ICD-10 Coding for Hirschsprung's Disease(Q43.1, K56.609)
Complete ICD-10-CM coding and documentation guide for Hirschsprung's Disease. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Hirschsprung's Disease
Q43.1Primary Range
Congenital absence of ganglion cells in the distal bowel
Primary code for Hirschsprung's disease, indicating congenital absence of ganglion cells.
Other and unspecified intestinal obstruction
Used for intestinal obstruction secondary to Hirschsprung's disease.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| Q43.1 | Congenital absence of ganglion cells in the distal bowel | Use when biopsy confirms absence of ganglion cells in the bowel. |
|
| K56.609 | Unspecified intestinal obstruction | Use when obstruction is secondary to Hirschsprung's disease. |
|
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 Hirschsprung's disease
Essential facts and insights about Hirschsprung's Disease
Primary ICD-10-CM Codes for hirschsprung's disease
Decision Criteria
clinical Criteria
- Biopsy shows absence of ganglion cells.
Applicable To
- Hirschsprung's disease
- Congenital megacolon
Excludes
- Acquired megacolon (K59.3)
Clinical Validation Requirements
- Absence of ganglion cells in rectal biopsy
- Hypertrophic nerve fibers on AChE staining
Code-Specific Risks
- Ensure biopsy confirmation to avoid misdiagnosis.
Coding Notes
- Always confirm with biopsy results.
K56.609 - Unspecified intestinal obstruction
Use when obstruction is secondary to Hirschsprung's disease.
Clinical Validation Requirements
- Documented intestinal obstruction
Coding Notes
Sequence after Q43.1 when used.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Unspecified intestinal obstruction
K56.609Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Other specified congenital malformations of intestine
Q43.8Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Hirschsprung's Disease to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code Q43.1.
Impact
Clinical: Inaccurate diagnosis and treatment planning., Regulatory: Non-compliance with coding standards., Financial: Potential claim denials.
Mitigation Strategy
Verify biopsy results are documented before coding., Educate staff on documentation requirements.
Impact
Reimbursement: Incorrect sequencing can lead to denied claims., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate data representation of patient condition.
Mitigation Strategy
Sequence Q43.1 first, followed by K56.609.
Impact
Incorrect sequencing of primary and ancillary codes.
Mitigation Strategy
Educate coders on proper sequencing rules.
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 Hirschsprung's Disease, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Hirschsprung's Disease
Use these documentation templates to ensure complete and accurate documentation for Hirschsprung's Disease. These templates include all required elements for proper coding and billing.
Neonatal Hirschsprung's Disease
Specialty: PediatricsRequired Elements
- Gestational age
- Time to first meconium
- Abdominal distension
- Biopsy results
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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