ICD-10 Coding for Gilbert Syndrome(E80.4)
Complete ICD-10-CM coding and documentation guide for Gilbert Syndrome. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Gilbert Syndrome
E70-E88Primary Range
Metabolic disorders
This range includes disorders of bilirubin metabolism, including Gilbert Syndrome.
Key Information: ICD-10 code for Gilbert syndrome
Essential facts and insights about Gilbert Syndrome
Primary ICD-10-CM Code for gilbert syndrome
Decision Criteria
clinical Criteria
- Presence of unconjugated hyperbilirubinemia with normal liver function tests.
documentation Criteria
- Genetic testing for UGT1A1 mutations supports diagnosis.
Applicable To
- Unconjugated hyperbilirubinemia with normal liver enzymes
Clinical Validation Requirements
- Unconjugated hyperbilirubinemia (total bilirubin <6 mg/dL)
- Normal liver enzymes (ALT, AST, ALP)
- Absence of hemolysis
Code-Specific Risks
- Misclassification with other hyperbilirubinemia disorders
Coding Notes
- Ensure documentation specifies Gilbert syndrome and not just jaundice.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Unspecified jaundice
R17Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Other disorders of bilirubin metabolism
E80.6Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Gilbert Syndrome to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code E80.4.
Impact
Clinical: May lead to incorrect treatment., Regulatory: Fails to meet coding standards., Financial: Potential for denied claims.
Mitigation Strategy
Educate providers on documentation requirements., Use templates for consistent documentation.
Impact
Reimbursement: Incorrect DRG assignment., Compliance: Potential audit risk., Data Quality: Misleading clinical data.
Mitigation Strategy
Confirm unconjugated hyperbilirubinemia and genetic testing.
Impact
Using E80.6 instead of E80.4 for confirmed Gilbert syndrome.
Mitigation Strategy
Ensure clinical validation is documented.
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 Gilbert Syndrome, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Gilbert Syndrome
Use these documentation templates to ensure complete and accurate documentation for Gilbert Syndrome. These templates include all required elements for proper coding and billing.
Confirmed Gilbert Syndrome Diagnosis
Specialty: GastroenterologyRequired Elements
- History of recurrent jaundice
- Triggers like fasting or stress
- Laboratory results
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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