Accurate ICD-10 coding for gallstones is essential for clinical clarity, appropriate reimbursement, and regulatory compliance. Calculus of gallbladder without cholecystitis without obstruction often appears on outpatient problem lists, radiology reports, and surgical planning notes; selecting the correct code supports medical necessity for imaging, elective procedures, and postoperative care while minimizing denials and audits.
This guide explains what Calculus of gallbladder without cholecystitis without obstruction means clinically, when to use the ICD-10-CM Code K80.20, when to avoid it, and practical documentation and billing tips to improve claim acceptance. Intended for coders, billers, and revenue cycle managers, the content focuses on actionable rules and common pitfalls.
The ICD-10-CM Code for Calculus of gallbladder without cholecystitis without obstruction is K80.20.
Calculus of gallbladder without cholecystitis without obstruction (commonly called gallstones) describes the presence of one or more calculi (stones) within the gallbladder when there is no accompanying acute or chronic cholecystitis and no biliary obstruction. Clinically this includes asymptomatic stones found incidentally on imaging, chronic biliary colic without inflammatory signs, or documented gallstones when reports explicitly state “no cholecystitis” and “no obstruction.” In the ICD-10-CM classification, K80.20 is the specific code used to capture gallstones limited to the gallbladder without inflammation or evidence of bile duct obstruction.
Use K80.20 when abdominal ultrasound, CT, or MRI documents gallstones and the radiology report or clinician notes explicitly state absence of cholecystitis and no dilation of biliary tree. This includes ASCs or clinic visits where imaging drives the encounter and no inflammatory signs or elevated LFTs suggest obstruction.
When patients present for elective cholecystectomy for biliary colic and documentation shows gallstones but no acute cholecystitis or obstructive features, code K80.20 supports procedure justification while reflecting absence of acute inflammation. Use it when the operative indication is symptomatic stones only.
For periodic follow-up visits where the problem list includes prior gallstones and no new signs of cholecystitis or obstruction are present, K80.20 accurately captures the chronic, noninflammatory status. This is appropriate for medication management, counseling, or surveillance imaging scheduling.
Do not use K80.20 if the clinician documents acute or chronic cholecystitis. Use the specific code for calculus of gallbladder with cholecystitis (documented as acute or chronic) because inflammatory complications change medical necessity and reimbursement. The record must match the cholecystitis descriptor.
If there is documentation of obstruction, dilated bile ducts, rising bilirubin/LFTs, or stones in the common bile duct (choledocholithiasis), K80.20 is inappropriate. Instead assign the code for calculus with obstruction or a code for bile duct calculi to reflect increased acuity and different management pathways.
Do not use K80.20 for postoperative complications, postcholecystectomy remnants, or when gallstones are described as secondary to systemic disease without specific gallbladder findings. Assign the code that reflects the postprocedural state or the primary underlying condition driving care.
| Condition | Code | When It Is Used | When It Is Not Used |
|---|---|---|---|
| Calculus of gallbladder without cholecystitis without obstruction | K80.20 | When imaging or clinician documents gallstones in the gallbladder and explicitly notes there is no cholecystitis and no biliary obstruction; appropriate for asymptomatic or chronic stable stones | When cholecystitis, biliary obstruction, choledocholithiasis, or postprocedural complications are documented |
| Calculus of gallbladder with cholecystitis | K80.0 | When gallstones are documented with acute or chronic cholecystitis described in the record; use when inflammation is the reason for the encounter | When there is no cholecystitis; do not use if record states “no cholecystitis” |
| Calculus of gallbladder without cholecystitis with obstruction | K80.3 | When gallstones in the gallbladder are associated with obstruction of biliary flow noted clinically or radiographically (dilated ducts, abnormal LFTs, obstructive symptoms) | When there is no obstruction or imaging/labs are normal for biliary drainage |
| Calculus of bile duct (choledocholithiasis) | K80.5 | When stones are documented in the common bile duct or biliary tree (ERCP reports, MRCP, or intraoperative findings) and obstruction or cholangitis may be present | When stones are limited to the gallbladder and there is explicit documentation of no bile duct stones |
Always include a clinician statement that cholecystitis is present or absent. Phrases like “no sonographic Murphy’s sign; no wall thickening; no pericholecystic fluid” strengthen support for using K80.20 and reduce denials for conflicting diagnoses.
Link ultrasound/CT findings to clinical exam and liver function tests in notes. Document that labs and exam do not indicate obstruction. This triangulation establishes medical necessity and helps auditors accept a noninflammatory gallstone diagnosis.
If the record documents inflammation, obstruction, or bile duct stones, code to that more specific condition. Using K80.20 when another condition is documented increases audit and denial risk. Specificity improves correct DRG/CPT pairing and reduces edits.
Ensure the diagnosis listed on orders, imaging requests, procedure notes, and discharge summaries match. Inconsistent documentation across the record is a common cause of denials and coding discrepancies.
Leverage CombineHealth.ai's AI-powered platform and its automated claim scrubbing and coding validation capabilities to catch mismatches between clinical documentation and assigned diagnosis codes before submission. Automated validation reduces denials and improves first-pass acceptance.
Coding for gallstones has direct impact on revenue cycle outcomes:
Accurate ICD-10 coding is critical for healthcare revenue cycle performance. CombineHealth.ai's AI-powered platform helps RCM teams ensure coding accuracy, reduce denials, and optimize reimbursement through intelligent denial management and claim validation. CombineHealth.ai's intelligent platform provides automated claim scrubbing and coding validation to catch errors before submission, reducing denials and improving first-pass acceptance rates.
Q1: What is the ICD-10 code for gallstones?
The ICD-10-CM code for gallstones (Calculus of gallbladder without cholecystitis without obstruction) is K80.20. Use this code when stones are documented in the gallbladder and the chart explicitly notes no cholecystitis and no biliary obstruction.
Q2: When should I use K80.20 vs related codes?
Use K80.20 when there are gallstones without inflammation or obstruction. Use a code for gallstones with cholecystitis (documented acute or chronic) when inflammation is present, a code for obstruction when imaging or labs indicate biliary blockage, and a bile duct calculus code for choledocholithiasis.
Q3: What documentation is required when coding for gallstones?
Document the presence of stones, symptom status (asymptomatic, biliary colic), explicit statement of absence or presence of cholecystitis, imaging findings (gallbladder wall, pericholecystic fluid, ductal dilation), and relevant labs. Link imaging results to clinical assessment to support medical necessity.
Q4: What are common denial reasons when coding for gallstones?
Denials commonly arise from conflicting or incomplete documentation (e.g., imaging that suggests cholecystitis while notes say none), lack of documentation supporting the medical necessity of a procedure, or failure to use the most specific diagnosis code. See our guide on denial management for strategies to prevent and appeal denials: https://www.combinehealth.ai/blog/denial-management-in-healthcare