2027 ICD-10-CM Diagnosis Code K86.1Other chronic pancreatitis
ICD-10-CM Codes›K00–K95›K80-K87›K86
- Billable — Valid for Submission
- CC — Complication or Comorbidity
- Risk Adjusts — HCC 79
- Chronic Condition
K86.1 is a billable ICD-10-CM diagnosis code for other chronic pancreatitis. It is valid on HIPAA claims for fiscal year 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 438 through 440. As a secondary diagnosis, it counts as a complication or comorbidity (CC) and moves an inpatient stay to a higher severity level within its MS-DRG family. It does not count, however, when the principal diagnosis is one of 27 closely related codes. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Pancreatic disorders (excluding diabetes).
For Medicare Advantage risk adjustment, K86.1 maps to CMS-HCC Category 79 (Chronic Pancreatitis) under the V28 model, adding a risk factor of about 0.357 for a community, non-dual, aged beneficiary in payment year 2027.
Code Identity
Code Classification
Medicare Risk Adjustment (HCC)Billing
K86.1 maps to a payment category in the CMS-HCC model used to risk-adjust Medicare Advantage payments. Weights are the published community factors for payment year 2027.
Source: CMS Payment Year 2027 risk adjustment mappings and model software. Weights are relative factors, not dollar amounts; a beneficiary's total RAF also includes demographics and interactions. Browse all CMS-HCC categories.
Approximate SynonymsGuidance
Alternate terms and clinical phrases that map to this code.
- Acute on chronic pancreatitis
- Calcific chronic pancreatitis
- Chronic fibrosing pancreatitis
- Chronic infectious pancreatitis
- Chronic pancreatitis
- Chronic pancreatitis due to gallbladder calculus
- Diabetes mellitus associated with pancreatic disease
- Diabetes mellitus due to chronic pancreatitis
- Drug-induced chronic pancreatitis
- Familial chronic pancreatitis
- Fibrosis of pancreas
- Groove pancreatitis
- Hereditary pancreatitis
- Idiopathic chronic pancreatitis
- Infectious pancreatitis
- Interstitial pancreatitis
- Metabolic pancreatitis
- Obstructive chronic pancreatitis
- Pseudocyst of pancreas
- Pseudocyst of pancreas due to chronic pancreatitis
- Recurrent pancreatitis
- Relapsing pancreatitis
- Secondary endocrine diabetes mellitus
- Tropical calcific chronic pancreatitis
Instructional NotesGuidance
Instructions from the official ICD-10-CM Tabular List that apply to K86.1: its own notes plus those printed at K86 and Chapter 11. A note printed at a category, block or chapter applies to every code under it.
Applicable To
Conditions this code is used for: synonyms of the title or, for "other specified" codes, the conditions assigned to it. The list is not exhaustive.
- Chronic pancreatitis NOS
- Infectious chronic pancreatitis
- Recurrent chronic pancreatitis
- Relapsing chronic pancreatitis
Excludes2
Not included here: the excluded condition is not part of this code, but a patient may have both, so both codes may be reported.
- certain conditions originating in the perinatal period (P04-P96)
- certain infectious and parasitic diseases (A00-B99)
- complications of pregnancy, childbirth and the puerperium (O00-O9A)
- congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)
- endocrine, nutritional and metabolic diseases (E00-E88)
- injury, poisoning and certain other consequences of external causes (S00-T88)
- neoplasms (C00-D49)
- symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)
Code Also
A second code may be needed to fully describe the condition; the note gives no sequencing direction.
- exocrine pancreatic insufficiency (K86.81)
Source: CMS ICD-10-CM Tabular List. How to read instructional notes.
Referenced in Other NotesGuidance
Instructional notes printed at other codes that name K86.1, its category, or a range that includes it.
Code First 1
These codes say to code first a condition named in the note, and K86.1 is one of the conditions named.
- E08 Diabetes mellitus due to underlying condition
Index to Diseases and InjuriesGuidance
Alphabetical index entries that point to this code.
Hypertension, hypertensive (accelerated) (benign) (essential) (idiopathic) (malignant) (systemic) I10
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
Patient EducationClinical
Pancreatitis
The pancreas is a large gland behind the stomach and close to the first part of the small intestine. It secretes digestive juices into the small intestine through a tube called the pancreatic duct. The pancreas also releases the hormones insulin and glucagon into the bloodstream.
Read the full article at MedlinePlus
Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.
Convert K86.1 to ICD-9-CMHistory
Code HistoryHistory
Questions About K86.1Overview
What is the ICD-10 code for other chronic pancreatitis?
The ICD-10-CM code for other chronic pancreatitis is K86.1 (sometimes written as K861). It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
Is K86.1 (Other diseases of pancreas) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report other chronic pancreatitis on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
What MS-DRG does K86.1 group to?
When other chronic pancreatitis is the principal diagnosis on an inpatient stay, it groups to MS-DRG 440, 438, 439, with relative weights from 0.5966 to 1.5763 depending on complications. Higher weights mean higher Medicare reimbursement.
Is K86.1 a CC or MCC?
CMS lists K86.1 as a CC (complication or comorbidity) for FY 2027. Reported as a secondary diagnosis, it moves the inpatient stay to a higher-weighted DRG within its severity family. It does not count when the principal diagnosis is one of the 27 closely related codes in its exclusion list.
What is the ICD-9 equivalent of K86.1?
Under the General Equivalence Mappings, other chronic pancreatitis converts to ICD-9-CM 577.1 (chronic pancreatitis) and 577.8 (pancreatic disease NEC). The mapping is approximate, so confirm the match fits the documentation.
What HCC is K86.1?
K86.1 (other chronic pancreatitis) maps to CMS-HCC Category 79 (Chronic Pancreatitis), commonly written as HCC 79, in the CMS-HCC V28 model used for Medicare Advantage risk adjustment in payment year 2027. It mapped to HCC 34 under the retired V24 model. It also maps in the PACE (CMS-HCC V22), ESRD (V21), and ESRD (V24) models. In the Part D prescription drug model it maps to RxHCC 65.
Does K86.1 risk-adjust for Medicare Advantage payment?
Yes. When documented and reported on a Medicare Advantage encounter, K86.1 adds a risk adjustment factor of about 0.357 to the beneficiary's RAF score for a community, non-dual, aged enrollee (published V28 weights range from 0.218 to 0.799 depending on the payment segment). HCC 79 sits at the top of its hierarchy, so no other condition category supersedes it. See the full factor table on the HCC 79 category page.
