How to Order
Prior Authorization Information
Here is some helpful information for submitting the Prior Authorization form correctly.
Enter Patient Diagnosis Code (ICD-10)
Here is a list of possible ICD-10 codes that may apply to a CSID patient (may not be an all-inclusive list):
|Other disorders of intestinal carbohydrate absorption||E74.39|
|Malabsorption due to intolerance, not elsewhere classified||K90.49|
|Abdominal distension (gaseous)||R14.0|
*If CSID is suspected, this ICD-10 code may be required for some insurance plans and financial assistance programs.
Identify Patient Symptoms
Experiencing symptoms of Congenital Sucrase-Isomaltase Deficiency (CSID), including diarrhea, gas, bloating, abdominal cramping, nausea, or other.
Detail Patient History
- Prior treatment
- Medical history
- Dietary counseling
Indicate Patient Tests and Results
Evidence of deficient sucrase activity through one of the following recommended diagnoses:
- 13C-sucrose breath test
- Sucrose hydrogen-methane breath test
- EGD biopsy and disaccharidase assay
- 2 extra distal duodenal biopsy samples
- Sent to specialty disaccharidase testing lab; results evaluated
|Lactase||5 - 55 U/g protein|
|Sucrase||26 - 110 U/g protein|
|Maltase||105 - 380 U/g protein|
|Palatinase||9 - 32 U/g protein|
Hackenmueller SA, Grenache DG. Reference intervals for intestinal disaccharidase activities determined from a non-referenced population. J Appl Lab Med. 2016;1(2):172-80.