January 26, 2026

Sandifer Syndrome and ICD-10-CM: Coding GERD With Neuromuscular Symptoms

According to Cleaveland Clinic, “Sandifer syndrome is a condition that causes a baby to have uncontrollable muscle spasms after they eat. This happens because the baby has acid reflux and moves their body in different ways to ease the discomfort that they feel.” Seven percent of infants in the US experience GERD and less than 1% of those infants experience muscle spams (Sandifer Syndrome).

Clinical Presentation and Diagnostic Considerations

Symptoms that can trigger potential query for Sandifer Syndrome: post-feeding dystonic movements, neck twisting, arching, or muscle spasms in an infant with GERD. Sandifer syndrome symptoms my mimic seizure activity. Make sure to review any work-up.
Do not code Sandifer syndrome as a standalone condition or assume the diagnosis based solely on symptoms. Provider documentation must support GERD and the associated neuromuscular finding.
Symptoms are most common after the baby eats when the contents of their stomach haven’t settled.
Sandifer syndrome typically affects infants, young children and those with developmental delays.
Babies that experience this have symptoms that are equivalent to adult “heartburn”

Sandifer syndrome is a temporary condition that typically disappears by the time they reach one year old. Dietary changes, medications, keeping their head elevated while they eat and burping them during and immediately after they eat can all help reduce the symptoms.

ICD-10-CM Coding Guidance for Sandifer Syndrome

Code Assignment: Sandifer syndrome does not have a unique ICD-10-CM code. When documented, assign:

K21.9 – Gastro-esophageal reflux disease without esophagitis, and
An additional code for the associated manifestation (e.g., torticollis or muscle spasm), if separately documented and clinically evaluated.

Guidance from Coding Clinic, First Q 1995 page 7 directs us to capture GERD (K21.9) and Torticollis or muscle spasms documented in the chart.

Liz Burson, BS, CCS

Senior Consultant, Audit at UASI

Liz Burson serves as a Senior Consultant in Auditing at UASI, with 20+ years of outpatient and inpatient coding experience. She provides coding tips based on current audit findings to help coders improve their accuracy in capturing the correct ICD-10-CM and PCS codes.