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K59.00
ICD-10-CM
Constipation

Find information on Constipation (C), including clinical documentation, medical coding, and healthcare best practices for managing irregular bowel movements and dyschezia. Learn about diagnosing and treating constipation, ICD-10 codes related to constipation, and effective strategies for patients experiencing infrequent or difficult bowel movements. This resource provides valuable insights for healthcare professionals, medical coders, and patients seeking information on constipation management.

Also known as

Irregular bowel movements
Dyschezia

Diagnosis Snapshot

Key Facts
  • Definition : Infrequent or difficult bowel movements, often with hard stools.
  • Clinical Signs : Straining, abdominal pain, bloating, infrequent stools, hard stools.
  • Common Settings : Primary care, gastroenterology, geriatrics.

Related ICD-10 Code Ranges

Complete code families applicable to AAPC K59.00 Coding
K59.0

Constipation

Infrequent or difficult bowel movements.

K59.00-K59.09

Constipation, unspecified

Constipation without further specification.

R19.4

Other abdominal pain

May include pain associated with constipation.

Code-Specific Guidance

Decision Tree for

Follow this step-by-step guide to choose the correct ICD-10 code.

Is constipation opioid-induced?

  • Yes

    Is there documentation of drug resistance?

  • No

    Is constipation related to a medical condition?

Code Comparison

Related Codes Comparison

When to use each related code

Description
Infrequent, difficult bowel movements.
Severe constipation with inability to pass stool or gas.
Hardened stool mass in the rectum or colon.

Documentation Best Practices

Documentation Checklist
  • Document frequency, consistency, color, and amount of stool.
  • Record patient's dietary habits, fluid intake, and exercise levels.
  • Note any associated symptoms: abdominal pain, bloating, nausea.
  • Document use of laxatives, enemas, or other bowel aids.
  • Specify duration of constipation and its impact on daily life.

Coding and Audit Risks

Common Risks
  • Unspecified Constipation

    Coding constipation without specifying chronic/acute or functional status risks inaccurate reimbursement and data analysis.

  • Comorbidity Overlook

    Failing to code underlying causes like medication side effects or neurological conditions leads to incomplete clinical picture.

  • Symptom vs. Diagnosis

    Coding constipation as a symptom when it's the primary diagnosis can impact quality reporting and severity assessment.

Mitigation Tips

Best Practices
  • High-fiber diet (ICD-10 K59.0, N39.4): Increase fruit/vegetable intake.
  • Hydration (SNOMED CT 716557006): Drink plenty of fluids daily.
  • Regular exercise (ICD-10 Z72.8): Promotes bowel motility.
  • Bowel training (SNOMED CT 223366009): Establish regular toilet habits.
  • Stool softeners/laxatives (consult CDI guidelines for appropriate use).

Clinical Decision Support

Checklist
  • Rome IV criteria documented? (ICD-10 K59.0)
  • Frequency, consistency, straining noted? Improve documentation.
  • Diet, meds, lifestyle assessed? Patient education provided.
  • Red flags (e.g., blood, weight loss) screened? If yes, investigate.

Reimbursement and Quality Metrics

Impact Summary
  • Constipation (ICD-10-CM K59.*) coding accuracy impacts reimbursement for office visits, hospitalizations, and procedures.
  • Proper E/M coding for constipation evaluation and management optimizes revenue cycle management and minimizes denials.
  • Accurate constipation diagnosis reporting improves quality metrics for patient care, bowel management protocols, and resource utilization.
  • Chronic constipation (K59.0) coding affects risk adjustment models and value-based care reimbursement.

Streamline Your Medical Coding

Let S10.AI help you select the most accurate ICD-10 codes for . Our AI-powered assistant ensures compliance and reduces coding errors.

Frequently Asked Questions

Common Questions and Answers

Q: What are the most effective evidence-based strategies for managing chronic constipation in adult patients with comorbidities?

A: Managing chronic constipation in adults with comorbidities requires a multifaceted approach tailored to the individual patient. Evidence-based strategies include increasing dietary fiber intake (e.g., recommending a daily intake of 25-30 grams), ensuring adequate fluid intake, promoting regular physical activity, and establishing a consistent toileting routine. For patients with opioid-induced constipation, consider peripheral opioid antagonists like naloxegol or methylnaltrexone. For patients with slow-transit constipation, stimulant laxatives like bisacodyl or senna may be appropriate. Bulk-forming laxatives like psyllium can be helpful for increasing stool bulk. Osmotic laxatives such as polyethylene glycol can help soften the stool. Always consider potential drug interactions and contraindications based on the patient's comorbidities. Explore how integrating a bowel diary and patient education can improve adherence and outcomes. Learn more about the Rome IV criteria for diagnosing functional constipation.

Q: How can I differentiate between functional constipation and secondary constipation due to medication side effects in older adults?

A: Differentiating between functional and secondary constipation in older adults necessitates a thorough medication review and clinical assessment. Many medications, including anticholinergics, opioids, calcium channel blockers, and certain antidepressants, can contribute to secondary constipation. Ask about the onset of symptoms relative to medication initiation and consider a trial of discontinuation or dose reduction if appropriate, after consulting with the prescribing physician. Functional constipation, on the other hand, is often characterized by symptoms like infrequent bowel movements, straining, and hard stools without an identifiable underlying medical cause. Red flags suggesting a secondary cause include sudden changes in bowel habits, unintentional weight loss, rectal bleeding, and family history of colorectal cancer. Consider implementing a stepwise approach starting with conservative management, including lifestyle modifications and over-the-counter laxatives, before moving on to prescription medications. Explore the potential benefits of collaborating with a geriatrician or gastroenterologist for complex cases. Learn more about age-related changes in bowel function.

Quick Tips

Practical Coding Tips
  • Code C14.9 for unspecified constipation
  • Document bowel movement frequency
  • Query physician for dyschezia details
  • Consider K59.0 for slow transit
  • R14.8 for fecal incontinence if applicable

Documentation Templates

Patient presents with complaints consistent with constipation, characterized by infrequent bowel movements, straining during defecation, and hard or lumpy stools.  The patient reports experiencing dyschezia and describes bowel movements occurring less than three times per week.  Onset of symptoms is reported as [timeframe].  Associated symptoms include abdominal discomfort, bloating, and a sensation of incomplete evacuation.  Patient denies any rectal bleeding, nausea, vomiting, or significant weight loss.  Differential diagnoses considered include irritable bowel syndrome with constipation (IBS-C), pelvic floor dysfunction, and medication-induced constipation.  Review of systems is otherwise unremarkable.  Physical examination revealed normal bowel sounds and no palpable abdominal masses.  Rectal examination revealed normal sphincter tone and no evidence of impaction.  The patient's current medications include [list medications].  A review of the patient's medical history indicates [relevant past medical history, including relevant comorbidities like hypothyroidism or diabetes].  Diagnosis of functional constipation (ICD-10 code K59.0) is made based on Rome IV criteria.  Plan includes increasing dietary fiber intake, encouraging fluid intake, and initiating a trial of over-the-counter osmotic laxative therapy with polyethylene glycol (PEG 3350).  Patient education provided on lifestyle modifications for constipation management, including regular exercise and establishing a consistent toileting schedule.  Follow-up scheduled in [timeframe] to assess treatment efficacy and adjust management plan as needed.  Patient advised to return sooner if symptoms worsen or new symptoms develop.
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