K85.10
BillableBiliary acute pancreatitis without necrosis or infection
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is K85.10 an HCC code?
No. K85.10 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).
What This Code Means
K85.10 is the ICD-10-CM diagnosis code for biliary acute pancreatitis without necrosis or infection. Sudden inflammation of the pancreas caused by gallstones, without tissue death or bacterial infection. K85.10 sits in the ICD-10-CM chapter for diseases of the digestive system (k00-k95), within the section covering disorders of gallbladder, biliary tract and pancreas (k80-k87).
K85.10 is a billable ICD-10-CM code but does not map to a payment HCC under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can be reported on Medicare Advantage encounter data submissions but it does not contribute to a beneficiary's RAF score and therefore does not affect risk-adjusted payments to the plan.
Confirm that gallstones are the documented cause; this is the most common cause of acute pancreatitis.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for K85.10 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.