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ICD-10 Guide
ICD-10 CodesK31.7

K31.7

Billable

Polyp of stomach and duodenum

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

Code Description

ICD-10 K31.7 is a billable code used to indicate a diagnosis of polyp of stomach and duodenum.

Key Diagnostic Point:

Polyp of the stomach and duodenum refers to abnormal growths that arise from the lining of these gastrointestinal organs. These polyps can vary in size and number and may be asymptomatic or present with symptoms such as abdominal pain, nausea, or gastrointestinal bleeding. The stomach and duodenum are part of the upper gastrointestinal tract, with the stomach serving as a reservoir for food and the duodenum being the first section of the small intestine where significant digestion occurs. Disease progression can vary; while many polyps are benign, some may have the potential to progress to malignancy, necessitating careful monitoring and potential intervention. Diagnostic considerations include endoscopy for direct visualization and biopsy of polyps, imaging studies, and evaluation of family history, especially in cases of hereditary syndromes like familial adenomatous polyposis. Regular surveillance is recommended for patients with a history of polyps to prevent complications such as gastric cancer.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires endoscopic evaluation and potential biopsy.
  • Treatment complexity: May involve surveillance, polypectomy, or surgical intervention depending on the type and size of the polyp.
  • Documentation requirements: Detailed clinical notes, endoscopy reports, and pathology results are essential.
  • Coding specificity: Requires accurate identification of the type of polyp and associated symptoms.

Audit Risk Factors

  • Common coding errors: Misclassification of polyp type or failure to document the presence of symptoms.
  • Documentation gaps: Incomplete endoscopy reports or lack of follow-up notes.
  • Billing challenges: Denials may occur if documentation does not support the medical necessity of procedures.

Specialty Focus

Medical Specialties

Primary medical specialty: 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

Secondary specialty: 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

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The clinical significance of K31.7 lies in its potential to identify precursors to gastric cancer, thereby impacting population health through early detection and intervention. Quality measures may include the rate of surveillance endoscopies in patients with a history of polyps. Understanding the epidemiology of gastric polyps can inform healthcare utilization patterns, as these conditions may vary in prevalence based on demographic factors and underlying health conditions.

ICD-9 vs ICD-10

The clinical significance of K31.7 lies in its potential to identify precursors to gastric cancer, thereby impacting population health through early detection and intervention. Quality measures may include the rate of surveillance endoscopies in patients with a history of polyps. Understanding the epidemiology of gastric polyps can inform healthcare utilization patterns, as these conditions may vary in prevalence based on demographic factors and underlying health conditions.

Reimbursement & Billing Impact

Reimbursement considerations include the patient's insurance coverage for diagnostic endoscopy and potential surgical interventions. Common denials may arise from insufficient documentation supporting the medical necessity of procedures or failure to provide adequate follow-up care notes. Best practices include ensuring all documentation is complete and accurately reflects the patient's condition and treatment plan.

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 K31.7?

K31.7 covers gastric and duodenal polyps, including hyperplastic polyps, adenomatous polyps, and other specified types. It is essential to differentiate these from malignant lesions and other gastrointestinal disorders.

When should K31.7 be used instead of related codes?

K31.7 should be used when a patient has a confirmed diagnosis of a polyp in the stomach or duodenum, particularly when the type of polyp is specified and documented through endoscopic findings.

What documentation supports K31.7?

Documentation should include endoscopy reports detailing the presence, size, and type of polyps, pathology reports confirming the diagnosis, and any relevant clinical notes regarding symptoms or treatment plans.