K85.92
BillableAcute pancreatitis with infected necrosis, unspecified
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is K85.92 an HCC code?
No. K85.92 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
K85.92 is the ICD-10-CM diagnosis code for acute pancreatitis with infected necrosis, unspecified. Sudden inflammation of the pancreas of unknown or unspecified cause with dead pancreatic tissue that has become infected. K85.92 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).
K85.92 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.
This represents severe acute pancreatitis with unknown etiology requiring close monitoring.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for K85.92 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This represents severe acute pancreatitis with unknown etiology requiring close monitoring
- •Infected necrosis warrants aggressive management regardless of unknown cause