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v1.0.0
ICD-10 Guide
ICD-10 CodesZ13.810

Z13.810

Encounter for screening for upper gastrointestinal disorder

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/12/2025

Code Description

ICD-10 Z13.810 is a billable code used to indicate a diagnosis of encounter for screening for upper gastrointestinal disorder.

Key Diagnostic Point:

Z13.810 is used to indicate an encounter for screening for upper gastrointestinal disorders, which may include conditions such as gastroesophageal reflux disease (GERD), peptic ulcers, and esophageal cancer. This screening is crucial for early detection and prevention of serious gastrointestinal issues. Factors influencing health status, such as diet, lifestyle, and socioeconomic status, play a significant role in gastrointestinal health. Social determinants of health, including access to healthcare, education, and community resources, can affect an individual's likelihood of undergoing screening. Preventive care through regular screenings can lead to timely interventions, reducing morbidity and mortality associated with upper GI disorders. This code is particularly relevant in primary care settings where routine health assessments are conducted, and it emphasizes the importance of proactive health management.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Need for comprehensive patient history and risk factor assessment
  • Documentation of patient consent for screening
  • Differentiation between screening and diagnostic procedures
  • Understanding of specific screening guidelines and recommendations

Audit Risk Factors

  • Inadequate documentation of screening rationale
  • Failure to document patient risk factors
  • Misuse of the code for diagnostic encounters instead of screening
  • Lack of follow-up documentation post-screening

Specialty Focus

Medical Specialties

Primary Care

Documentation Requirements

Documentation should include patient history, risk factors, and consent for screening. The provider should note any relevant symptoms or family history of GI disorders.

Common Clinical Scenarios

Routine checkups where screening for upper GI disorders is indicated based on patient age or risk factors.

Billing Considerations

Consideration of social determinants such as access to healthcare, dietary habits, and education level that may influence screening uptake.

Public Health

Documentation Requirements

Population-level data collection and surveillance documentation to track screening rates and outcomes.

Common Clinical Scenarios

Community health initiatives aimed at increasing awareness and screening for upper GI disorders.

Billing Considerations

Focus on health equity and addressing barriers to screening in underserved populations.

Coding Guidelines

Inclusion Criteria

Use Z13.810 When
  • Z codes are used to indicate encounters for screening when no symptoms are present
  • It is important to sequence Z codes appropriately, typically as secondary diagnoses when a primary condition is being treated
  • Payer requirements may vary, so it is essential to verify coverage for screening services

Exclusion Criteria

Do NOT use Z13.810 When
No specific exclusions found.

Related CPT Codes

45378CPT Code

Colonoscopy, flexible, diagnostic

Clinical Scenario

Used in conjunction with Z13.810 when a screening colonoscopy is performed.

Documentation Requirements

Documentation must include indication for the procedure and any findings.

Specialty Considerations

Primary care providers should ensure that screening guidelines are followed.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for greater specificity in coding, enabling better tracking of screening practices and outcomes for upper GI disorders.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for greater specificity in coding, enabling better tracking of screening practices and outcomes for upper GI disorders.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for greater specificity in coding, enabling better tracking of screening practices and outcomes for upper GI disorders.

Resources

Clinical References

  • •
    American Cancer Society Guidelines for GI Cancer Screening

Coding & Billing References

  • •
    American Cancer Society Guidelines for GI Cancer Screening

Frequently Asked Questions

When should Z13.810 be used?

Z13.810 should be used during encounters specifically for screening upper gastrointestinal disorders, particularly when no symptoms are present. It is essential to document the rationale for screening and any relevant patient history.