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ICD-10 Guide
ICD-10 CodesK31.9

K31.9

Billable

Disease of stomach and duodenum, unspecified

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

Code Description

ICD-10 K31.9 is a billable code used to indicate a diagnosis of disease of stomach and duodenum, unspecified.

Key Diagnostic Point:

K31.9 refers to unspecified diseases of the stomach and duodenum, which encompasses a variety of gastrointestinal conditions that may not have a clearly defined etiology or specific diagnosis. Clinically, patients may present with nonspecific symptoms such as abdominal pain, nausea, vomiting, dyspepsia, or changes in appetite. The stomach and duodenum are critical components of the digestive system, responsible for the initial breakdown of food and nutrient absorption. Diseases affecting these areas can progress from mild irritation to severe conditions such as ulcers or gastritis, which may lead to complications like bleeding or perforation. Diagnostic considerations include a thorough patient history, physical examination, and potentially imaging studies or endoscopy to rule out specific conditions such as peptic ulcers, gastritis, or malignancies. Given the broad nature of this code, it is essential for healthcare providers to document symptoms and any diagnostic tests performed to support the use of K31.9 effectively.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Varies widely based on symptoms and potential underlying conditions.
  • Treatment complexity: Treatment may range from lifestyle modifications to pharmacotherapy or surgical interventions.
  • Documentation requirements: Requires detailed documentation of symptoms, diagnostic tests, and clinical rationale.
  • Coding specificity: Lacks specificity, which may lead to challenges in accurately capturing the patient's condition.

Audit Risk Factors

  • Common coding errors: Misuse of K31.9 when a more specific diagnosis exists.
  • Documentation gaps: Insufficient detail in patient records to support the diagnosis.
  • Billing challenges: Potential for claim denials if documentation does not clearly justify the use of this unspecified code.

Specialty Focus

Medical Specialties

Primary medical specialty: 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

Secondary specialty: Internal Medicine

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

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The clinical significance of K31.9 lies in its representation of a broad spectrum of gastrointestinal disorders that can affect a significant portion of the population. These conditions can lead to increased healthcare utilization, including outpatient visits, diagnostic testing, and potential hospitalizations. Understanding and accurately coding these unspecified diseases is crucial for population health management and quality measures, as they can impact treatment outcomes and healthcare resource allocation.

ICD-9 vs ICD-10

The clinical significance of K31.9 lies in its representation of a broad spectrum of gastrointestinal disorders that can affect a significant portion of the population. These conditions can lead to increased healthcare utilization, including outpatient visits, diagnostic testing, and potential hospitalizations. Understanding and accurately coding these unspecified diseases is crucial for population health management and quality measures, as they can impact treatment outcomes and healthcare resource allocation.

Reimbursement & Billing Impact

Reimbursement considerations may vary based on the payer, so understanding the specific requirements of each insurance provider is essential for successful billing.

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 K31.9?

K31.9 covers a range of unspecified diseases affecting the stomach and duodenum, including but not limited to gastritis, functional dyspepsia, and other non-specific gastrointestinal disorders that do not fit into more defined categories.

When should K31.9 be used instead of related codes?

K31.9 should be used when a patient presents with gastrointestinal symptoms that do not lead to a specific diagnosis after thorough evaluation. It is important to ensure that all other potential conditions have been ruled out before using this code.

What documentation supports K31.9?

Documentation should include a detailed account of the patient's symptoms, any diagnostic tests performed (such as endoscopy or imaging), and the clinical rationale for using an unspecified code. Clear notes on the absence of a specific diagnosis are crucial.