cholelithiasis

DEFINITION of cholelithiasis

Cholelithiasis is the condition of having one or more calculi (gallstones) formed within the gallbladder or, when stones migrate, within the biliary ductal system, resulting from the supersaturation and crystallization of bile constituents — most commonly cholesterol, bilirubin pigment, or calcium salts. It is distinguished from cholecystitis, which refers specifically to inflammation of the gallbladder wall (most often caused by stone obstruction of the cystic duct) and from choledocholithiasis, which denotes stones residing within the common bile duct rather than the gallbladder itself, though the two conditions frequently coexist and are coded separately. The underlying pathophysiological mechanism involves an imbalance between the solubility of bile components and their concentration: cholesterol stones (the most common type, ~80% of cases in Western populations) form when bile becomes supersaturated with cholesterol relative to bile salts and phospholipids, while pigment stones form from excess unconjugated bilirubin, often in the setting of hemolytic disease or biliary infection. Cholelithiasis may be entirely physiological in presentation — the majority of gallstones are asymptomatic and discovered incidentally — or pathological, manifesting as biliary colic, acute cholecystitis (K81.0), cholangitis (K83.09), or pancreatitis (K85.10-K85.12) when a stone obstructs the cystic, common bile, or pancreatic duct. For ICD-10-CM coding, the primary axis of specificity is location (gallbladder vs. bile duct) and presence of complications (obstruction, acute cholecystitis, chronic cholecystitis, or acute-on-chronic cholecystitis), with the full K80.xx family requiring precise documentation of both to assign the most specific code. Cholelithiasis is commonly confused with biliary dyskinesia — the key distinction is that dyskinesia involves abnormal gallbladder motility without stones, coded to K82.8, whereas cholelithiasis requires confirmed calculi on imaging.

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ETYMOLOGY of cholelithiasis

greek

Component	Origin	Meaning
chol- / chole-	Greek χολή (kholē, KHO-lay)	“bile,” “gall” — the yellow-green digestive fluid produced by the liver; also the root of the humoral concept of “choler” (yellow bile); combining prefix in all biliary medical terms
-lith-	Greek λίθος (lithos, LEE-thos)	“stone,” “rock,” “calculus” — combining form denoting a calcified or stone-like concretion within a body organ or duct
-iasis	Greek -ίασις (-iasis, ee-AH-sis)	Noun-forming suffix — “condition of,” “pathological state characterized by” — used in medicine to denote a disease state defined by the presence of something (e.g., infestation, concretion, or organism)

The word entered English medical usage in the 1850s as cholelithiasis (noun), formed directly from Greek elements in Neo-Latin scientific nomenclature — literally “condition of bile stones.” The root lithos (“stone”) is extraordinarily productive in medical terminology and connects cholelithiasis to the entire -lith- family: nephrolithiasis (nephro- + lith- + -iasis → “condition of kidney stones”), urolithiasis (uro- + lith- + -iasis → “condition of urinary stones”), sialolithiasis (sialo- + lith- + -iasis → “condition of salivary duct stones”), and lithotripsy (lith- + -tripsy → “stone crushing”). The combining form chole- (“bile”) is equally productive: cholecystitis (chole- + cyst- + -itis → “inflammation of the bile bladder”), choledocholithiasis (chole- + docho- + lith- + -iasis → “condition of stones in the bile duct”), cholangitis (chol-+ angi- + -itis → “inflammation of bile vessels/ducts”), and cholesterol (chole- + stereos → “solid bile substance”).

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🔀 ALIASES / ALTERNATE TERMS

• Cholelithic (adjective form — used in clinical collocations such as “cholelithic pancreatitis,” “cholelithic cholecystitis,” and “cholelithic biliary colic”)
• Gallstones (primary lay term and the most common clinical shorthand; used universally across specialties — maps to K80.xx depending on location and complication status)
• Biliary calculi (formal anatomic synonym; preferred in radiology and pathology reports; codes to the same K80.xx family based on location and complications)
• Cholecystolithiasis (synonym specifying stones within the gallbladder specifically, as opposed to the biliary ducts; maps to K80.10-K80.21)
• Choledocholithiasis (stones located within the common bile duct — a distinct and separately coded condition from gallbladder stones; maps to K80.30-K80.51; always query for this when ERCP is performed or CBD dilation is noted on imaging)
• Biliary colic (the symptomatic presentation of intermittent cystic duct obstruction by a gallstone without sustained inflammation; coded under K80.20 or K80.21 — cholelithiasis without cholecystitis, with or without obstruction; not a standalone ICD-10-CM code)
• Symptomatic cholelithiasis (clinical descriptor for gallstones causing pain, nausea, or biliary colic; drives the indication for cholecystectomy; maps to K80.20 or K80.21)
• Asymptomatic cholelithiasis (incidental stones found on imaging without symptoms; most common presentation overall; still coded to K80.xx as appropriate — “asymptomatic” does not change code assignment)
• Cholesterol gallstones (most common stone type in Western populations — ~80%; formed by cholesterol supersaturation; no separate ICD-10-CM subtype code — all map to K80.xx based on location and complication)
• Pigment gallstones (black or brown stones composed of bilirubin; associated with hemolytic anemia, cirrhosis, and biliary infection; code to K80.xx based on location; code the underlying hemolytic or hepatic condition separately)
• Microlithiasis|Biliary microlithiasis (stones too small to be seen on standard ultrasound, detected on EUS or MRCP; associated with recurrent pancreatitis; maps to K80.20 or K80.21 when documented)
• Gallbladder sludge (viscous bile mixture of cholesterol crystals, calcium bilirubinate, and mucin; precursor to stone formation; coded to K82.8 — other specified diseases of gallbladder — not K80.xx unless frank stones are documented)

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🔗 RELATED TERMS

• Cholecystitis — inflammation of the gallbladder, most commonly caused by cystic duct obstruction by a gallstone; when occurring together with cholelithiasis, the combination is coded with a single combination code from the K80.0x (acute) or K80.1x (chronic) subcategories rather than coding both K80.xx and K81.x separately — a critical combination code rule for inpatient coding
• Choledocholithiasis — gallstones that have migrated from the gallbladder into the common bile duct; coded separately at K80.3x-K80.5x; clinically significant because CBD stones cause obstructive jaundice, cholangitis, and pancreatitis; always query when ERCP or intraoperative cholangiogram is performed
• Cholangitis — bacterial infection of the bile ducts, most commonly caused by choledocholithiasis with obstruction; coded to K83.09 (other cholangitis) as a complication; Charcot’s triad (fever, jaundice, RUQ pain) and Reynolds’ pentad (+ shock + altered mental status) are clinical triggers for query
• Acute pancreatitis — inflammation of the pancreas caused by gallstone obstruction at the ampulla of Vater; coded to K85.10-K85.12 (biliary acute pancreatitis); the gallstone etiology must be documented to assign the biliary subtype — query when pancreatitis admission includes cholelithiasis on imaging
• Biliary obstruction — blockage of bile flow through the cystic or common bile duct by a calculus; reflected in ICD-10-CM as the “with obstruction” axis within the K80.xx combination codes (e.g., K80.21 vs. K80.20); always query for obstruction when dilation of the CBD is noted on imaging or bilirubin is elevated
• Biliary dyskinesia — abnormal gallbladder motility without stones; presents similarly to biliary colic but is distinguished by a normal ultrasound and abnormal HIDA scan with low ejection fraction; coded to K82.8 — not K80.xx; a key differential when cholecystectomy is performed without confirmed stones
• Jaundice — yellowing of skin and sclera from hyperbilirubinemia; occurs when choledocholithiasis obstructs bile flow; coded as R17 when present as a symptom not integral to the primary diagnosis — query for the underlying cause (obstruction vs. hepatic vs. hemolytic)
• Cholesterol — the primary constituent of the most common gallstone type; hypercholesterolemia and obesity are major risk factors for cholesterol gallstone formation; code comorbid hyperlipidemia (E78.xx) separately when documented
• Hepatolithiasis — stones within the intrahepatic bile ducts; less common, associated with recurrent pyogenic cholangitis; coded to K83.1 (obstruction of bile duct) or K80.80-K80.81 (other cholelithiasis); query for this when intrahepatic duct dilation is noted
• Postcholecystectomy syndrome — persistent biliary symptoms following gallbladder removal; may indicate retained CBD stone or sphincter of Oddi dysfunction; coded to K91.5
• Hemolytic anemia — systemic condition causing excess bilirubin production, predisposing to pigment gallstone formation; code the specific anemia (D55.x-D58.x) as a comorbidity when documented as contributing to cholelithiasis
• Abdominal ultrasound — primary and first-line diagnostic modality for gallstone detection; highly sensitive (>95%) for gallbladder stones; less sensitive for choledocholithiasis (CBD stones), which may require MRCP or EUS for definitive diagnosis

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CODING CORNER

🏥 ICD-10-CM CODES

Calculus of Gallbladder with Acute Cholecystitis (K80.0x — Combination Codes)

Code	Description
K80.00	Calculus of gallbladder with acute cholecystitis without obstruction
K80.01	Calculus of gallbladder with acute cholecystitis with obstruction

Calculus of Gallbladder with Other Cholecystitis (K80.1x — Chronic & Acute-on-Chronic)

Code	Description
K80.10	Calculus of gallbladder with chronic cholecystitis without obstruction
K80.11	Calculus of gallbladder with chronic cholecystitis with obstruction
K80.12	Calculus of gallbladder with acute and chronic cholecystitis without obstruction
K80.13	Calculus of gallbladder with acute and chronic cholecystitis with obstruction
K80.18	Calculus of gallbladder with other cholecystitis without obstruction
K80.19	Calculus of gallbladder with other cholecystitis with obstruction

Calculus of Gallbladder without Cholecystitis (K80.2x — Biliary Colic / Uncomplicated)

Code	Description
K80.20	Calculus of gallbladder without cholecystitis without obstruction
K80.21	Calculus of gallbladder without cholecystitis with obstruction

Calculus of Bile Duct with Cholangitis (K80.3x — Choledocholithiasis + Cholangitis)

Code	Description
K80.30	Calculus of bile duct with cholangitis, unspecified, without obstruction
K80.31	Calculus of bile duct with cholangitis, unspecified, with obstruction
K80.32	Calculus of bile duct with acute cholangitis without obstruction
K80.33	Calculus of bile duct with acute cholangitis with obstruction
K80.34	Calculus of bile duct with chronic cholangitis without obstruction
K80.35	Calculus of bile duct with chronic cholangitis with obstruction
K80.36	Calculus of bile duct with acute and chronic cholangitis without obstruction
K80.37	Calculus of bile duct with acute and chronic cholangitis with obstruction

Calculus of Bile Duct with Cholecystitis (K80.4x — CBD Stone + Cholecystitis)

Code	Description
K80.40	Calculus of bile duct with cholecystitis, unspecified, without obstruction
K80.41	Calculus of bile duct with cholecystitis, unspecified, with obstruction
K80.42	Calculus of bile duct with acute cholecystitis without obstruction
K80.43	Calculus of bile duct with acute cholecystitis with obstruction
K80.44	Calculus of bile duct with chronic cholecystitis without obstruction
K80.45	Calculus of bile duct with chronic cholecystitis with obstruction
K80.46	Calculus of bile duct with acute and chronic cholecystitis without obstruction
K80.47	Calculus of bile duct with acute and chronic cholecystitis with obstruction

Calculus of Bile Duct without Cholangitis or Cholecystitis (K80.5x)

Code	Description
K80.50	Calculus of bile duct without cholangitis or cholecystitis without obstruction
K80.51	Calculus of bile duct without cholangitis or cholecystitis with obstruction

Calculus of Gallbladder and Bile Duct (K80.6x — Stones at Both Sites)

Code	Description
K80.60	Calculus of gallbladder and bile duct with cholecystitis, unspecified, without obstruction
K80.61	Calculus of gallbladder and bile duct with cholecystitis, unspecified, with obstruction
K80.62	Calculus of gallbladder and bile duct with acute cholecystitis without obstruction
K80.63	Calculus of gallbladder and bile duct with acute cholecystitis with obstruction
K80.64	Calculus of gallbladder and bile duct with chronic cholecystitis without obstruction
K80.65	Calculus of gallbladder and bile duct with chronic cholecystitis with obstruction
K80.66	Calculus of gallbladder and bile duct with acute and chronic cholecystitis without obstruction
K80.67	Calculus of gallbladder and bile duct with acute and chronic cholecystitis with obstruction
K80.70	Calculus of gallbladder and bile duct without cholecystitis without obstruction
K80.71	Calculus of gallbladder and bile duct without cholecystitis with obstruction

Other Cholelithiasis (K80.8x)

Code	Description
K80.80	Other cholelithiasis without obstruction
K80.81	Other cholelithiasis with obstruction

Closely Related Gallbladder & Biliary Codes (Frequently Coded with K80.xx)

Code	Description
K81.0	Acute cholecystitis (without gallstones — code only when stones are NOT documented; use K80.0x combination codes when stones ARE present)
K81.1	Chronic cholecystitis (without stones — same rule applies; use K80.1x when stones are documented)
K81.9	Cholecystitis, unspecified
K83.09	Other cholangitis (used for cholangitis not captured in K80.3x combination codes, or when stones not confirmed)
K83.1	Obstruction of bile duct (biliary obstruction without confirmed stones — e.g., stricture, external compression)
K82.8	Other specified diseases of gallbladder (includes biliary dyskinesia and gallbladder sludge)
K82.9	Disease of gallbladder, unspecified
K85.10	Biliary acute pancreatitis without necrosis or infection
K85.11	Biliary acute pancreatitis with uninfected necrosis
K85.12	Biliary acute pancreatitis with infected necrosis
K91.5	Postcholecystectomy syndrome
R17	Unspecified jaundice (code as additional dx when obstructive jaundice is present and not integral to the primary code)

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🔧 COMMON CPT CODES (Cholelithiasis — Diagnosis & Treatment)

CPT Code	Description
76700	Ultrasound, abdominal, real time with image documentation, complete (primary first-line imaging for gallstone detection)
76705	Ultrasound, abdominal, real time with image documentation, limited (focused RUQ ultrasound for gallbladder evaluation)
74181	MRI abdomen without contrast (MRCP protocol for biliary tree evaluation and choledocholithiasis detection)
74183	MRI abdomen without and with contrast (MRCP with contrast for complex biliary anatomy or suspected mass)
43260	Endoscopic retrograde cholangiopancreatography (ERCP); diagnostic, including collection of specimen(s) by brushing or washing
43264	ERCP with removal of calculi/debris from biliary and/or pancreatic ducts (therapeutic ERCP — stone extraction from CBD; primary treatment for choledocholithiasis)
43262	ERCP with sphincterotomy/papillotomy (biliary sphincterotomy to facilitate stone passage or extraction)
47562	Laparoscopic cholecystectomy (definitive surgical treatment for symptomatic cholelithiasis; most common elective general surgery procedure)
47563	Laparoscopic cholecystectomy with intraoperative cholangiography (adds cholangiogram to assess for CBD stones intraoperatively — triggers query for choledocholithiasis if CBD stone found)
47564	Laparoscopic cholecystectomy with exploration of common duct
47600	Cholecystectomy, open (open approach; used in cases with complex anatomy, perforation, or failed laparoscopic approach)

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⚠️ Coding Note: The K80.xx family is built on a two-axis matrix — (1) stone location (gallbladder, bile duct, or both) and (2) complication status (acute cholecystitis, chronic cholecystitis, acute-on-chronic, cholangitis, or no cholecystitis) — plus the obstruction flag as the final digit (0 = without, 1 = with); all three axes must be captured from documentation before assigning a code, and a query should be generated whenever the physician documents only “cholelithiasis” or “gallstones” without specifying inflammation or obstruction status. A critical combination code rule: do not separately code K81.x (cholecystitis) when stones are present — the K80.0x and K80.1x subcategories are combination codes that fully capture both the stone and the inflammation; coding both K80.xx and K81.x is duplicative and incorrect. The highest-value undercoding alert in this family is obstruction — when imaging documents a dilated common bile duct, elevated direct bilirubin, or delayed biliary drainage, the “with obstruction” 7th character should be assigned, and a physician query should confirm obstruction if not explicitly stated, as this distinction affects medical necessity and DRG weight. When biliary acute pancreatitis (K85.10-K85.12) is the reason for admission and cholelithiasis is the confirmed etiology, the pancreatitis is typically sequenced as principal diagnosis with K80.xx as a secondary code, unless the clinical circumstances clearly indicate the stone as the primary focus of treatment (e.g., emergent ERCP performed before pancreatitis workup). For inpatient profee encounters involving laparoscopic cholecystectomy with intraoperative cholangiogram (CPT 47563), always review the operative report for CBD stone documentation — a positive cholangiogram finding supports upgrading the ICD-10-CM from a K80.2x (gallbladder stones without cholecystitis) to a K80.5x or K80.6x (bile duct stone or combined) code.

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DERIVATIONS of cholelithiasis

TABLE definition AS Definition
FROM #medterm
WHERE length(filter(roots, (word) => econtains([[Cholelithiasis]].roots, word))) > 0 AND file.name != [[Cholelithiasis]].file.name
SORT file.name ASC

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Query functionality

TABLE definition AS Definition
FROM #medterm
WHERE length(filter(definition, (word) => econtains([[Cholelithiasis]].definition, word))) > 0 AND file.name != [[Cholelithiasis]].file.name

Med roots dictionary Appendix A Prefixes Appendix B Combining Forms Appendix C Suffixes Appendix D Suffix forms