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K86.81 ICD-10-CM Code: Exocrine pancreatic insufficiency

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

Coding at a Glance

Tabular directives
3 Excludes2
Risk adjustment
RxHCC V08 category 66

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 v44, Appendix B.

  • MS-DRG 438 — DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC (MDC 07)
  • MS-DRG 439 — DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC (MDC 07)
  • MS-DRG 440 — DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CC/MCC (MDC 07)

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 K86.81 in the official ICD-10-CM tabular list, quoted as published.

Source: CMS/CDC — ICD-10-CM Tabular ListRelease: FY2027Effective: October 1, 2026

Trace:FY2027 changesChange historyRelease, file and checksum

Notes without a marker are published on K86.81 itself; “inherited from” names the category or block whose note applies here.

Excludes2 — Not Included Here

Conditions not covered by this code, but which may be reported alongside it when both are present.

Source: inherited from K86

Coder workflow for K86.81

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).

Official instructions as workflow

  • Excludes2 — not part of K86.81(3 notes)

    Coding workflow: The conditions named in this note are not included in K86.81. 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

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.

Don’t confuse K86.81 with…

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

The codes most likely to be picked instead of K86.81 — 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.

  • 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: K86.81 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: K86.81 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: K86.81 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.

Code Overview

Exocrine pancreatic insufficiency is a billable ICD-10-CM diagnosis code (K86.81).

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 (1)

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

Other codes that name K86.81 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.

Referenced by 8 Code Also instructions across 5 chapters: C25 — Malignant neoplasm of pancreas, C78.89 — Secondary malignant neoplasm of other digestive organs, D61.02 — Shwachman-Diamond syndrome, E84 — Cystic fibrosis, K86.0 — Alcohol-induced chronic pancreatitis, K86.1 — Other chronic pancreatitis, K90.0 — Celiac disease, Z90.41 — Acquired absence of pancreas.

These codes suggest coding this condition alongside when both are present.

MS-DRG Grouper Relationships (FY2027)

Potential MS-DRG participation — not a DRG assignment.

FY2027 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 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 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, K86.1 — Other chronic pancreatitis, K86.2 — Cyst of pancreas, K86.3 — Pseudocyst of pancreas, K86.8 — Other specified diseases of pancreas, 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 term “Insufficiency, insufficient”; these codes share that main term but sit in a different category of the Tabular List.

J98.4 — Other disorders of lung (pulmonary), K08.89 — Other specified disorders of teeth and supporting structures (anatomic crown height), K13.79 — Other lesions of oral mucosa (velopharyngeal, acquired), K22.89 — Other specified disease of esophagus (gastroesophageal), K31.89 — Other diseases of stomach and duodenum (pyloric), K55.059 — Acute (reversible) ischemia of intestine, part and extent unspecified (vascular, intestine, acute), K55.1 — Chronic vascular disorders of intestine (mesenteric), K55.9 — Vascular disorder of intestine, unspecified (vascular, intestine), K62.89 — Other specified diseases of anus and rectum (anus), K83.8 — Other specified diseases of biliary tract (biliary), M26.36 — Insufficient interocclusal distance of fully erupted teeth (ridge) (interocclusal distance of fully erupted teeth), M26.54 — Insufficient anterior guidance (anteriorguidance), N18.9 — Chronic kidney disease, unspecified (renal, chronic), N28.9 — Disorder of kidney and ureter, unspecified (renal), O09.3 — Supervision of pregnancy with insufficient antenatal care (prenatal care affecting management of pregnancy), O36.51 — Maternal care for known or suspected placental insufficiency (placental), P28.5 — Respiratory failure of newborn (respiratory, newborn), P28.89 — Other specified respiratory conditions of newborn (pulmonary, newborn), P29.0 — Neonatal cardiac failure (heart, newborn), P29.89 — Other cardiovascular disorders originating in the perinatal period (circulatory NEC, newborn), +74 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.

Blood Glucose Test, Fecal Occult Blood Test (FOBT), Lipid Panel

Contextual Map

Every relationship of K86.81 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 K86.81 with these 9 related codes in Claim Check

Hierarchy

Referenced by Code First instructions

Referenced by Code Also instructions

Clinical classification (CCSR)

MS-DRG Grouper

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. 2,488 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2027

Index entries

  • Insufficiency, insufficient, pancreatic, exocrine[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2027

Nearest codes

Change history

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 FY2027 tabular list, index and tables, effective October 1, 2026 Release, file and checksum · Publisher’s page
Coding guidelines Official source data
ICD-10-CM Official Guidelines for Coding and Reporting (FY2027), quoted by section Release, file and checksum · Publisher’s page
Claim edits Official source data
CMS Definitions of Medicare Code Edits — v44.0 (October 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 — v44 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

Cite this page

Reference this page in a research guide, syllabus or article. The release is included because code content changes each year.

MedCoder.ai. "K86.81 — Exocrine pancreatic insufficiency." ICD-10-CM FY2027. https://medcoder.ai/icd10/code/k86.81-exocrine-pancreatic-insufficiency

Change history

  • FY2017 — October 1, 2016
    Added to the code set
    Exocrine pancreatic insufficiency
    FY2017 changes

Nearest Codes in This Family

Official ICD-10-CM classifications closest to K86.81 in its code family, with their registry titles.

View all codes in the K86 family