Health Information Management

GERD yourself for coding digestive diseases in ICD-10-CM

HIM-HIPAA Insider, March 18, 2013

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Based on the prevalence of commercials for acid reflux remedies, you’d think the entire country suffered from some sort of digestive disease.

Maybe some of it comes from coders who are sick to their stomachs at the thought of the upcoming ICD-10-CM transition. Let’s look at some common digestive system diseases and see if we can decrease our worry level.

Take a look at GERD—gastro-esophageal reflux disease. ICD-9-CM offers one code: 530.81. ICD-10-CM includes two codes (but doesn’t include the abbreviation GERD):

  • K21.0, gastro-esophageal reflux disease with esophagitis
  • K21.9, gastro-esophageal reflux disease without esophagitis

The only difference is in ICD-10-CM, we need to know whether the patient has esophagitis, any inflammation, irritation, or swelling of the esophagus. Maybe physicians document that now, maybe they don’t.

If they don’t after the transition to ICD-10-CM, never fear. You don’t have to query (although it might not be a bad idea). You can default to K21.9, which includes esophageal reflux NOS.

Maybe you’ve worried yourself into a digestive ulcer. In both coding systems, we need to know the location and both break codes down into these four areas:

  • Gastric
  • Duodenal
  • Peptic
  • Gastrojejunal

Both ICD-9-CM and ICD-10-CM include specific codes for

  • Acute or chronic
  • With hemorrhage
  • With perforation
  • With hemorrhage and perforation
  • Without mention of hemorrhage or perforation

This is all very familiar. ICD-9-CM actually seems to require one piece of information ICD-10-CM does not: a character to identify without mention of obstruction or with obstruction.

This is easy. We need the same information, we’re coding to the same sites.

Things get a little more complicated when we look at Cronh’s disease. ICD-9-CM offers four codes in the 555 series (regional enteritis):

  • 555.0, small intestine
  • 555.1, large intestine
  • 555.2, small intestine with large intestine
  • 555.9, unspecified site

ICD-10-CM includes these four main categories:

  • K50.0, Crohn’s disease of small intestine
  • K50.1, Crohn’s disease of large intestine
  • K50.8, Crohn’s disease of both small and large intestine
  • K50.9, Crohn’s disease, unspecified

Each of those categories contains two main subcategories for without complications and with complications.

The subcategories for with complication include six additional codes to specify the complication. For example, for Crohn’s disease of the large intestine with complications, we would choose from:

  • K50.111, Crohn’s disease of large intestine with rectal bleeding
  • K50.112, Crohn’s disease of large intestine with intestinal obstruction
  • K50.113, Crohn’s disease of large intestine with fistula
  • K50.114, Crohn’s disease of large intestine with abscess
  • K50.118, Crohn’s disease of large intestine with other complication
  • K50.119, Crohn’s disease of large intestine with unspecified complications

We’re going to need a lot more information from the physicians before we can accurately code Crohn’s disease. If you code a large volume of cases for Crohn’s, start working with your physicians now to make sure they’re including the necessary additional information. Otherwise, you’re going to be sending them a lot of queries after October 1, 2014.

In the meantime, someone pass me an antacid.

This article originally appeared on the ICD-10 trainer blog.



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