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ICD-10 Guide
ICD-10 CodesK59.0

K59.0

Non-billable

Constipation

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

Code Description

ICD-10 K59.0 is a used to indicate a diagnosis of constipation.

Key Diagnostic Point:

Constipation, classified under ICD-10 code K59.0, is a common gastrointestinal condition characterized by infrequent bowel movements or difficulty in passing stools. Clinically, it is defined as having fewer than three bowel movements per week, often accompanied by straining, hard stools, or a sensation of incomplete evacuation. The anatomy involved primarily includes the colon and rectum, where stool formation and elimination occur. Constipation can arise from various factors, including dietary habits, hydration levels, physical inactivity, and certain medications. Disease progression may lead to complications such as fecal impaction or hemorrhoids if not addressed. Diagnostic considerations include a thorough patient history, physical examination, and, if necessary, additional tests like abdominal imaging or colonoscopy to rule out underlying conditions such as obstructive lesions or metabolic disorders. Effective management often involves lifestyle modifications, dietary adjustments, and, in some cases, pharmacological interventions.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Moderate; requires assessment of symptoms and potential underlying causes.
  • Treatment complexity: Moderate; may involve lifestyle changes, medications, or referrals to specialists.
  • Documentation requirements: Moderate; necessitates detailed patient history and treatment plans.
  • Coding specificity: Medium; requires accurate differentiation from other gastrointestinal codes.

Audit Risk Factors

  • Common coding errors: Misclassification with other gastrointestinal disorders.
  • Documentation gaps: Incomplete patient history or lack of symptom details.
  • Billing challenges: Denials due to insufficient documentation or failure to meet medical necessity.

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 ICD-10 Codes

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

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Constipation significantly affects population health, with prevalence rates affecting up to 20% of the general population. It can lead to decreased quality of life, increased healthcare utilization, and higher costs associated with treatment and management. Understanding and addressing constipation is crucial for improving patient outcomes and reducing the burden on healthcare systems.

ICD-9 vs ICD-10

Constipation significantly affects population health, with prevalence rates affecting up to 20% of the general population. It can lead to decreased quality of life, increased healthcare utilization, and higher costs associated with treatment and management. Understanding and addressing constipation is crucial for improving patient outcomes and reducing the burden on healthcare systems.

Reimbursement & Billing Impact

Reimbursement considerations include ensuring that the diagnosis is supported by clinical documentation and that it meets medical necessity criteria. Common denials may arise from insufficient documentation or failure to demonstrate the need for treatment. Best practices include maintaining clear records of patient interactions, treatment plans, and follow-up care to substantiate claims and reduce audit risks.

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 K59.0?

K59.0 covers functional constipation, which may include chronic idiopathic constipation and constipation due to lifestyle factors. It does not include constipation due to other underlying diseases, which may require different codes.

When should K59.0 be used instead of related codes?

K59.0 should be used when the primary diagnosis is constipation without a known underlying cause. If constipation is secondary to another condition, the primary condition should be coded instead.

What documentation supports K59.0?

Documentation should include a detailed patient history, symptom description, frequency of bowel movements, and any treatments attempted. Evidence of lifestyle factors contributing to constipation should also be noted.