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ICD-10 Guide
ICD-10 CodesK94.12

K94.12

Billable

Enterostomy infection

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

Code Description

ICD-10 K94.12 is a billable code used to indicate a diagnosis of enterostomy infection.

Key Diagnostic Point:

Enterostomy infection refers to an infection that occurs at the site of an enterostomy, which is a surgically created opening in the abdominal wall that connects the intestine to the outside of the body. This condition can arise from various factors, including poor hygiene, improper stoma care, or complications from the surgical procedure itself. Clinically, patients may present with symptoms such as redness, swelling, discharge, and pain at the stoma site. The anatomy involved includes the intestinal tract, abdominal wall, and surrounding skin. Disease progression can lead to more severe complications, such as abscess formation or systemic infection if not addressed promptly. Diagnostic considerations include a thorough clinical examination, patient history, and possibly imaging studies to rule out deeper infections. Laboratory tests may also be necessary to identify the causative organism and guide appropriate antibiotic therapy.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires clinical evaluation and possibly microbiological testing.
  • Treatment complexity: May involve antibiotics, wound care, or surgical intervention.
  • Documentation requirements: Detailed documentation of symptoms, treatment plans, and follow-up care is essential.
  • Coding specificity: Requires accurate coding to differentiate from other gastrointestinal infections.

Audit Risk Factors

  • Common coding errors: Misclassification of the infection type or site.
  • Documentation gaps: Incomplete records regarding the patient's stoma care or infection management.
  • Billing challenges: Potential denials due to lack of supporting documentation for the infection.

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: General 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

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Enterostomy infections can significantly affect patient quality of life and lead to increased healthcare utilization, including hospital admissions and extended recovery times. Understanding the epidemiology of these infections is crucial for improving patient outcomes and implementing preventive measures. Quality measures may include monitoring infection rates and ensuring adherence to stoma care protocols to reduce the incidence of such infections.

ICD-9 vs ICD-10

Enterostomy infections can significantly affect patient quality of life and lead to increased healthcare utilization, including hospital admissions and extended recovery times. Understanding the epidemiology of these infections is crucial for improving patient outcomes and implementing preventive measures. Quality measures may include monitoring infection rates and ensuring adherence to stoma care protocols to reduce the incidence of such infections.

Reimbursement & Billing Impact

Reimbursement considerations include the severity of the infection and any associated procedures performed. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity for the treatment provided. Best practices include ensuring that all clinical notes are complete, including the rationale for the diagnosis and treatment, and that coding accurately reflects the patient's condition.

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 K94.12?

K94.12 specifically covers infections at the enterostomy site, including localized infections, abscesses, and cellulitis. It does not cover infections related to other types of ostomies or gastrointestinal infections not associated with an enterostomy.

When should K94.12 be used instead of related codes?

K94.12 should be used when the infection is specifically at the enterostomy site. If the infection is systemic or involves other gastrointestinal structures, other codes may be more appropriate, such as K65 (Peritonitis) or K63.9 (Disorder of intestine, unspecified).

What documentation supports K94.12?

Documentation should include a detailed description of the stoma site, clinical findings, any laboratory results indicating infection, treatment plans, and follow-up care. Photographic evidence may also be beneficial in supporting the diagnosis.