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ICD-10 Guide
ICD-10 CodesK56.1

K56.1

Billable

Intussusception

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

Code Description

ICD-10 K56.1 is a billable code used to indicate a diagnosis of intussusception.

Key Diagnostic Point:

Intussusception is a condition where a part of the intestine telescopes into an adjacent segment, leading to obstruction. This often occurs in children but can also affect adults. The clinical presentation may include acute abdominal pain, vomiting, and the passage of currant jelly-like stools due to the presence of blood and mucus. The anatomy involved typically includes the ileum and cecum, although any segment of the intestine can be affected. Disease progression can lead to ischemia, perforation, and peritonitis if not promptly diagnosed and treated. Diagnostic considerations include imaging studies such as ultrasound or CT scans, which can reveal the characteristic 'target sign' or 'doughnut sign' indicative of intussusception. Early recognition and intervention are crucial to prevent complications, making awareness of this condition essential for healthcare providers.

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 type of obstruction.
  • Documentation gaps may arise if imaging results are not clearly noted.
  • Billing challenges can occur if the urgency of treatment is not adequately documented.

Specialty Focus

Medical Specialties

Pediatrics

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

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

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

Intussusception has significant clinical implications, particularly in pediatric populations where it is a common cause of intestinal obstruction. Early diagnosis and treatment can reduce complications and improve outcomes. Understanding the epidemiology of intussusception can help healthcare providers identify at-risk populations and implement preventive measures, ultimately enhancing quality of care and reducing healthcare utilization.

ICD-9 vs ICD-10

Intussusception has significant clinical implications, particularly in pediatric populations where it is a common cause of intestinal obstruction. Early diagnosis and treatment can reduce complications and improve outcomes. Understanding the epidemiology of intussusception can help healthcare providers identify at-risk populations and implement preventive measures, ultimately enhancing quality of care and reducing healthcare utilization.

Reimbursement & Billing Impact

Reimbursement considerations include the urgency of treatment, as intussusception often necessitates immediate intervention. Common denials may arise from insufficient documentation of the clinical necessity for surgery or imaging. Best practices include ensuring that all clinical notes, imaging results, and treatment plans are clearly documented and linked to the diagnosis to support claims.

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 K56.1?

K56.1 specifically covers intussusception, which may be classified further based on the location (e.g., ileocolic, ileoileal) and whether it is acute or chronic. It does not cover other types of intestinal obstructions.

When should K56.1 be used instead of related codes?

K56.1 should be used when the diagnosis of intussusception is confirmed through imaging or clinical findings. It is distinct from other obstruction codes, which may not involve the telescoping mechanism.

What documentation supports K56.1?

Documentation should include clinical findings, imaging results confirming intussusception, and any surgical reports if applicable. Detailed notes on symptoms and treatment plans are also essential.