ICD-10 Logo
ICDxICD-10 Medical Coding
ICD-10 Logo
ICDxICD-10 Medical Coding
ICD 10 CodesDiagnoses
ICD 10 CodesDiagnoses
ICD-10 Logo
ICDxICD-10 Medical Coding

Comprehensive ICD-10-CM code reference with AI-powered search capabilities.

© 2025 ICD Code Compass. All rights reserved.

Browse

  • All Chapters
  • All Categories
  • Diagnoses

Tools

  • AI Code Search
ICD-10-CM codes are maintained by the CDC and CMS. This tool is for reference purposes only.
v1.0.0
ICD-10 Guide
ICD-10 CodesK59.04

K59.04

Billable

Chronic idiopathic constipation

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

Code Description

ICD-10 K59.04 is a billable code used to indicate a diagnosis of chronic idiopathic constipation.

Key Diagnostic Point:

Chronic idiopathic constipation (CIC) is a common gastrointestinal disorder characterized by infrequent bowel movements or difficulty in passing stools that persists for at least three months. Patients typically present with symptoms such as straining during defecation, hard or lumpy stools, and a sensation of incomplete evacuation. The condition is termed 'idiopathic' as the exact cause remains unknown, although it may be influenced by factors such as diet, lifestyle, and psychological stress. The anatomy involved primarily includes the colon and rectum, where motility issues can lead to stool retention. Disease progression can vary, with some patients experiencing intermittent episodes while others may have persistent symptoms that significantly impact quality of life. Diagnostic considerations include a thorough patient history, physical examination, and potentially additional tests such as colonoscopy to rule out other underlying conditions. The Rome IV criteria are often utilized for diagnosis, emphasizing the need for a comprehensive assessment to differentiate CIC from other forms of constipation.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires thorough evaluation to rule out other causes of constipation.
  • Treatment complexity: Management may involve dietary changes, medications, or behavioral therapies.
  • Documentation requirements: Detailed clinical documentation is necessary to support the diagnosis and treatment plan.
  • Coding specificity: Accurate coding requires understanding of the nuances between different types of constipation.

Audit Risk Factors

  • Common coding errors: Misclassification of constipation types or failure to document chronicity.
  • Documentation gaps: Incomplete patient history or lack of symptom description.
  • Billing challenges: Potential denials due to insufficient evidence of chronicity or lack of treatment documentation.

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

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Chronic idiopathic constipation significantly impacts patient quality of life and can lead to increased healthcare utilization, including frequent visits to primary care and gastroenterology specialists. It is prevalent in various populations, particularly among older adults, and is associated with comorbidities such as depression and anxiety. Understanding and addressing CIC is crucial for improving population health outcomes and implementing effective quality measures in gastrointestinal care.

ICD-9 vs ICD-10

Chronic idiopathic constipation significantly impacts patient quality of life and can lead to increased healthcare utilization, including frequent visits to primary care and gastroenterology specialists. It is prevalent in various populations, particularly among older adults, and is associated with comorbidities such as depression and anxiety. Understanding and addressing CIC is crucial for improving population health outcomes and implementing effective quality measures in gastrointestinal care.

Reimbursement & Billing Impact

Reimbursement considerations include ensuring that the diagnosis is clearly supported by clinical evidence. Common denials may arise from insufficient documentation or failure to demonstrate the chronic nature of the condition. Best practices include maintaining thorough records of patient interactions, treatment plans, and follow-up assessments to substantiate the medical necessity of services rendered.

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 K59.04?

K59.04 specifically covers chronic idiopathic constipation, which is characterized by infrequent bowel movements and difficulty in stool passage without identifiable physiological or structural abnormalities.

When should K59.04 be used instead of related codes?

K59.04 should be used when the constipation is chronic and idiopathic, meaning no underlying cause has been identified after thorough evaluation. It is important to differentiate it from other constipation codes that may indicate specific causes.

What documentation supports K59.04?

Documentation should include a detailed patient history, symptom duration, frequency of bowel movements, and any treatments attempted. Additionally, evidence of ruling out other causes of constipation is crucial for supporting the diagnosis.