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ICD-10 Guide
ICD-10 CodesK31.4

K31.4

Billable

Gastric diverticulum

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

Code Description

ICD-10 K31.4 is a billable code used to indicate a diagnosis of gastric diverticulum.

Key Diagnostic Point:

Gastric diverticulum, classified under ICD-10 code K31.4, refers to the presence of a diverticulum in the stomach, which is a pouch-like structure that protrudes from the gastric wall. This condition can be asymptomatic or may present with symptoms such as abdominal pain, nausea, vomiting, and dyspepsia. The diverticulum typically occurs in the antrum of the stomach and can be congenital or acquired due to factors such as chronic inflammation or increased intragastric pressure. Disease progression may lead to complications such as diverticulitis, perforation, or obstruction, necessitating careful monitoring and management. Diagnosis is primarily achieved through imaging studies such as endoscopy or barium swallow studies, which can visualize the diverticulum and assess for associated complications. Clinicians must consider differential diagnoses, including peptic ulcer disease and gastric tumors, to ensure accurate diagnosis and treatment planning.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires imaging and differential diagnosis.
  • Treatment complexity: May involve surgical intervention in complicated cases.
  • Documentation requirements: Detailed clinical notes and imaging reports are essential.
  • Coding specificity: Requires precise coding to differentiate from other gastric conditions.

Audit Risk Factors

  • Common coding errors: Misclassification with other gastric conditions.
  • Documentation gaps: Incomplete clinical notes or lack of imaging reports.
  • Billing challenges: Potential denials if documentation does not support 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

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The clinical significance of gastric diverticulum lies in its potential complications, which can affect patient quality of life and healthcare utilization. While the condition itself may be rare, understanding its implications is crucial for gastroenterologists and surgeons. Population health impact is minimal, but awareness can lead to better management of symptomatic patients and reduce the risk of complications. Quality measures may include monitoring for timely diagnosis and appropriate intervention, contributing to improved patient outcomes.

ICD-9 vs ICD-10

The clinical significance of gastric diverticulum lies in its potential complications, which can affect patient quality of life and healthcare utilization. While the condition itself may be rare, understanding its implications is crucial for gastroenterologists and surgeons. Population health impact is minimal, but awareness can lead to better management of symptomatic patients and reduce the risk of complications. Quality measures may include monitoring for timely diagnosis and appropriate intervention, contributing to improved patient outcomes.

Reimbursement & Billing Impact

Reimbursement considerations may vary based on the complexity of the case and the interventions performed. Common denials can occur if the documentation does not clearly establish the diagnosis or if the procedure codes do not align with the diagnosis. Best practices include thorough documentation of symptoms, imaging results, and any treatments administered.

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 K31.4?

K31.4 specifically covers gastric diverticulum, which may be asymptomatic or symptomatic. It does not include complications such as diverticulitis, which is coded separately under K31.5.

When should K31.4 be used instead of related codes?

K31.4 should be used when a gastric diverticulum is diagnosed without associated complications. If complications such as inflammation or perforation are present, K31.5 or other relevant codes should be utilized.

What documentation supports K31.4?

Documentation must include clinical findings, imaging results confirming the presence of a gastric diverticulum, and any relevant patient history that supports the diagnosis.