- Currently, ICD Codes for pancreatitis associate the disease with alcohol consumption, which is scientifically inaccurate. Physicians use a system called ICD-10 codes to identify diagnoses and procedures in patient medical records and for insurance reimbursement.
- Chronic Pancreatitis has been inaccurately thought to be caused by alcohol. This is now known to be inaccurate, but is still reflected in ICD codes. That needs correcting.
- Inaccurate coding harms patients, causing incorrect diagnosis, delayed treatment, bias and stigma.
- Mission: Cure has submitted a proposal to the CDC to delete the code for Alcoholic Chronic Pancreatitis and replace it with scientifically relevant codes.
- We will need patients and family members to contact CMS and the CDC to speak up against the current coding structure and demand changes to the codes that reflect accurate diagnosis.
Pancreatitis and Alcohol
When pancreatitis patients go to the doctor or the emergency room, they face a barrage of questions and numerous tests in hopes of finding the cause of their intense pain. If you are a pancreatitis patient, you have probably been asked if you drink alcohol. You may have been told that drinking caused your pancreatitis or that you have “alcoholic pancreatitis.” You might have felt pressured to say that you have had alcoholic drinks, even occasionally, socially or for special occasions, and you may have been treated with skepticism if you denied drinking alcohol.
Without other clear options, doctors often assume the traditional diagnosis: Alcohol-induced chronic pancreatitis. This diagnosis corresponds to the code submitted for reimbursement by an insurance company, namely, K86.0. K86.0 is an ICD-10 code. ICD-10 codes are used to diagnose all types of disorders, injuries, and diseases. These codes, once entered, stay on a patient’s medical record for the rest of their life as it is extremely difficult to remove or change a code once on a patient’s record. For Chronic Pancreatitis, this incorrect diagnosis and code follows the patient, biasing future providers and denying access to further diagnostic investigation and appropriate treatment options.
ICD Codes, Pancreatitis, and Alcohol
Currently, there are only two ICD codes for Chronic Pancreatitis: The first is Alcohol-Induced Chronic Pancreatitis (K86.0). As highlighted above, this is an incorrect diagnosis for chronic pancreatitis.
The second is Other Chronic Pancreatitis (K86.1) where all other causes of chronic pancreatitis are lumped together, which is neither accurate nor helpful for diagnosis, treatment or reimbursement. This focus on alcoholic chronic pancreatitis obscures all the other causes of pancreatitis, something of particular concern.
Dangers of the “Alcohol-Induced Chronic Pancreatitis” ICD Codes
This Code Does Not Reflect Current Science
- Research in the last twenty years has shown that alcohol does not cause chronic pancreatitis
“Alcoholic Pancreatitis” Label Creates Bias Against Patients
- Patients labeled with Alcohol-Induced Chronic Pancreatitis are told to stop drinking and sent away without further testing, including genetic testing. We now know that genetic drivers are an important cause of Chronic Pancreatitis but without genetic testing, patients are denied accurate diagnosis and treatment.
- Given an alcohol-induced chronic pancreatitis diagnosis, patients often blame themselves for their debilitating illness, which is associated with increased levels of depression and suicide.
Missed Opportunities for Research
- Physicians and researchers who believe that alcohol causes Pancreatitis have ignored the need for clinical research of the genetic and biological causes of the disease instead blaming patients and assuming that alcohol abstinence is the “cure.”
- For more information on the connection between Pancreatitis and Alcohol, please read our blog post. For information on Genetic drivers of Pancreatitis please watch our webinar.
Mission: Cure’s Proposal to Change ICD Codes for Pancreatitis
Mission Cure recognizes the harm to patients perpetuated by the current coding structure and we aim to correct this problem. We submitted a proposal to the CDC requesting a complete overhaul of the current Chronic Pancreatitis coding structure including:
- Chronic Pancreatitis should be identified as a specific disease and code, not a subset under Other Diseases of the Pancreas.
- Alcohol-Induced Pancreatitis must be removed from the ICD-10-CM codes because alcohol-induced pancreatitis is not scientifically accurate, to improve patient experience and to increase research into cures and drivers of disease. We propose adding codes for genetic and other specific causes of Chronic Pancreatitis.
What’s Next and How You Can Help
Mission: Cure’s proposal is currently under review and pending approval for presentation at the ICD-10 meeting being held in March, 2021.
We will need patients to attend the meeting and submit comments during the post-meeting comment period. If you believe you were incorrectly labeled with alcohol-induced pancreatitis, if you were mistreated treated as a result of this label, or if you simply find this coding structure unacceptable, please give us your name and contact information so we can let you know how to participate.
We believe this change in what appear to be boring administrative codes can make a huge difference in patients’ lives.