K11.4 — Fistula of salivary gland
K11.4 is a billable, specific ICD-10-CM code for fistula of salivary gland. It is valid for submission on a claim.
Excludes1 — never code together
These conditions cannot occur together. Billing both on the same encounter is a denial.
- congenital fistula of salivary gland (Q38.4)
Risk adjustment
K11.4 does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.
Medicare coverage
K11.4 is named in 1 Medicare coverage policy — 1 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- A57204Billing and Coding: MRI and CT Scans of the Head and Neck
How K11.4 is indexed
Coders do not find codes by browsing the tabular list — they look them up in the alphabetic index, under the word the physician wrote. These are the index entries that lead here, so you can see which chart wordings map to K11.4.
- Fistula›parotid(gland)
- Fistula›salivary duct or gland(any)
- Fistula›sublingual gland
- Fistula›submandibular gland
- Fistula›submaxillary(gland)
Related codes at this level
Codes that share K11. If K11.4 is not quite right, the correct code is usually one of these.
Questions about K11.4
- Is K11.4 a billable ICD-10-CM code?
- Yes. K11.4 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does K11.4 sit in the tabular list?
- Diseases of the digestive system (K00-K95), in the block Diseases of oral cavity and salivary glands (K00-K14).
- What cannot be coded together with K11.4?
- K11.4 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.