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ICD-10 Guide
ICD-10 CodesK31.1

K31.1

Billable

Adult hypertrophic pyloric stenosis

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/06/2025

Code Description

ICD-10 K31.1 is a billable code used to indicate a diagnosis of adult hypertrophic pyloric stenosis.

Key Diagnostic Point:

Adult hypertrophic pyloric stenosis is a condition characterized by the abnormal thickening of the pyloric sphincter, which is located at the junction of the stomach and the small intestine. This thickening leads to a narrowing of the pylorus, resulting in gastric outlet obstruction. Clinically, patients may present with symptoms such as persistent vomiting, abdominal pain, and weight loss. The condition is often diagnosed through imaging studies such as ultrasound or upper gastrointestinal series, which can reveal the characteristic 'string sign' or delayed gastric emptying. The disease progression can lead to severe dehydration and electrolyte imbalances if not addressed promptly. Anatomically, the pylorus consists of the pyloric canal and pyloric sphincter, which play a crucial role in regulating the passage of food from the stomach to the duodenum. Diagnostic considerations include a thorough patient history, physical examination, and appropriate imaging to confirm the diagnosis and rule out other gastrointestinal disorders. Treatment typically involves surgical intervention, specifically a pyloromyotomy, to relieve the obstruction and restore normal gastric function.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity
  • Treatment complexity
  • Documentation requirements
  • Coding specificity

Audit Risk Factors

  • Common coding errors include misidentifying the condition as a pediatric issue, as it primarily affects adults in this coding context.
  • Documentation gaps may arise if the clinical presentation is not thoroughly detailed.
  • Billing challenges can occur if the surgical procedure is not properly linked to the diagnosis.

Specialty Focus

Medical Specialties

Gastroenterology

Documentation Requirements

Standard ICD-10-CM documentation requirements apply

Common Clinical Scenarios

Various clinical presentations within this specialty area

Billing Considerations

Follow specialty-specific billing guidelines

General Surgery

Documentation Requirements

Standard ICD-10-CM documentation requirements apply

Common Clinical Scenarios

Various clinical presentations within this specialty area

Billing Considerations

Follow specialty-specific billing guidelines

Related ICD-10 Codes

Related CPT Codes

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The clinical significance of K31.1 lies in its potential to cause severe gastrointestinal complications if left untreated. Understanding the epidemiology of this condition is crucial, as it can affect adult populations, particularly those with underlying gastrointestinal disorders. Quality measures may focus on timely diagnosis and effective surgical intervention, impacting healthcare utilization patterns and improving patient outcomes.

ICD-9 vs ICD-10

The clinical significance of K31.1 lies in its potential to cause severe gastrointestinal complications if left untreated. Understanding the epidemiology of this condition is crucial, as it can affect adult populations, particularly those with underlying gastrointestinal disorders. Quality measures may focus on timely diagnosis and effective surgical intervention, impacting healthcare utilization patterns and improving patient outcomes.

Reimbursement & Billing Impact

Reimbursement considerations include ensuring that the surgical procedure performed, such as pyloromyotomy, is appropriately linked to the diagnosis. Common denials may arise from insufficient documentation or failure to provide evidence of medical necessity. Best practices include maintaining thorough records of patient symptoms, imaging studies, and treatment plans to support claims and reduce the risk of audits.

Resources

Clinical References

  • •
    ICD-10 Official Guidelines for K00-K99
  • •
    Clinical Documentation Requirements

Coding & Billing References

  • •
    ICD-10 Official Guidelines for K00-K99
  • •
    Clinical Documentation Requirements

Frequently Asked Questions

What specific conditions are covered by K31.1?

K31.1 specifically covers adult hypertrophic pyloric stenosis, which is characterized by the thickening of the pyloric sphincter leading to gastric outlet obstruction. It is important to differentiate this condition from other types of pyloric stenosis that may occur in infants.

When should K31.1 be used instead of related codes?

K31.1 should be used when the diagnosis of adult hypertrophic pyloric stenosis is confirmed, particularly when the clinical presentation aligns with the symptoms and diagnostic findings associated with this specific condition, as opposed to other gastrointestinal disorders.

What documentation supports K31.1?

Documentation for K31.1 should include a detailed patient history, physical examination findings, imaging results confirming pyloric stenosis, and any surgical notes if applicable. Clear documentation of symptoms and treatment plans is essential for accurate coding.