ICD-10 Coding for Opioid-Induced Constipation(K59.03, T40.4X5A)
Complete ICD-10-CM coding and documentation guide for Opioid-Induced Constipation. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Opioid-Induced Constipation
K59-K59.9Primary Range
Functional intestinal disorders
Includes specific codes for drug-induced constipation, including opioid-induced constipation.
Poisoning by narcotics and psychodysleptics [hallucinogens]
Includes codes for adverse effects of synthetic narcotics, necessary for coding opioid-induced constipation.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| K59.03 | Drug-induced constipation | Use when constipation is directly linked to opioid use. |
|
| T40.4X5A | Adverse effect of synthetic narcotics | Use alongside K59.03 to specify the narcotic causing the adverse effect. |
|
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 opioid-induced constipation
Essential facts and insights about Opioid-Induced Constipation
Primary ICD-10-CM Codes for opioid induced constipation
Decision Criteria
clinical Criteria
- Constipation onset within 14 days of opioid initiation
documentation Criteria
- BFI score ≥28.8 and lack of response to laxatives
Applicable To
- Opioid-induced constipation
Excludes
- Constipation NOS (K59.00)
Clinical Validation Requirements
- Documentation of opioid use with temporal relationship to constipation onset
- Bowel Function Index (BFI) score ≥28.8
- Lack of response to laxatives
Code-Specific Risks
- Incorrectly coding as general constipation (K59.00)
Coding Notes
- Ensure documentation specifies the opioid and the temporal relationship to constipation.
T40.4X5A - Adverse effect of synthetic narcotics
Use alongside K59.03 to specify the narcotic causing the adverse effect.
Applicable To
- Adverse effect of fentanyl
Excludes
- Poisoning by narcotics (T40.2X1A)
Clinical Validation Requirements
- Presence of opioid prescription
- Temporal relationship to constipation
Coding Notes
Ensure the specific narcotic is documented.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Adverse effect of synthetic narcotics
T40.4X5ADifferential 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 Opioid-Induced Constipation to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code K59.03.
Impact
Clinical: May lead to inappropriate treatment, Regulatory: Non-compliance with coding standards, Financial: Potential claim denials
Mitigation Strategy
Always specify the opioid in documentation, Use BFI scores to support diagnosis
Impact
Reimbursement: Incorrect coding may lead to denied claims., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate data on opioid-related adverse effects.
Mitigation Strategy
Use T40.4X5A for synthetic narcotics.
Impact
Using general constipation codes instead of opioid-specific codes.
Mitigation Strategy
Educate staff on the importance of linking constipation to opioid use.
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 Opioid-Induced Constipation, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Opioid-Induced Constipation
Use these documentation templates to ensure complete and accurate documentation for Opioid-Induced Constipation. These templates include all required elements for proper coding and billing.
Pain Management Clinic Note
Specialty: Pain ManagementRequired Elements
- History of opioid use
- Bowel Function Index score
- Response to laxatives
- Specific opioid causing constipation
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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