The ICD-10 code range K55-K64 encompasses a variety of diseases and conditions related to the intestines. These codes cover conditions such as vascular disorders of the intestines, diverticular disease, irritable bowel syndrome, and other functional intestinal disorders. The codes also include conditions such as fistulas, abscesses, and perforations of the intestines. The range is designed to provide a comprehensive classification system for a wide range of intestinal diseases, allowing for accurate documentation and billing.

Key Usage Points:

•Always code to the highest level of specificity.
•Use additional codes to identify any associated conditions or complications.
•Use combination codes when a single code can describe both the condition and its manifestation.
•Remember to code for any underlying conditions first, followed by the manifestation.
•Always verify codes in the ICD-10-CM book before finalizing your coding.

Coding Guidelines

When to Use:

✓When a patient has been diagnosed with a vascular disorder of the intestines.
✓When a patient has diverticular disease of the intestines.
✓When a patient has a functional intestinal disorder such as irritable bowel syndrome.
✓When a patient has a condition such as a fistula, abscess, or perforation of the intestines.
✓When a patient has other specified diseases of the intestines.

When NOT to Use:

✗When a patient has a condition related to the stomach or esophagus. These conditions have their own specific codes.
✗When a patient has a condition related to the rectum or anus. These conditions also have their own specific codes.
✗When a patient has a condition related to the liver, gallbladder, or pancreas. These conditions are not included in the K55-K64 range.
✗When a patient has a condition related to the digestive system but it is not specifically related to the intestines. These conditions have their own specific codes.
✗When a patient has a condition that is a symptom or sign rather than a diagnosed disease or disorder. These conditions have their own specific codes.

Code Exclusions

Always verify exclusions in the ICD-10-CM book to ensure accurate coding.

Documentation Requirements

Proper documentation for the K55-K64 range requires detailed clinical information and supporting evidence. The documentation should clearly state the specific condition, its location in the intestines, and any associated conditions or complications. The documentation should also include information on the patient's symptoms, the results of any diagnostic tests, and the treatment plan.

Clinical Information:

•Specific diagnosis
•Location of the condition in the intestines
•Associated conditions or complications
•Patient's symptoms
•Results of diagnostic tests

Supporting Evidence:

•Medical history
•Physical examination findings
•Laboratory test results
•Imaging results

Good Documentation Example:

Patient diagnosed with diverticular disease of the sigmoid colon. Patient reports abdominal pain and bloating. CT scan confirms the presence of diverticula.

Poor Documentation Example:

Patient has stomach pain.

Common Documentation Errors:

⚠Not coding to the highest level of specificity
⚠Not using additional codes to identify associated conditions or complications
⚠Not coding for underlying conditions first
⚠Not verifying codes in the ICD-10-CM book

Range Statistics

Total Codes

130

Billable

Complexity:

Medium

Primary Use:Clinical Documentation

Chapter:11

Coding Complexity

Medium

Complexity Rating

The K55-K64 range is rated as medium complexity due to the need for detailed clinical information and supporting evidence. The coder must also be familiar with the use of additional codes and the correct order of coding. However, with proper documentation and verification, these codes can be used accurately and effectively.

Key Factors:

▸The need to code to the highest level of specificity
▸The need to use additional codes to identify associated conditions or complications
▸The need to code for underlying conditions first
▸The need to verify codes in the ICD-10-CM book

Specialty Focus

The K55-K64 range is most commonly used by gastroenterologists, but may also be used by general practitioners, internists, and surgeons. These codes are used to document a wide range of intestinal diseases and conditions.

Primary Specialties:

Gastroenterology

60%

General Practice

30%

Surgery

10%

Clinical Scenarios:

• A patient presents with abdominal pain and is diagnosed with diverticular disease of the sigmoid colon.
• A patient with a history of irritable bowel syndrome presents with increased frequency of bowel movements and abdominal pain.
• A patient is diagnosed with a fistula in the intestines following a surgical procedure.
• A patient presents with abdominal pain and is diagnosed with a vascular disorder of the intestines.
• A patient is diagnosed with an abscess in the intestines following a CT scan.

Resources & References

There are many resources available to assist with coding in the K55-K64 range. These include the official ICD-10-CM guidelines, clinical reference sources, and educational materials.

Official Guidelines:

ICD-10-CM Official Guidelines for Coding and Reporting
American Health Information Management Association (AHIMA) Coding Guidelines
Centers for Medicare & Medicaid Services (CMS) Coding Guidelines

Clinical References:

American Gastroenterological Association Clinical Guidelines
American College of Gastroenterology Clinical Guidelines
World Gastroenterology Organisation Global Guidelines

Educational Materials:

AHIMA ICD-10-CM Coding Workbook
AAPC ICD-10-CM Training Manual
CMS ICD-10-CM Training Materials

Frequently Asked Questions

What is the most important factor in coding accurately in the K55-K64 range?

The most important factor is having detailed clinical information and supporting evidence. This allows for coding to the highest level of specificity and the use of additional codes to identify associated conditions or complications.

What are the most common errors in coding in the K55-K64 range?

The most common errors include not coding to the highest level of specificity, not using additional codes to identify associated conditions or complications, not coding for underlying conditions first, and not verifying codes in the ICD-10-CM book.