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ICD-10 Guide
ICD-10 CodesK31.5

K31.5

Billable

Obstruction of duodenum

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

Code Description

ICD-10 K31.5 is a billable code used to indicate a diagnosis of obstruction of duodenum.

Key Diagnostic Point:

Obstruction of the duodenum is a condition characterized by a blockage in the first section of the small intestine, which can impede the normal passage of food and digestive fluids. The duodenum is anatomically situated between the stomach and the jejunum, playing a crucial role in the digestive process by receiving chyme from the stomach and bile from the liver. Clinical presentation may include symptoms such as abdominal pain, nausea, vomiting, and distension, often leading to dehydration and electrolyte imbalances if not addressed promptly. Disease progression can vary; acute obstruction may arise from conditions such as adhesions, tumors, or inflammatory processes, while chronic obstruction may develop due to strictures or congenital anomalies. Diagnostic considerations include imaging studies like X-rays, CT scans, or endoscopy to visualize the obstruction and determine its cause. Timely diagnosis and intervention are critical to prevent complications such as bowel ischemia or perforation.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires imaging and possibly endoscopic evaluation to confirm the diagnosis.
  • Treatment complexity: Management may involve surgical intervention or conservative measures depending on the cause.
  • Documentation requirements: Detailed clinical notes are necessary to justify the diagnosis and treatment plan.
  • Coding specificity: Requires precise coding to differentiate from other gastrointestinal obstructions.

Audit Risk Factors

  • Common coding errors: Misclassification of the type of obstruction or failure to specify the location.
  • Documentation gaps: Incomplete clinical notes that do not support the diagnosis or treatment.
  • Billing challenges: Potential for denials if the medical necessity is not clearly documented.

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

General Surgery

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 K31.5 lies in its potential to cause severe complications if left untreated, including bowel ischemia or perforation, which can lead to increased morbidity and mortality. Understanding the epidemiology of duodenal obstruction is vital, as it can affect various populations, particularly those with a history of abdominal surgeries or malignancies. Quality measures in managing this condition focus on timely diagnosis and intervention, which can significantly reduce healthcare utilization and improve patient outcomes.

ICD-9 vs ICD-10

The clinical significance of K31.5 lies in its potential to cause severe complications if left untreated, including bowel ischemia or perforation, which can lead to increased morbidity and mortality. Understanding the epidemiology of duodenal obstruction is vital, as it can affect various populations, particularly those with a history of abdominal surgeries or malignancies. Quality measures in managing this condition focus on timely diagnosis and intervention, which can significantly reduce healthcare utilization and improve patient outcomes.

Reimbursement & Billing Impact

reimbursement. Providers should include detailed clinical notes that outline the patient's symptoms, diagnostic tests performed, and the rationale for any surgical interventions. Common denials may arise from insufficient documentation or lack of medical necessity. It is essential to follow payer-specific guidelines and ensure that all services rendered are appropriately coded and justified to avoid billing issues.

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 K31.5?

K31.5 encompasses various causes of duodenal obstruction, including mechanical obstructions from tumors, strictures, or adhesions, as well as functional obstructions due to motility disorders.

When should K31.5 be used instead of related codes?

K31.5 should be used when the obstruction specifically involves the duodenum, as opposed to other parts of the small intestine or gastrointestinal tract, which would require different codes.

What documentation supports K31.5?

Documentation should include clinical findings, imaging results, and any surgical notes that detail the nature of the obstruction and the treatment provided.