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ICD-10 Guide
ICD-10 CodesChapter 11: Diseases of the digestive systemK30

K30

Billable

Functional dyspepsia

Chapter 11:Diseases of the digestive system

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

Code Description

ICD-10 K30 is a billable code used to indicate a diagnosis of functional dyspepsia.

Key Diagnostic Point:

Functional dyspepsia, classified under ICD-10 code K30, is a common gastrointestinal disorder characterized by chronic or recurrent pain or discomfort in the upper abdomen without any identifiable organic cause. Clinically, patients may present with symptoms such as bloating, early satiety, nausea, and epigastric pain. The anatomy involved primarily includes the stomach and proximal small intestine, where motility and sensory functions may be impaired. Disease progression can vary; while some patients may experience intermittent symptoms, others may have persistent discomfort that significantly impacts their quality of life. Diagnostic considerations for K30 include a thorough patient history, physical examination, and exclusion of other gastrointestinal conditions such as peptic ulcer disease, gastroesophageal reflux disease (GERD), and malignancies through appropriate imaging and endoscopic evaluations. The Rome IV criteria are often utilized to help establish the diagnosis of functional dyspepsia, emphasizing the importance of symptom-based classification in the absence of structural abnormalities.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires exclusion of other conditions and may involve multiple tests.
  • Treatment complexity: Management may include lifestyle modifications, dietary changes, and pharmacotherapy.
  • Documentation requirements: Detailed symptom descriptions and exclusion of other diagnoses are necessary.
  • Coding specificity: Requires precise coding to differentiate from other gastrointestinal disorders.

Audit Risk Factors

  • Common coding errors: Misclassification with organic dyspepsia or other gastrointestinal disorders.
  • Documentation gaps: Insufficient detail in symptom descriptions or lack of exclusion criteria.
  • Billing challenges: Potential for denials if documentation does not support the diagnosis.

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 CPT Codes

CPT Code

Clinical Scenario

Documentation Requirements

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

Functional dyspepsia has significant clinical implications, affecting a large portion of the population and leading to increased healthcare utilization. It is associated with decreased quality of life and can contribute to absenteeism in work and school settings. Understanding the epidemiology of K30 is crucial for healthcare providers as it informs treatment strategies and resource allocation, ultimately aiming to improve patient outcomes and reduce the burden of gastrointestinal disorders on the healthcare system.

ICD-9 vs ICD-10

Functional dyspepsia has significant clinical implications, affecting a large portion of the population and leading to increased healthcare utilization. It is associated with decreased quality of life and can contribute to absenteeism in work and school settings. Understanding the epidemiology of K30 is crucial for healthcare providers as it informs treatment strategies and resource allocation, ultimately aiming to improve patient outcomes and reduce the burden of gastrointestinal disorders on the healthcare system.

Reimbursement & Billing Impact

Reimbursement considerations include the need for thorough documentation of symptoms and the exclusion of other gastrointestinal conditions. Common denials may arise if the documentation does not clearly establish the diagnosis or if the treatment provided is not well-supported. Best practices include maintaining detailed records of patient encounters, treatment plans, and follow-up assessments to ensure compliance with payer requirements and to facilitate appropriate reimbursement.

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 K30?

K30 covers functional dyspepsia, which includes symptoms of upper abdominal discomfort without any identifiable organic cause. It is important to differentiate it from other conditions like peptic ulcer disease and GERD.

When should K30 be used instead of related codes?

K30 should be used when the patient presents with dyspeptic symptoms that cannot be attributed to any structural or biochemical abnormalities after thorough evaluation. It is essential to document the absence of other gastrointestinal diseases.

What documentation supports K30?

Documentation should include a detailed patient history, symptom descriptions, results from diagnostic tests that exclude other conditions, and any treatments attempted. The use of the Rome IV criteria can also support the diagnosis.