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ICD-10 Guide
ICD-10 CodesK59.00

K59.00

Billable

Constipation, unspecified

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

Code Description

ICD-10 K59.00 is a billable code used to indicate a diagnosis of constipation, unspecified.

Key Diagnostic Point:

Constipation, unspecified, refers to a condition characterized by infrequent bowel movements or difficulty in passing stools, which can lead to discomfort and other gastrointestinal symptoms. The anatomy involved primarily includes the colon and rectum, where stool formation and elimination occur. Constipation can result from various factors, including dietary habits, lack of physical activity, medication side effects, and underlying medical conditions such as hypothyroidism or diabetes. The disease progression may vary; it can be acute or chronic, with chronic constipation often leading to complications like fecal impaction or hemorrhoids. Diagnostic considerations include a thorough patient history, physical examination, and possibly additional tests to rule out secondary causes. It is essential to differentiate K59.00 from other specific types of constipation, such as those due to obstructive causes or functional disorders, to ensure appropriate management and treatment.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Moderate, as it requires a differential diagnosis to rule out other gastrointestinal disorders.
  • Treatment complexity: Moderate, as treatment may involve lifestyle changes, medications, or referrals to specialists.
  • Documentation requirements: Moderate, necessitating detailed patient history and symptom descriptions.
  • Coding specificity: Low, as K59.00 is a broad category without specific etiological factors.

Audit Risk Factors

  • Common coding errors: Misclassification with other constipation codes.
  • Documentation gaps: Insufficient detail on patient history or treatment plans.
  • Billing challenges: Potential denials due to lack of specificity or supporting documentation.

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: Family Medicine

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

Constipation is a prevalent condition that affects a significant portion of the population, impacting quality of life and healthcare utilization. It can lead to increased healthcare costs due to frequent visits to healthcare providers and potential complications. Understanding and accurately coding for constipation can improve patient management, enhance quality measures, and contribute to better population health outcomes.

ICD-9 vs ICD-10

Constipation is a prevalent condition that affects a significant portion of the population, impacting quality of life and healthcare utilization. It can lead to increased healthcare costs due to frequent visits to healthcare providers and potential complications. Understanding and accurately coding for constipation can improve patient management, enhance quality measures, and contribute to better population health outcomes.

Reimbursement & Billing Impact

Reimbursement considerations include ensuring that the diagnosis is supported by clinical evidence and that the treatment plan is clearly outlined. Common denials may arise from insufficient documentation or lack of specificity in the diagnosis. Best practices include using the most specific code available, providing detailed notes on the patient's condition, and ensuring that all relevant tests and treatments are documented to support the claim.

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 K59.00?

K59.00 encompasses unspecified constipation, which may include cases where the etiology is not clearly defined. It does not cover constipation due to specific causes such as obstructive lesions or functional disorders, which have their own codes.

When should K59.00 be used instead of related codes?

K59.00 should be used when the constipation is not attributable to a specific cause or when the clinician has not determined the underlying etiology. If a more specific diagnosis is available, such as functional constipation (K59.01), that code should be used.

What documentation supports K59.00?

Documentation should include a detailed patient history, symptom duration, frequency of bowel movements, and any relevant physical examination findings. It is also important to note any treatments attempted and their outcomes.