ICD-10 Coding for Encopresis(F98.1, K59.04)
Complete ICD-10-CM coding and documentation guide for Encopresis. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Encopresis
F98.1Primary Range
Non-organic encopresis
Used for encopresis without a physiological cause, often related to psychological factors.
Functional intestinal disorders
Includes constipation codes that may be related to encopresis with physiological causes.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| F98.1 | Non-organic encopresis | Use when encopresis is confirmed to be non-organic and related to psychological factors. |
|
| K59.04 | Chronic idiopathic constipation with overflow incontinence | Use when constipation is the primary cause of encopresis. |
|
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 encopresis
Essential facts and insights about Encopresis
Primary ICD-10-CM Codes for encopresis
Decision Criteria
clinical Criteria
- Absence of physiological causes confirmed by tests.
documentation Criteria
- Documented psychological assessment.
Applicable To
- Functional encopresis
- Incontinence of nonorganic origin
Excludes
- Encopresis due to a medical condition
Clinical Validation Requirements
- Normal anorectal manometry
- Bristol Stool Chart 3-4
- Negative abdominal imaging for fecal loading
- Psychological assessment showing anxiety/oppositional behavior
Code-Specific Risks
- Incorrectly coding when a physiological cause is present.
Coding Notes
- Ensure psychological factors are documented to support the use of F98.1.
K59.04 - Chronic idiopathic constipation with overflow incontinence
Use when constipation is the primary cause of encopresis.
Applicable To
- Chronic constipation with overflow
Excludes
- Encopresis without constipation
Clinical Validation Requirements
- Rectal exam: Hard stool in vault
- Abdominal X-ray: Leach score >8
- Documented failure of polyethylene glycol trial
Coding Notes
Ensure constipation is documented as the primary issue.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Fecal impaction
K56.41Differential 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 Encopresis to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code F98.1.
Impact
Clinical: Misrepresentation of the patient's condition., Regulatory: Potential for audit issues., Financial: Incorrect billing and potential claim denials.
Mitigation Strategy
Ensure DSM-5 criteria are met before coding., Use F98.1 for encopresis with psychological factors.
Impact
Reimbursement: Incorrect coding may lead to denied claims., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Ensure constipation is ruled out through clinical evaluation before using F98.1.
Impact
Using F98.1 without ruling out physiological causes.
Mitigation Strategy
Ensure comprehensive clinical evaluation and documentation.
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 Encopresis, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Encopresis
Use these documentation templates to ensure complete and accurate documentation for Encopresis. These templates include all required elements for proper coding and billing.
Pediatric GI Progress Note
Specialty: PediatricsRequired Elements
- Assessment of encopresis with or without constipation.
- Plan for disimpaction and maintenance therapy.
- Behavioral interventions.
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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