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v1.0.0
ICD-10 Guide
ICD-10 CodesD13.91

D13.91

Billable

Familial adenomatous polyposis

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/05/2025

Code Description

ICD-10 D13.91 is a billable code used to indicate a diagnosis of familial adenomatous polyposis.

Key Diagnostic Point:

Familial adenomatous polyposis (FAP) is a hereditary condition characterized by the development of numerous adenomatous polyps in the colon and rectum, typically beginning in adolescence or early adulthood. These polyps are benign but have a high risk of progressing to colorectal cancer if left untreated. FAP is caused by mutations in the APC gene, leading to abnormal cell growth in the intestinal lining. Patients with FAP may develop hundreds to thousands of polyps, and the risk of colorectal cancer approaches nearly 100% by the age of 40 if prophylactic measures are not taken. Surveillance through regular colonoscopy is crucial for early detection and management of polyps, and surgical intervention, such as colectomy, is often recommended to prevent cancer development. Additionally, individuals with FAP may also experience extraintestinal manifestations, including desmoid tumors and other malignancies, necessitating comprehensive management and surveillance strategies.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Genetic testing documentation requirements
  • Need for detailed family history
  • Management of associated conditions
  • Surveillance protocols and frequency

Audit Risk Factors

  • Inadequate documentation of genetic testing
  • Failure to document surveillance procedures
  • Misclassification of polyps as malignant
  • Lack of family history documentation

Specialty Focus

Medical Specialties

Gastroenterology

Documentation Requirements

Detailed colonoscopy reports, polyp pathology results, and family history of colorectal cancer.

Common Clinical Scenarios

Routine surveillance colonoscopy, management of polyps, and referral for genetic counseling.

Billing Considerations

Ensure accurate coding of polyp type and size, and document any interventions performed.

Genetics

Documentation Requirements

Genetic test results, family pedigree charts, and counseling notes.

Common Clinical Scenarios

Genetic testing for APC mutations, family risk assessment, and management recommendations.

Billing Considerations

Document the rationale for genetic testing and the implications for family members.

Coding Guidelines

Inclusion Criteria

Use D13.91 When
  • Follow the official ICD
  • CM coding guidelines, ensuring accurate documentation of the diagnosis, associated conditions, and any procedures performed
  • Include family history and genetic testing results when applicable

Exclusion Criteria

Do NOT use D13.91 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

45378CPT Code

Colonoscopy, flexible, diagnostic

Clinical Scenario

Used for routine surveillance in patients with FAP.

Documentation Requirements

Document findings, number of polyps, and any biopsies taken.

Specialty Considerations

Gastroenterologists should ensure thorough documentation of polyp characteristics.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of familial adenomatous polyposis, improving the accuracy of data collection and enhancing the ability to track outcomes and resource utilization in affected populations.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of familial adenomatous polyposis, improving the accuracy of data collection and enhancing the ability to track outcomes and resource utilization in affected populations.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of familial adenomatous polyposis, improving the accuracy of data collection and enhancing the ability to track outcomes and resource utilization in affected populations.

Resources

Clinical References

  • •
    National Cancer Institute - Familial Adenomatous Polyposis

Coding & Billing References

  • •
    National Cancer Institute - Familial Adenomatous Polyposis

Frequently Asked Questions

What is the significance of genetic testing in familial adenomatous polyposis?

Genetic testing is crucial for confirming the diagnosis of FAP, identifying at-risk family members, and guiding surveillance and management strategies.