Wiki Fecal impaction 560.32 and Constipation 564.00 what to code

[tser05@yahoo.co.in]

If the medical records contain both the fecal impaction and constipation, can we consider to code both 560.32 followed by 564.00. Or we can consider only 560.32 although both the icd exclude to each other. Please help with any supportive references.

 

[NYCPC]

Hi Dawa, you would code only the 560.32. If you look at your book under the "EXCLUDES' section you will able to see it listed there. 564.00 states Constipation, unspecified wheras 560.32 gives a definitive diagnosis hence the constipation. Hope that helped!!



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[tser05@yahoo.co.in]

I agree with you but the 564.00 and 560.32 both exclude each other and exclude note is under both icd. Can you please provide any reference material like coding clinic or any aha article so that it should be more supportive instead of assumption.

 

[mitchellde]

Yes they exclude each other. Excludes notes in ICD-9 CM are very ambiguous as to whether you can code them together or not.
So you have to use logic,and the guidelines. Constipation is more of a symptom caused by the fecal impaction. If the impaction is removed, the constipation goes away. The guidelines state that you do not code the symptom with the underlying dx.
Since the excludes notes are better defined in ICD-10 CM I looked at the equivalent codes there. K56.41 is the code for fecal impaction, it has an exclude 1 note for constipation codes K59.0-. Exclude 1 means it cannot be coded here, you can code only one.

 

[AmandaBriggs]

Yes they exclude each other. Excludes notes in ICD-9 CM are very ambiguous as to whether you can code them together or not.
So you have to use logic,and the guidelines. Constipation is more of a symptom caused by the fecal impaction. If the impaction is removed, the constipation goes away. The guidelines state that you do not code the symptom with the underlying dx.
Since the excludes notes are better defined in ICD-10 CM I looked at the equivalent codes there. K56.41 is the code for fecal impaction, it has an exclude 1 note for constipation codes K59.0-. Exclude 1 means it cannot be coded here, you can code only one.

I agree with Debra. Per the ICD-9 guidelines, if you have a definitive diagnosis, you don't code the signs and symptoms. So, definitive diagnosis is fecal impaction, therefore you wouldn't code the symptom of constipation.