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ICD-10 Guide
ICD-10 CodesK94.23

K94.23

Billable

Gastrostomy malfunction

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

Code Description

ICD-10 K94.23 is a billable code used to indicate a diagnosis of gastrostomy malfunction.

Key Diagnostic Point:

Gastrostomy malfunction refers to complications arising from a gastrostomy tube, which is surgically placed through the abdominal wall into the stomach for nutritional support. Clinical presentations may include tube dislodgement, blockage, leakage, or infection at the insertion site. The anatomy involved includes the abdominal wall, stomach, and surrounding tissues. Disease progression can vary; for instance, a blocked tube may lead to inadequate nutrition and dehydration, while an infected site can result in systemic complications if not addressed promptly. Diagnostic considerations include a thorough clinical assessment, imaging studies if necessary, and laboratory tests to evaluate for infection or metabolic imbalances. It is essential for healthcare providers to monitor patients with gastrostomy tubes closely, as timely intervention can prevent serious complications and ensure nutritional needs are met effectively.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires understanding of potential complications and their management.
  • Treatment complexity: May involve surgical intervention or adjustments to feeding protocols.
  • Documentation requirements: Detailed records of symptoms, interventions, and outcomes are necessary.
  • Coding specificity: Requires precise coding to differentiate between types of malfunctions.

Audit Risk Factors

  • Common coding errors: Misclassification of the type of malfunction.
  • Documentation gaps: Incomplete records of the patient's condition and treatment.
  • Billing challenges: Potential denials due to insufficient evidence of medical necessity.

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

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

The clinical significance of K94.23 lies in its association with the management of patients requiring nutritional support via gastrostomy. Malfunctions can lead to serious health issues, impacting population health by increasing hospitalizations and healthcare costs. Quality measures may include monitoring the incidence of gastrostomy complications and ensuring timely interventions. Understanding the epidemiology of gastrostomy use and complications can help healthcare providers optimize care and improve patient outcomes.

ICD-9 vs ICD-10

The clinical significance of K94.23 lies in its association with the management of patients requiring nutritional support via gastrostomy. Malfunctions can lead to serious health issues, impacting population health by increasing hospitalizations and healthcare costs. Quality measures may include monitoring the incidence of gastrostomy complications and ensuring timely interventions. Understanding the epidemiology of gastrostomy use and complications can help healthcare providers optimize care and improve patient outcomes.

Reimbursement & Billing Impact

Reimbursement considerations include ensuring that the procedure is deemed medically necessary and that all relevant documentation is submitted. Common denials may arise from insufficient evidence of complications or lack of prior authorization for interventions. Best practices include maintaining thorough records of patient assessments, treatment plans, and follow-up care to support claims.

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 K94.23?

K94.23 covers various complications related to gastrostomy tubes, including but not limited to tube dislodgement, blockage, leakage, and infection at the insertion site. It is essential to document the specific nature of the malfunction for accurate coding.

When should K94.23 be used instead of related codes?

K94.23 should be used when the gastrostomy tube is malfunctioning but does not fit the specific criteria for dislodgement (K94.21) or blockage (K94.22). It is crucial to assess the patient's condition and document the specific complications to select the appropriate code.

What documentation supports K94.23?

Documentation should include a detailed account of the patient's symptoms, clinical findings, any interventions performed, and the outcomes of those interventions. This may also include imaging studies or lab results that support the diagnosis of gastrostomy malfunction.