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v1.0.0
ICD-10 Guide
ICD-10 CodesK91.850

K91.850

Billable

Pouchitis

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

Code Description

ICD-10 K91.850 is a billable code used to indicate a diagnosis of pouchitis.

Key Diagnostic Point:

Pouchitis is an inflammatory condition affecting the ileal pouch, which is a surgically created reservoir for stool following proctocolectomy, often performed in patients with ulcerative colitis or familial adenomatous polyposis. Clinically, patients may present with symptoms such as abdominal pain, diarrhea, rectal bleeding, and urgency. The anatomy involved includes the ileum, which is reconfigured into a pouch, and the anal canal, where the pouch is connected. Disease progression can vary, with some patients experiencing intermittent episodes of pouchitis, while others may develop chronic pouchitis, leading to significant morbidity. Diagnostic considerations include clinical evaluation, stool studies to rule out infections, and endoscopic examination to assess inflammation and rule out other complications such as pouch fistulas or strictures. Management typically involves antibiotics, anti-inflammatory medications, and in some cases, surgical intervention may be necessary for refractory cases.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires differentiation from other gastrointestinal disorders.
  • Treatment complexity: May involve multiple treatment modalities including medication and surgery.
  • Documentation requirements: Detailed clinical documentation is necessary to support the diagnosis.
  • Coding specificity: Requires accurate coding to reflect the specific type of pouchitis.

Audit Risk Factors

  • Common coding errors: Misclassification of pouchitis severity.
  • Documentation gaps: Incomplete clinical notes regarding symptoms and treatment.
  • 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

Colorectal Surgery

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

Pouchitis significantly affects the quality of life for patients post-surgery, leading to increased healthcare utilization due to frequent medical visits and potential hospitalizations. Understanding the epidemiology of pouchitis is crucial, as it can impact population health strategies aimed at managing inflammatory bowel diseases. Quality measures may include monitoring the frequency of pouchitis episodes and the effectiveness of treatment protocols, which can inform better patient care and resource allocation.

ICD-9 vs ICD-10

Pouchitis significantly affects the quality of life for patients post-surgery, leading to increased healthcare utilization due to frequent medical visits and potential hospitalizations. Understanding the epidemiology of pouchitis is crucial, as it can impact population health strategies aimed at managing inflammatory bowel diseases. Quality measures may include monitoring the frequency of pouchitis episodes and the effectiveness of treatment protocols, which can inform better patient care and resource allocation.

Reimbursement & Billing Impact

Reimbursement may vary based on the severity of the condition and the complexity of treatment. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity for procedures. Coders should ensure that all relevant clinical notes, lab results, and treatment plans are included in the patient's record to support claims. Best practices include regular audits of coding accuracy and ensuring that all services rendered are clearly documented.

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 K91.850?

K91.850 specifically covers pouchitis, which is inflammation of the ileal pouch. It does not cover other gastrointestinal conditions or complications unless specified.

When should K91.850 be used instead of related codes?

K91.850 should be used when a patient presents with acute pouchitis symptoms without chronicity or other complications. If the condition is chronic or recurrent, K91.851 may be more appropriate.

What documentation supports K91.850?

Documentation should include a detailed history of symptoms, results from stool tests, endoscopic findings, and any treatments attempted. Clear notes on the patient's surgical history and current medications are also essential.