- Diagnostic Code
- 7301
- CFR Section
- §4.114 — Digestive
Rating Tiers
Persistent partial bowel obstruction that is either inoperable and refractory to treatment, or requires total parenteral nutrition (TPN) for obstructive symptoms
Symptomatic peritoneal adhesions, persisting or recurring after surgery, trauma, inflammatory disease process such as chronic cholecystitis or Crohn's disease, or infection, as determined by a healthcare provider; and clinical evidence of recurrent obstruction requiring hospitalization at least once a year; and medically-directed dietary modification other than total parenteral nutrition (TPN); and at least one of the following: (1) abdominal pain, (2) nausea, (3) vomiting, (4) colic, (5) constipation, or (6) diarrhea
Symptomatic peritoneal adhesions, persisting or recurring after surgery, trauma, inflammatory disease process such as chronic cholecystitis or Crohn's disease, or infection, as determined by a healthcare provider; and medically-directed dietary modification other than total parenteral nutrition (TPN); and at least one of the following: (1) abdominal pain, (2) nausea, (3) vomiting, (4) colic, (5) constipation, or (6) diarrhea
Symptomatic peritoneal adhesions, persisting or recurring after surgery, trauma, inflammatory disease process such as chronic cholecystitis or Crohn's disease, or infection, as determined by a healthcare provider, and at least one of the following: (1) abdominal pain, (2) nausea, (3) vomiting, (4) colic, (5) constipation, or (6) diarrhea
History of peritoneal adhesions, currently asymptomatic
What Raters Look For
Based on M21-1 adjudication criteria for Digestive conditions. These are the factors a VA rater evaluates when assigning a rating percentage.
M21-1 III.iv.4.D- •Weight loss — documented weight changes in treatment records
- •Frequency and severity of symptoms: pain, nausea, vomiting, diarrhea
- •Dietary restrictions required due to the condition
- •Need for surgical intervention, feeding tubes, or colostomy
- •Imaging and endoscopy findings (scope reports, biopsy results)
- •Hepatic function if liver disease is involved: bilirubin, albumin, INR, Child-Pugh score