ICD-10 Coding for Formula Intolerance(K90.49, E73.9)
Complete ICD-10-CM coding and documentation guide for Formula Intolerance. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Formula Intolerance
K90.4Primary Range
Malabsorption due to intolerance
This range includes codes for malabsorption conditions related to dietary intolerances, including formula intolerance.
Lactose intolerance
This range is relevant for cases where lactose intolerance is specifically identified without broader malabsorption issues.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| K90.49 | Other malabsorption due to intolerance | Use when there is documented evidence of malabsorption linked to formula intolerance. |
|
| E73.9 | Lactose intolerance, unspecified | Use when lactose intolerance is confirmed without evidence of broader malabsorption. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for formula intolerance
Essential facts and insights about Formula Intolerance
Primary ICD-10-CM Codes for formula intolerance
Decision Criteria
clinical Criteria
- Fecal elastase <100 μg/g
documentation Criteria
- Documented weight loss >5% in 30 days
Applicable To
- Formula intolerance with malabsorption
Excludes
- Lactose intolerance (E73.-)
Clinical Validation Requirements
- Chronic diarrhea (≥3 loose stools/day for 14 days)
- Abnormal fecal fat or elastase
- Failed trial of ≥2 formulas
Code-Specific Risks
- Misclassification as lactose intolerance
- Insufficient documentation of malabsorption
Coding Notes
- Ensure documentation clearly links formula trials to malabsorption evidence.
E73.9 - Lactose intolerance, unspecified
Use when lactose intolerance is confirmed without evidence of broader malabsorption.
Applicable To
- Isolated lactose intolerance
Excludes
- Malabsorption due to other causes (K90.4-)
Clinical Validation Requirements
- Positive hydrogen breath test
- Absence of growth failure
Coding Notes
Ensure lactose intolerance is specifically documented and confirmed.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Adverse effect of other and unspecified agents, initial encounter
T45.4X5ADifferential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Formula Intolerance to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code K90.49.
Impact
Clinical: Inadequate treatment planning, Regulatory: Non-compliance with documentation standards, Financial: Potential claim denials
Mitigation Strategy
Use specific symptom descriptions, Include diagnostic test results
Impact
Reimbursement: Incorrect coding may lead to denied claims., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate representation of patient condition.
Mitigation Strategy
Use K90.49 when malabsorption is present.
Impact
Claims may be denied if documentation does not support malabsorption.
Mitigation Strategy
Ensure comprehensive documentation of symptoms and diagnostic tests.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Formula Intolerance, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Formula Intolerance
Use these documentation templates to ensure complete and accurate documentation for Formula Intolerance. These templates include all required elements for proper coding and billing.
Infant with formula intolerance
Specialty: PediatricsRequired Elements
- Formula trial history
- Growth trajectory
- Stool studies
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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