Gastroenterology Coding Alert

You’ll find nearly 400 changes in the new ICD-10 code set.

Just when you think your ICD-10 manual couldn’t get any more specific (or heavy!), a twist heads your way – and that’s the case this year, with nearly 400 changes to the ICD-10-CM code set. The agency published the full listing of codes in mid-June, but we’ve reviewed the list to identify the changes most relevant to GI coders.

Check out New Personal History of Cancer Codes

Effective Oct. 1, you’ll find new codes that allow additional specificity demonstrating a personal history of cancer of the digestive organs, as follows:

• Z86.003 (Personal history of in-situ neoplasm of oral cavity, esophagus and stomach)
• Z86.004 (Personal history of in-situ neoplasm of other and unspecified digestive organs)

These codes expand on the existing section, “Personal history of in-situ and benign neoplasms and neoplasms of uncertain behaviors.” Your GI might use these codes when a patient presents noting that she has lesions in her throat, but that she’s had abnormal cells in the past that have not been classified as cancer. This can help add more depth to the claim, and can explain to medical reviewers why physicians may have performed certain tests.

You’ll typically use these codes as secondary codes following either the code for the presenting symptoms or the definitive diagnosis. But if they’re the only codes in the chart, it may be possible to report them as primary codes, depending on your insurer. “Z codes may be used as either a first-listed (principal diagnosis code in the inpatient setting) or secondary code, depending on the circumstances of the encounter,” the ICD-10 manual says.

Check out These Code Revisions

In addition to the new codes in the ICD-10 manual, you’ll also find a few revisions that will affect gastroenterology practices. The revised code descriptors are as follows, which describe specific E. coli diagnoses:

• B96.21 (Shiga toxin-producing Escherichia coli (E. coli) (STEC) O157 as the cause of diseases classified elsewhere)
• B96.22 (Other specified Shiga toxin-producing Escherichia coli (E. coli) (STEC) as the cause of diseases classified elsewhere)
• B96.23 (Unspecified Shiga toxin-producing Escherichia coli (E. coli) (STEC) as the cause of diseases classified elsewhere)

These diagnoses are intended to allow practitioners to better specify the E. coli type when it causes other diseases.

Resource: To check out the complete list of new ICD-10 codes, visit the CMS website at https://www.cms.gov/Medicare/Coding/ICD10/2020-ICD-10-CM.html.