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ICD-10 Guide
ICD-10 CodesK94.19

K94.19

Billable

Other complications of enterostomy

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

Code Description

ICD-10 K94.19 is a billable code used to indicate a diagnosis of other complications of enterostomy.

Key Diagnostic Point:

K94.19 refers to 'Other complications of enterostomy,' which encompasses a range of issues that may arise following the surgical creation of an enterostomy. An enterostomy is a procedure that involves the formation of an opening in the abdominal wall to allow for the diversion of intestinal contents. Common complications include stoma-related issues such as prolapse, retraction, or stenosis, as well as skin irritation and infection around the stoma site. Patients may present with symptoms such as abdominal pain, changes in bowel habits, or signs of infection. The anatomy involved primarily includes the intestines and the abdominal wall, and complications can significantly impact the patient's quality of life. Disease progression can vary, with some complications being acute and others developing over time due to improper stoma care or anatomical changes. Diagnostic considerations include physical examination, imaging studies, and sometimes endoscopic evaluation to assess the stoma and surrounding tissues. Proper management of these complications is crucial to prevent further morbidity and ensure optimal patient outcomes.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires understanding of various stoma complications and their presentations.
  • Treatment complexity: Involves multidisciplinary approaches including surgical, nursing, and dietary interventions.
  • Documentation requirements: Detailed clinical notes are necessary to support the diagnosis and treatment plan.
  • Coding specificity: Requires precise coding to differentiate between various complications.

Audit Risk Factors

  • Common coding errors: Misclassification of complications or failure to specify the type of complication.
  • Documentation gaps: Incomplete clinical notes that do not adequately describe the complications.
  • Billing challenges: Potential denials due to lack of supporting documentation or incorrect coding.

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: 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

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 K94.19 lies in its association with post-operative complications that can severely affect patient quality of life and healthcare utilization. Complications from enterostomies can lead to increased hospital visits, additional surgeries, and prolonged recovery times. Understanding these complications is crucial for improving patient outcomes and implementing quality measures in gastrointestinal care. Epidemiologically, as the prevalence of conditions requiring enterostomies rises, so does the importance of accurately coding and managing these complications.

ICD-9 vs ICD-10

The clinical significance of K94.19 lies in its association with post-operative complications that can severely affect patient quality of life and healthcare utilization. Complications from enterostomies can lead to increased hospital visits, additional surgeries, and prolonged recovery times. Understanding these complications is crucial for improving patient outcomes and implementing quality measures in gastrointestinal care. Epidemiologically, as the prevalence of conditions requiring enterostomies rises, so does the importance of accurately coding and managing these complications.

Reimbursement & Billing Impact

reimbursement.

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 K94.19?

K94.19 covers a variety of complications related to enterostomy, including but not limited to stoma prolapse, retraction, stenosis, and skin irritation or infection. Each condition may present with unique symptoms and requires specific diagnostic criteria for accurate coding.

When should K94.19 be used instead of related codes?

K94.19 should be used when the complication does not fit the more specific codes such as K94.0 or K94.1. It is essential to evaluate the clinical documentation to determine if the complication is unique or if it falls under a more defined category.

What documentation supports K94.19?

Documentation supporting K94.19 should include detailed clinical notes describing the patient's symptoms, the nature of the complication, treatment provided, and any relevant diagnostic tests performed. Clear descriptions of the stoma condition and its impact on the patient's health are crucial.