Here is some helpful information for submitting the prior authorization form correctly.
See if Sucraid® is right for your patients diagnosed
with CSID.
Here is a list of possible ICD-10 codes that may apply to a CSID patient (may not be an all-inclusive list):
Sucrase-isomaltase deficiency
E74.31
Other disorders of intestinal carbohydrate absorption
E74.39
Malabsorption due to intolerance, not elsewhere classified
K90.49
Diarrhea, unspecified
R19.7
Flatulence
R14.3
Abdominal distension (gaseous)
R14.0
Nausea
R11.0
Experiencing symptoms of Congenital Sucrase-Isomaltase Deficiency (CSID), including diarrhea, gas, bloating, abdominal cramping, nausea, or other.
Evidence of deficient sucrase activity through one of the following recommended diagnoses:
Disaccharidase
Normal Range
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.
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