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ICD-10 Guide
ICD-10 CodesK63.8219

K63.8219

Billable

Small intestinal bacterial overgrowth, unspecified

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

Code Description

ICD-10 K63.8219 is a billable code used to indicate a diagnosis of small intestinal bacterial overgrowth, unspecified.

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, which can lead to various gastrointestinal symptoms. Clinically, patients may present with bloating, diarrhea, abdominal pain, and malabsorption, which can result in nutritional deficiencies. The anatomy involved primarily includes the small intestine, where the overgrowth disrupts normal digestion and absorption processes. Disease progression can vary; if left untreated, SIBO may lead to chronic gastrointestinal issues and complications such as weight loss and vitamin deficiencies. Diagnostic considerations include breath tests (such as hydrogen and methane breath tests), stool tests, and sometimes endoscopy with aspirate culture to confirm the presence of excessive bacteria. It is essential to differentiate SIBO from other gastrointestinal disorders, such as irritable bowel syndrome (IBS) and celiac disease, to ensure appropriate management and treatment.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires specific testing and differentiation from other GI disorders.
  • Treatment complexity: Management may involve dietary changes, antibiotics, and probiotics.
  • Documentation requirements: Detailed clinical history and test results are necessary for accurate coding.
  • Coding specificity: Must ensure correct application of the code based on clinical findings.

Audit Risk Factors

  • Common coding errors: Misapplication of codes related to other gastrointestinal conditions.
  • Documentation gaps: Insufficient clinical evidence to support the diagnosis.
  • Billing challenges: Potential denials due to lack of specificity in documentation.

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

Primary Care

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 K63.8219 lies in its potential to affect patient quality of life through chronic gastrointestinal symptoms and malabsorption issues. Understanding and addressing SIBO can improve population health outcomes by reducing the burden of gastrointestinal diseases. Quality measures may include tracking the incidence of SIBO and the effectiveness of treatment protocols. Epidemiologically, SIBO is increasingly recognized as a common condition, particularly in patients with underlying gastrointestinal disorders, highlighting the need for awareness and appropriate management strategies.

ICD-9 vs ICD-10

The clinical significance of K63.8219 lies in its potential to affect patient quality of life through chronic gastrointestinal symptoms and malabsorption issues. Understanding and addressing SIBO can improve population health outcomes by reducing the burden of gastrointestinal diseases. Quality measures may include tracking the incidence of SIBO and the effectiveness of treatment protocols. Epidemiologically, SIBO is increasingly recognized as a common condition, particularly in patients with underlying gastrointestinal disorders, highlighting the need for awareness and appropriate management strategies.

Reimbursement & Billing Impact

reimbursement considerations include the necessity of diagnostic tests and the appropriateness of treatment plans. It is crucial to follow payer-specific guidelines for coding and billing to minimize the risk of claim denials. Best practices include regular audits of documentation and coding accuracy to ensure compliance with coding standards.

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 K63.8219?

K63.8219 covers small intestinal bacterial overgrowth that is not specified as being due to a particular underlying condition. It is important to note that SIBO can be secondary to conditions such as diabetes, scleroderma, or anatomical abnormalities, but this code is used when those specifics are not documented.

When should K63.8219 be used instead of related codes?

K63.8219 should be used when the diagnosis of small intestinal bacterial overgrowth is confirmed but not linked to any specific underlying condition. If the overgrowth is due to a known cause, a more specific code should be selected.

What documentation supports K63.8219?

Documentation should include a detailed patient history, clinical symptoms, results from diagnostic tests (such as breath tests), and any treatment plans. Clear evidence of the diagnosis and rationale for the use of this code is essential.