ICD code K80.20 – Gallstones without cholecystitis or obstruction

Key takeaways

K80.20 applies only when imaging confirms gallbladder stones and the record rules out both cholecystitis and obstruction.

Documented obstruction moves the claim to K80.21, and documented cholecystitis moves it to a combination code from K80.00 to K80.19.

The K81 cholecystitis codes carry an Excludes1 note for K80, so K81.0 and K81.1 never go on a claim with K80.20.

A note that only says gallbladder disease forces a less specific code, which may not support a cholecystectomy claim.

Pabau’s claims management builds the claim and sends it through Claim.MD, which handles eligibility checks and claim scrubbing before the payer sees it.

ICD-10 code K80.20 means gallstones with no inflammation and no blockage

ICD-10 code K80.20 is the billable ICD-10-CM code for calculus of the gallbladder without cholecystitis, without obstruction. It is a fully billable, specific code requiring no further subdivision. It is valid for FY 2027 claims with dates of service from October 1, 2026.

Per the CDC/NCHS ICD-10-CM web tool, the code sits in Chapter 11, Diseases of the digestive system. Its block is K80-K87 and its parent category is K80, Cholelithiasis.

The two “without” qualifiers carry the weight. Each one maps to its own axis in the K80 structure, and the record has to settle both before the code fits.

Three findings need to be in the chart before K80.20 fits

K80.20 describes gallstones seen on imaging, with a normal gallbladder wall and no sign of a blocked duct. The classic picture is biliary colic. That means episodes of right upper quadrant pain, often after meals, lasting from 30 minutes to several hours. Fever, a raised white cell count and jaundice are absent. Epigastric pain with a raised lipase points to acute pancreatitis instead. If the physician links it to the stones, it codes to K85.1x, and with no documented cause it codes to K85.90.

Ultrasound is the first-line test. It shows echogenic foci with posterior acoustic shadowing inside the gallbladder. Before you assign the code, check that the chart carries all three of these findings.

• Calculus confirmed. Imaging must document stones (calculi) inside the gallbladder.
• Cholecystitis absent. No acute or chronic inflammation is present. Acute cholecystitis brings Murphy’s sign, fever and leukocytosis, so the note should make clear those are missing.
• Obstruction absent. No stone is impacted in the cystic duct, the common bile duct or at the ampulla. Bilirubin, alkaline phosphatase and biliary imaging should be normal or non-obstructive.

Gallstones found by chance in a patient with no symptoms also land here. Some payers, though, want symptom documentation before they approve surgery linked to K80.20.

One wrong answer on either axis changes the K80 code

The K80 category sorts gallstone codes on two axes at once: cholecystitis present or absent, and obstruction present or absent. Get one axis wrong and the claim carries the wrong code. The table maps the subcodes coders mix up most often.

K82.9 is the fallback for gallbladder disease nobody has specified. Don’t reach for it when clear imaging results are already in the chart. The AAPC’s ICD-10-CM code lookup shows the full K80 hierarchy side by side, which helps when the documentation is borderline.

Read the questions below in order, because the first yes takes the claim somewhere other than K80.20.

K80 notes decide which codes can share a claim

The CMS ICD-10-CM tabular list attaches its instructional notes at the K80 category level, and they govern every code beneath it.

Reading them correctly keeps conflicting codes off the same claim. These notes are also part of medical billing compliance for every HIPAA-covered transaction.

Key K80 coding conventions

• Excludes1 note (K80 category). Retained cholelithiasis following cholecystectomy is excluded and goes to K91.86. Stones found after the gallbladder is gone never take a K80 code.
• No code-level Excludes1 at K80.20. K80.20 carries no Excludes1 note of its own. It still inherits the K80 category Excludes1 for K91.86.
• Cholecystitis codes stay off the claim. Do not report K81.0 or K81.1 with K80.20, because K81 carries an Excludes1 for cholecystitis with cholelithiasis. When cholecystitis is present with stones, use K80.00-K80.19.
• Sequencing. When several digestive conditions are documented, list first the one chiefly responsible for the visit. For elective cholecystectomy, that is usually K80.20.
• HIPAA code sets. HIPAA requires a current, valid ICD-10-CM code on covered electronic transactions. K80.20 is valid for FY 2027 as written.

The physician’s note has to name what’s missing as well as what’s there

An imaging report alone can’t carry K80.20. The record as a whole must show stones, and it must show that someone looked for cholecystitis and obstruction and found neither. When any of that is missing, the coder either drops to a less specific code or queries the physician.

Confirm these five elements first:

1. Imaging report confirming calculus. Abdominal ultrasound is standard. The report should describe echogenic material with posterior shadowing, confirming stones rather than polyps or sludge alone. A CT report works when ultrasound is non-diagnostic.
2. No inflammatory findings. The note should record no Murphy’s sign, no fever and no raised white cell count. Imaging should show no wall thickening or pericholecystic fluid. “No acute cholecystitis” is enough, while “gallbladder disease” is not.
3. No biliary obstruction. Normal bilirubin and alkaline phosphatase, plus imaging with no dilated common bile duct, support the without-obstruction axis. A plain line such as “no CBD dilation” settles it.
4. Symptom history or an incidental-finding note. For surgery, payers generally want biliary colic, right upper quadrant pain or nausea documented, often across one or two visits. If the stones were incidental, the note should say so.
5. A diagnosis statement. The assessment and plan should name the condition rather than point at the scan. “Cholelithiasis without cholecystitis” or “symptomatic gallstones” gives the coder a diagnosis to assign.

A worked example shows how a K80.20 claim moves

Take an illustrative patient with three weeks of after-dinner pain under the right ribs. Here is the path from first visit to payment, and the point where it usually goes wrong.

1. First visit. Before any imaging, the visit is coded R10.11 for right upper quadrant pain. K80.20 can’t be assigned on symptoms alone.
2. Ultrasound. The report shows shadowing stones, a normal wall and a common bile duct of normal caliber. Now all three findings are on file.
3. Surgical consult. The surgeon writes “symptomatic cholelithiasis, no acute cholecystitis, no biliary dilation” and plans a laparoscopic cholecystectomy.
4. Authorization. The front desk confirms eligibility and obtains prior authorization, then logs the number on the patient record.
5. Claim. The coder links K80.20 to CPT 47562. The claim goes out as an 837P, the clearinghouse scrubs it, and the payer’s remittance comes back as an ERA.

The trip-up comes after surgery. Pathology often reports chronic inflammation in a gallbladder that looked normal on ultrasound. If that finding changes the final diagnosis, query the surgeon before you switch to K80.10, and follow your facility’s policy on coding from pathology reports.

Laparoscopic cholecystectomy is the procedure K80.20 most often supports

K80.20 is the primary diagnosis behind the most common gallstone procedures in outpatient and surgical settings. The table lists the CPT codes most often submitted with it, and both 47562 and 47563 have their own billing guides.

NCCI bundling edits change every year, so check the edits active on the date of service before you submit. If cholangiography finds a stone in the common bile duct, the principal diagnosis may need revising.

The likely choice is a K80.7- code when gallbladder and duct stones coexist, or K80.6- when cholecystitis is present. K80.5- covers duct stones without cholangitis or cholecystitis. When that duct stone causes no obstruction, assign code K80.50. If the duct stone is then cleared at ERCP after cutting the sphincter, bill the sphincterotomy under ERCP code 43262.

Payers treat elective gallbladder surgery as a medical-necessity question

Medicare and most commercial payers treat laparoscopic cholecystectomy linked to K80.20 as elective, so the record has to show why surgery is needed.

The CMS Physician Fee Schedule sets Medicare payment for the procedure. Coverage criteria vary by payer and plan, so check each payer’s policy before you schedule.

Common payer requirements for cholecystectomy

• Documented symptoms. Most payers want at least one or two documented episodes of biliary colic or related symptoms. Incidental gallstones alone may not meet the medical-necessity bar.
• Conservative management. Some commercial plans want proof of dietary changes or a watchful-waiting period before surgery for uncomplicated gallstones.
• Imaging report on file. The ultrasound or CT report confirming stones should be attached to, or cited in, the authorization request.
• Prior authorization. Commercial payers often require it for elective laparoscopic cholecystectomy. Requirements differ by plan, so verify before scheduling.
• Medicaid variation. Each state’s Medicaid program sets its own criteria for gallbladder surgery.

Policies change every year, so treat this list as a starting point and confirm the current rules with each payer.

Before you submit, run through this K80.20 checklist

Each item below closes off one of the denial reasons in the next section. It takes a couple of minutes per claim.

• The imaging report names stones, not sludge, polyps or “gallbladder pathology”.
• The physician’s note states no cholecystitis in those words or something equally explicit.
• Labs or imaging rule out obstruction, and nobody has assigned K80.21 without it.
• No K81.0 or K81.1 code sits on the same claim.
• Symptom episodes are dated, or the incidental finding is labeled as incidental.
• The prior authorization number is recorded and matches the CPT code on the claim.
• Any cholangiography findings are documented, and the diagnosis still fits them.

Five documentation misses cause the usual K80.20 denials

K80.20 denials tend to trace back to a handful of causes, and each one is preventable upstream. Good denial management in healthcare catches them before the claim reaches the clearinghouse.

When one slips through, the remittance carries a reason code you can look up in our guide to denial codes.

Every row in that table is a documentation question. Answer each one before the claim goes out and it becomes a clean claim.

How Pabau gets K80.20 claims out the door complete

In many surgical practices, the K80.20 paper trail lives in four places. The ultrasound sits in one inbox and the authorization number in a spreadsheet. The surgeon’s note lives in the EHR, and the claim in a separate billing tool. Each handoff is a chance for the documentation to fall out of step with the code.

Pabau, the practice management platform we build, keeps the patient record, the authorization details and the claim together. Its claims management software builds the claim from the visit and sends it through Claim.MD as a CMS-1500 or 837P.

You can run eligibility checks through Claim.MD against the payers it supports, and its claim scrubbing flags errors before the payer sees the claim. ERA remittances come back into Pabau, so your team sees a denial reason next to the patient’s notes.

Send gallstone claims out complete the first time

Pabau builds each claim from the patient record and sends it through Claim.MD, with eligibility checks, claim scrubbing and ERA remittances in one place.

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Conclusion

K80.20 is the right code more often than coders give it credit for. Under-documented records push it down to K82.9, and over-reading the imaging pushes it up to K80.21. The fix in both cases is the same: get the physician to write down what’s absent.

If you change one habit, make it the query. A short question to the surgeon before submission costs less than a denied cholecystectomy and an appeal. Then keep the imaging, the authorization and the note together so the next claim starts complete.

Book a demo to see how Pabau keeps the record and the claim together, so your gallstone claims go out with the documentation behind them.

Continue your research

Need to understand how clearinghouse submission works for gallstone claims? Claim.MD clearinghouse guide explains how electronic claims are checked and routed through the Claim.MD network.

Looking for a primer on the full billing cycle behind surgical claims? Revenue cycle management overview covers the workflow from code assignment through payment posting.

Want to read what the payer sends back after a K80.20 claim? Electronic remittance advice explained breaks down 835 ERA files and CARC denial reason codes.

Billing the surgery itself? CPT code 47562 billing guide covers how to code and bill a laparoscopic cholecystectomy.

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