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ICD-10 Guide
ICD-10 CodesK63.821

K63.821

Non-billable

Small intestinal bacterial overgrowth

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

Code Description

ICD-10 K63.821 is a used to indicate a diagnosis of small intestinal bacterial overgrowth.

Key Diagnostic Point:

Small intestinal bacterial overgrowth (SIBO) is a condition characterized by an abnormal increase in the overall bacterial population in the small intestine, particularly types of bacteria not commonly found in that part of the digestive tract. Clinically, patients may present with symptoms such as bloating, diarrhea, abdominal pain, and malabsorption, which can lead to weight loss and nutritional deficiencies. The anatomy involved primarily includes the small intestine, which is responsible for nutrient absorption. The disease progression can vary; if left untreated, SIBO can lead to chronic gastrointestinal issues and complications such as intestinal damage and further malabsorption. Diagnostic considerations for SIBO typically involve breath tests (such as lactulose or glucose breath tests) to measure hydrogen and methane levels, as well as stool tests to assess fat malabsorption. A thorough patient history and physical examination are also critical to rule out other gastrointestinal disorders that may mimic SIBO symptoms.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires specific tests to confirm
  • Treatment complexity: May involve dietary changes, antibiotics, and probiotics
  • Documentation requirements: Detailed clinical history and test results needed
  • Coding specificity: Requires precise coding to differentiate from other gastrointestinal disorders

Audit Risk Factors

  • Common coding errors: Misuse of related codes or unspecified codes
  • Documentation gaps: Lack of comprehensive patient history or test results
  • Billing challenges: Potential denials due to insufficient documentation or incorrect coding

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

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

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

SIBO has significant clinical implications, affecting patient quality of life and leading to potential nutritional deficiencies. Its prevalence is increasing, particularly among individuals with underlying gastrointestinal disorders. Understanding SIBO can improve population health outcomes by promoting early diagnosis and effective management, thereby reducing healthcare utilization and improving patient satisfaction.

ICD-9 vs ICD-10

SIBO has significant clinical implications, affecting patient quality of life and leading to potential nutritional deficiencies. Its prevalence is increasing, particularly among individuals with underlying gastrointestinal disorders. Understanding SIBO can improve population health outcomes by promoting early diagnosis and effective management, thereby reducing healthcare utilization and improving patient satisfaction.

Reimbursement & Billing Impact

Reimbursement considerations include ensuring that the diagnostic tests performed are medically necessary and properly documented. Common denials may arise from insufficient documentation or failure to provide evidence of the clinical rationale for testing. Best practices include maintaining thorough records of patient symptoms, test results, and treatment plans to support claims and reduce the likelihood 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 K63.821?

K63.821 specifically covers small intestinal bacterial overgrowth, which may be associated with conditions such as irritable bowel syndrome (IBS), celiac disease, and other disorders that affect gut motility or anatomy.

When should K63.821 be used instead of related codes?

K63.821 should be used when there is a confirmed diagnosis of SIBO based on clinical evaluation and diagnostic testing, differentiating it from other gastrointestinal disorders that may present with similar symptoms.

What documentation supports K63.821?

Documentation for K63.821 should include a detailed patient history, results from breath tests or stool tests confirming SIBO, and any relevant treatment plans or referrals to specialists.