• Hypertension, hypertensive (accelerated) (benign) (essential) (idiopathic) (malignant) (systemic), pancreatic duct - code to underlying condition, with chronic pancreatitis[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
• Pancreatitis (annular) (apoplectic) (calcareous) (edematous) (hemorrhagic) (malignant) (subacute) (suppurative), chronic (infectious)[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
• Pancreatitis (annular) (apoplectic) (calcareous) (edematous) (hemorrhagic) (malignant) (subacute) (suppurative), chronic (infectious), recurrent[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
• Pancreatitis (annular) (apoplectic) (calcareous) (edematous) (hemorrhagic) (malignant) (subacute) (suppurative), chronic (infectious), relapsing[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
• Pancreatitis (annular) (apoplectic) (calcareous) (edematous) (hemorrhagic) (malignant) (subacute) (suppurative), cystic (chronic)[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
• Pancreatitis (annular) (apoplectic) (calcareous) (edematous) (hemorrhagic) (malignant) (subacute) (suppurative), fibrous (chronic)[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
• Pancreatitis (annular) (apoplectic) (calcareous) (edematous) (hemorrhagic) (malignant) (subacute) (suppurative), interstitial (chronic)[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
• Pancreatitis (annular) (apoplectic) (calcareous) (edematous) (hemorrhagic) (malignant) (subacute) (suppurative), recurrent, chronic[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
• and 1 more

Nearest codes

• K86 — Other diseases of pancreas[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• K86.0 — Alcohol-induced chronic pancreatitis[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• K86.2 — Cyst of pancreas[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• K86.3 — Pseudocyst of pancreas[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• K86.8 — Other specified diseases of pancreas[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• K86.81 — Exocrine pancreatic insufficiency[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• K86.89 — Other specified diseases of pancreas[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• K86.9 — Disease of pancreas, unspecified[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026

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

Risk adjustment Official source data

2026 Mid-Year Final ICD-10 Mappings + Model Software (cms.gov/files/zip/2026-midyear-final-icd-10-mappings.zip, 2026-midyear-final-model-software.zip) — CMS-HCC V28, PY2026 mid-year final release 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

Nearest Codes in This Family

Official ICD-10-CM classifications closest to K86.1 in its code family, with their registry titles.

• K86 — Other diseases of pancreas
• K86.0 — Alcohol-induced chronic pancreatitis
• K86.2 — Cyst of pancreas
• K86.3 — Pseudocyst of pancreas
• K86.8 — Other specified diseases of pancreas
• K86.81 — Exocrine pancreatic insufficiency
• K86.89 — Other specified diseases of pancreas
• K86.9 — Disease of pancreas, unspecified

View all codes in the K86 family