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ICD-10 Guide
ICD-10 CodesK63.8212

K63.8212

Billable

Small intestinal bacterial overgrowth, hydrogen sulfide-subtype

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

Code Description

ICD-10 K63.8212 is a billable code used to indicate a diagnosis of small intestinal bacterial overgrowth, hydrogen sulfide-subtype.

Key Diagnostic Point:

Small intestinal bacterial overgrowth (SIBO) is a condition characterized by an abnormal increase in the number of bacteria in the small intestine, particularly those that are typically found in the colon. The hydrogen sulfide subtype of SIBO is associated with specific gastrointestinal symptoms such as bloating, diarrhea, abdominal pain, and flatulence, which may be exacerbated by certain foods. The small intestine is anatomically divided into three sections: the duodenum, jejunum, and ileum. In SIBO, the normal digestive process is disrupted, leading to malabsorption of nutrients and fermentation of carbohydrates, resulting in the production of gases like hydrogen sulfide. Disease progression can lead to more severe complications such as nutrient deficiencies, weight loss, and even intestinal damage if left untreated. Diagnosis often involves breath tests measuring hydrogen and methane levels after carbohydrate ingestion, as well as clinical evaluation of symptoms. It is crucial for healthcare providers to consider SIBO in patients with unexplained gastrointestinal symptoms, particularly those who have undergone gastrointestinal surgery or have conditions that affect gut motility.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires specific tests and clinical correlation.
  • Treatment complexity: May involve dietary changes, antibiotics, and probiotics.
  • Documentation requirements: Detailed symptomatology and test results needed.
  • Coding specificity: Requires precise coding to differentiate from other gastrointestinal disorders.

Audit Risk Factors

  • Common coding errors: Misidentification of SIBO subtype.
  • Documentation gaps: Incomplete clinical history or test results.
  • Billing challenges: Potential denials due to lack of supporting 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

Internal 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

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The clinical significance of K63.8212 lies in its potential to affect patient quality of life and nutritional status. SIBO can lead to malabsorption and deficiencies, impacting overall health. Understanding and addressing this condition can improve healthcare utilization patterns by reducing unnecessary procedures and hospitalizations. Epidemiologically, SIBO is increasingly recognized in populations with gastrointestinal disorders, highlighting the need for awareness and effective management strategies.

ICD-9 vs ICD-10

The clinical significance of K63.8212 lies in its potential to affect patient quality of life and nutritional status. SIBO can lead to malabsorption and deficiencies, impacting overall health. Understanding and addressing this condition can improve healthcare utilization patterns by reducing unnecessary procedures and hospitalizations. Epidemiologically, SIBO is increasingly recognized in populations with gastrointestinal disorders, highlighting the need for awareness and effective management strategies.

Reimbursement & Billing Impact

Reimbursement considerations include the need for pre-authorization for certain tests and procedures, as well as ensuring that all documentation aligns with the coding used. Common denials may arise from insufficient clinical evidence or failure to demonstrate medical necessity. Best practices include thorough documentation of the clinical rationale for testing and treatment, as well as regular updates to coding practices based on payer guidelines.

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 K63.8212?

K63.8212 specifically covers small intestinal bacterial overgrowth with a focus on the hydrogen sulfide subtype, which is characterized by symptoms such as bloating, diarrhea, and abdominal discomfort. It is important to differentiate this from other types of SIBO and gastrointestinal disorders.

When should K63.8212 be used instead of related codes?

K63.8212 should be used when the clinical presentation and diagnostic testing confirm the presence of hydrogen sulfide-producing bacteria in the small intestine, distinguishing it from other subtypes or gastrointestinal conditions that may present similarly.

What documentation supports K63.8212?

Documentation must include a detailed clinical history, symptom assessment, results from breath tests indicating hydrogen sulfide production, and any relevant imaging or laboratory findings that support the diagnosis of SIBO.