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ICD-10 Guide
ICD-10 CodesK52.81

K52.81

Billable

Eosinophilic gastritis or gastroenteritis

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

Code Description

ICD-10 K52.81 is a billable code used to indicate a diagnosis of eosinophilic gastritis or gastroenteritis.

Key Diagnostic Point:

Eosinophilic gastritis or gastroenteritis is characterized by the infiltration of eosinophils in the gastric or intestinal mucosa, leading to inflammation. Clinically, patients may present with symptoms such as abdominal pain, nausea, vomiting, diarrhea, and weight loss. The condition can affect any part of the gastrointestinal tract but is most commonly seen in the stomach and small intestine. The pathophysiology involves an abnormal immune response, often triggered by food allergens, medications, or infections. Disease progression can vary; some patients may experience acute episodes, while others may have chronic symptoms. Diagnosis typically involves endoscopic evaluation with biopsy to confirm eosinophilic infiltration, along with exclusion of other gastrointestinal disorders. Laboratory tests may also be conducted to identify potential allergens or underlying conditions contributing to eosinophilia. Accurate diagnosis is crucial for effective management, which may include dietary modifications, corticosteroids, or other immunosuppressive therapies.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires endoscopic evaluation and histological confirmation.
  • Treatment complexity: Management may involve dietary changes and medications.
  • Documentation requirements: Detailed clinical history and symptomatology are needed.
  • Coding specificity: Requires precise coding to differentiate from other gastrointestinal conditions.

Audit Risk Factors

  • Common coding errors: Misclassification with non-eosinophilic gastritis codes.
  • Documentation gaps: Incomplete clinical notes regarding symptomatology and treatment.
  • Billing challenges: Potential 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

Allergy and Immunology

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

Eosinophilic gastritis and gastroenteritis can significantly impact patient quality of life due to chronic gastrointestinal symptoms and dietary restrictions. Understanding the epidemiology of this condition is essential, as it may be underdiagnosed in certain populations, leading to increased healthcare utilization and costs. Quality measures focusing on accurate diagnosis and management can improve patient outcomes and reduce complications associated with untreated eosinophilic disorders.

ICD-9 vs ICD-10

Eosinophilic gastritis and gastroenteritis can significantly impact patient quality of life due to chronic gastrointestinal symptoms and dietary restrictions. Understanding the epidemiology of this condition is essential, as it may be underdiagnosed in certain populations, leading to increased healthcare utilization and costs. Quality measures focusing on accurate diagnosis and management can improve patient outcomes and reduce complications associated with untreated eosinophilic disorders.

Reimbursement & Billing Impact

Reimbursement considerations include verifying that the procedure codes used align with the diagnosis and that all necessary clinical information is provided to support the medical necessity of the services rendered. Common denials may arise from insufficient documentation or failure to demonstrate the need for specific treatments. Best practices include maintaining thorough clinical notes, ensuring accurate coding, and regularly reviewing payer guidelines to stay compliant with billing requirements.

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 K52.81?

K52.81 specifically covers eosinophilic gastritis and gastroenteritis, which are conditions characterized by eosinophilic infiltration in the gastric or intestinal mucosa. It is essential to differentiate these conditions from other forms of gastritis or gastroenteritis that do not involve eosinophils.

When should K52.81 be used instead of related codes?

K52.81 should be used when there is confirmed eosinophilic infiltration in the gastrointestinal tract, as evidenced by biopsy. It is important to differentiate it from other gastrointestinal disorders such as non-eosinophilic gastritis (K29.70) or eosinophilic colitis (K52.82) based on the location and histological findings.

What documentation supports K52.81?

Documentation for K52.81 should include a comprehensive clinical history, symptom descriptions, results from endoscopic evaluations, and biopsy findings confirming eosinophilic infiltration. Additional laboratory tests identifying potential allergens may also support the diagnosis.