Anesthesia Coding Alert

Your provider will need better documentation, or you’ll need access to surgical notes.

Coding for Barrett’s esophagus is simple under ICD-9, with only one diagnosis choice. Code 530.85 (Barrett’s esophagus) applies to all forms of the condition, regardless of the presence or absence of dysplastic changes. But that will no longer be the case when ICD-10 goes into effect.

Brush up on the changes now, so you’ll be prepared when you anesthesia providers are involved in these cases in October 2014 and beyond.

ICD-10 Specifies Dysplasia Options

Under ICD-10, 530.85 will be replaced by the parent code K22.7 (Barrett’s esophagus). But once you’re using ICD-10, you’ll have to look deeper in the patient notes before you can report the Barrett’s esophagus diagnosis.

That’s because ICD-10 codes are more specific than ICD-9, based on the presence or absence of dysplastic changes. So K22.7 expands into a fourth digit classification based on the presence or absence of dysplasia, as follows:

• K22.70 — Barrett’s esophagus without dysplasia
• K22.71 — Barrett’s esophagus with dysplasia.

In addition, K22.71 expands to a fifth-digit classification based on the dysplasia grade. So if dysplasia is present, you will have to further look through the documentation to see if there is any mention about the degree of dysplasia that is present to correctly report the diagnosis of Barrett’s esophagus.

• K22.710 — Barrett’s esophagus with low grade dysplasia
• K22.711 — Barrett’s esophagus with high grade dysplasia
• K22.719 — Barrett’s esophagus with dysplasia, unspecified.

Remember When to Report Barrett’s Esophagus

A diagnosis of Barrett’s esophagus could apply when the surgeon performs an endoscopy of the esophagus and the stomach, such as 43235 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]).

The presence of any suggestive changes might make the surgeon suspect Barrett’s esophagus, and require further investigation.

“If during the endoscopy the [surgeon] sees inflammation, erosions, or irregular salmon colored mucosa, he will perform a biopsy (43239, Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with biopsy, single or multiple) of the lower esophagus,” says Michael Weinstein, MD, former representative of the AMA’s CPT^® Advisory Panel.. The surgeon will then send the biopsied specimen to the laboratory for analysis to check for dysplasia, and if present, to check the grade of dysplasia.

Coding tip: You’ll need to use all the patient information, including the pathology report, to assign the final ICD-10 code for Barrett’s esophagus. Work with the surgeon’s office to verify whether samples were sent for further analysis and to ensure you’re coding based on the most accurate diagnosis.