2027 ICD-10-CM Diagnosis Code K86.81Exocrine pancreatic insufficiency

ICD-10-CM Codes›K00–K95›K80-K87›K86

ICD-10-CM K86.81
CMSSource: CMS FY 2027 ICD-10-CM dataset · Effective Oct 1, 2026 – Sep 30, 2027

K86.81 is a billable ICD-10-CM diagnosis code for exocrine pancreatic insufficiency. 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. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Pancreatic disorders (excluding diabetes).

K86.81 does not risk-adjust for Medicare Advantage under the CMS-HCC V28 model. It still risk-adjusts in the RxHCC Part D (V08) category 66 for payment year 2027.

Code Identity

ICD-10-CM Code
K86.81
Billable Status
Yes — Valid for Submission
Code Describes
Exocrine pancreatic insufficiency
Short Description
Exocrine pancreatic insufficiency
Same as the full description in the CMS dataset.
Parent Code
K86.8
Other specified diseases of pancreas

Code Classification

ChapterK00–K95Diseases of the digestive system
SectionK80-K87Disorders of gallbladder, biliary tract and pancreas
CategoryK86Other diseases of pancreas
This CodeK86.81Exocrine pancreatic insufficiency

Medicare Risk Adjustment (HCC)Billing

K86.81 does not risk-adjust for Medicare Advantage under the CMS-HCC V28 model, but it maps to payment categories in the other CMS models shown below.

CMS-HCC V28 (Medicare Advantage Payment Model)
Not mapped
no payment category in the model that pays 100% of MA risk scores
Prior Model (CMS-HCC V24)
Not mapped under V24
this diagnosis newly risk-adjusts under the V28 model
Part D (RxHCC)
RxHCC 66 — Pancreatic Disorders and Intestinal Malabsorption, Except Pancreatitis
also risk-adjusts in the Part D prescription drug model (V08)

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.

  • Exocrine pancreatic insufficiency
  • Pancreatic insufficiency

Instructional NotesGuidance

Instructions from the official ICD-10-CM Tabular List that apply to K86.81: 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.

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.

From K86 Other diseases of pancreas applies to 7 codes
  • fibrocystic disease of pancreas (E84.-)
  • islet cell tumor (of pancreas) (D13.7)
  • pancreatic steatorrhea (K90.3)
From Chapter 11 (K00-K95) Diseases of the digestive system applies to 863 codes
  • 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)

Source: CMS ICD-10-CM Tabular List. How to read instructional notes.

Referenced in Other NotesGuidance

Instructional notes printed at other codes that name K86.81, its category, or a range that includes it.

Code First 1

These codes say to code first a condition named in the note, and K86.81 is one of the conditions named.

  • E08 Diabetes mellitus due to underlying condition
    pancreatitis and other diseases of the pancreas (K85-K86.-) names K85-K86, which includes this code

Code Also 8

These codes say K86.81 may also be needed to fully describe the condition. The note gives no sequencing direction.

  • C25 Malignant neoplasm of pancreas
    if applicable exocrine pancreatic insufficiency (K86.81)
  • C78.89 Secondary malignant neoplasm of other digestive organs
    exocrine pancreatic insufficiency (K86.81)
  • D61.02 Shwachman-Diamond syndrome
    exocrine pancreatic insufficiency (K86.81)
  • E84 Cystic fibrosis
    exocrine pancreatic insufficiency (K86.81)
  • K86.0 Alcohol-induced chronic pancreatitis
    exocrine pancreatic insufficiency (K86.81)
  • K86.1 Other chronic pancreatitis
    exocrine pancreatic insufficiency (K86.81)
  • K90.0 Celiac disease
    exocrine pancreatic insufficiency (K86.81)
  • Z90.41 Acquired absence of pancreas
    exocrine pancreatic insufficiency (K86.81)

Index to Diseases and InjuriesGuidance

Alphabetical index entries that point to this code.

Clinical ClassificationClinical

AHRQ’s CCSR groups this code into broader clinical categories.

CCSR DIG020
Pancreatic disorders (excluding diabetes)
Default principal diagnosis: inpatient Yes · outpatient Yes

Clinical InformationClinical

  • Exocrine Pancreatic Insufficiency

    a malabsorption condition resulting from greater than 10% reduction in the secretion of pancreatic digestive enzymes (lipase; proteases; and amylase) by the exocrine pancreas into the duodenum. this condition is often associated with cystic fibrosis and with chronic pancreatitis.

Patient EducationClinical

Pancreatic Diseases

The pancreas is a gland behind your stomach and in front of your spine. It produces juices that help break down food and hormones that help control blood sugar levels. Problems with the pancreas can lead to many health problems. These include:

Read the full article at MedlinePlus

Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.

Convert K86.81 to ICD-9-CMHistory

The closest ICD-9-CM equivalents under the General Equivalence Mappings.

ICD-9-CM
577.8 Pancreatic disease NEC
Approximate The match is approximate rather than exact.

Code History & ChangesHistory

Replacement K86.81 replaces the following previously assigned code(s):

  • K86.8 - Other specified diseases of pancreas
FY 2019AddedAdded to the ICD-10-CM code setEffective October 1, 2018.
FY 2020–2026No changes
FY 2027CurrentCurrent code set, no changesEffective October 1, 2026 through September 30, 2027.

Questions About K86.81Overview

What is the ICD-10 code for exocrine pancreatic insufficiency?

The ICD-10-CM code for exocrine pancreatic insufficiency is K86.81 (sometimes written as K8681). It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.

Is K86.81 (Other specified diseases of pancreas) a billable code?

Yes. This is a billable ICD-10-CM code, specific enough to report exocrine pancreatic insufficiency on HIPAA-covered claims from October 1, 2026 through September 30, 2027.

What MS-DRG does K86.81 group to?

When exocrine pancreatic insufficiency 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.

What is the ICD-9 equivalent of K86.81?

Under the General Equivalence Mappings, exocrine pancreatic insufficiency converts to ICD-9-CM 577.8 (pancreatic disease NEC). The mapping is approximate, so confirm the match fits the documentation.

Does K86.81 risk-adjust for Medicare Advantage payment?

Not for Medicare Advantage: K86.81 maps to no category in the CMS-HCC V28 model. It still risk-adjusts in the RxHCC Part D (V08) category 66 (Pancreatic Disorders and Intestinal Malabsorption, Except Pancreatitis).