Constipation (ICD-10 – K59.00 - Constipation unspecified) is number 30 in the top 100 list of diagnosis codes identified in the emergency medicine diagnosis coding performed at McKesson. It is described as: "[a] decrease in a person's normal frequency of defecation accompanied by difficult or incomplete passage of stool and/or passage of excessively hard, dry stool."¹ Constipation is not uncommon and almost everyone has it at some point in their life. Acute constipation is typically found in bed-ridden patients, particularly the elderly.

Normal bowel frequency varies from person to person. Some people normally have three bowel movements daily, while others have a normal pattern of one or two bowel movements a week. There are many causes of constipation which include your eating habits, daily activities, medications or prescriptions being taken, antacids that contain calcium or aluminum, and taking too much of a laxative over time can also be considered as a cause. Pregnancy, stress and problems with the nerves and muscles in the digestive system are also potential causes of constipation. "Certain neurologic disorders, like Parkinson's disease, cerebral thrombosis, tumor, spinal cord injury are also important extra-intestinal causes."²

Types of constipation

  • Outlet dysfunction constipation
  • Drug induced
  • Psychogenic
  • Neurogenic
  • Atonic
  • Simple
  • Spastic
  • Slow Transit
  • Specified

Diagnosis
"Before advising or reassuring a patient about defecatory habits, the physician must exclude serious disease by rectal and sigmoidscopic examinations and by barium enema when indicated. Everyone with constipation should have a full physical examination, including a rectal examination to exclude masses, CBC, blood tests to check on hormone levels and thyroid stimulating hormone, and fasting glucose and electrolytes are also appropriate for some patients. Those with resistant, prolonged, or unusual symptoms may need a colonoscopy. Whenever possible, medications that may cause constipation should be stopped.  Individual psychologic needs should be considered."³

Treatment
The treatment considered for constipation could begin with the diet and it should contain enough fiber to ensure adequate stool bulk.  Vegetable fiber increases stool bulk, so fruits and vegetables are recommended as are prunes and bran cereals. Increased water intake is also suggested, unless directed by a physician to limit fluids for other health reasons. The use of over the counter softeners could lead to overuse of laxatives which can worsen the symptoms. A doctor should be consulted for any sudden constipation with abdominal pain or cramping especially if the patient isn't able to pass any gas or stool.  A doctor should also be consulted if blood appears in the stool, there is weight loss, constipation has lasted more than two weeks and/or if stools are pencil-thin.

Diagnosis Coding

ICD-10 Look up, Code and Description
Look up as; Constipation– K59.00Constipation (includes Atonic, Neurogenic, simple, and spastic)
Look up as; Constipation, Drug-induced – see table of Drugs and Chemicals      
Look up as; Constipation, outlet dysfunction – K59.02
Look up as;  Constipation, Psychogenic – F45.8
Look up as;  Constipation, Slow Transit – K59.01
Look up as;  Constipation, Specified NEC – K59.09


It is imperative that the provider document the medical history, examination and the result of diagnostic studies', if any, to determine the exact course of action for the condition presented or defined after study.  This will also allow the coding staff to select the most appropriate ICD-10 diagnosis code for reporting on the claim for reimbursement.

 

References:           

ICD-10-CM, 2016 Complete Official Code Set, Chapter 11, Page 670, Diseases of the Digestive System (K00 – K95), AAPC, Optum360 2015
Merck Manual, Section 3 - Gastrointestinal Disorders, Chapter 27 – Diarrhea and Constipation, Page 278-282, Editor – Keryn A. G. Lane, Publisher – Gary Zelko, June 1999
WebMD click here for article on Constipation

¹Taber's Cyclopedic Medical Dictionary, 19th Edition, page 278, Editor – Donald Venes, M.D., M.S.J., F.A. Company.
²Merck Manual, Section 3 - Gastrointestinal Disorders, Chapter 27 – Diarrhea and Constipation, Page 278 - 282, Editor – Keryn A. G. Lane, Publisher – Gary Zelko, June 1999.
³ Ibid. 

Author - Male

About the author

Robert Bunting, CPC, CPC-H, CHC, CEDC, CEMC, CAC is Compliance Director – Emergency Medicine, McKesson Business Performance Services.