Gastroenterology Coding Alert

Determine whether you know the right ICD-10 codes for these scenarios.

You may find it frustrating to select an ICD-10 code among the thousands of options in your coding manual, but the truth is that your claims success depends on the fact that you know these codes as well as you know those in CPT^®. After all, your diagnosis codes are what insurers use to confirm that your services were medically necessary, so your income depends on making sure your ICD-10 knowledge is top-notch.

Check out the following examples and determine which code you should report before you read the answers to determine whether you were right.

Scenario 1: Umbilical Hernia

Scenario: Your gastroenterologist sees a 55-year-old patient complaining of severe pain that has developed around her umbilical area over the past few weeks. The patient says that she had a bulge over her umbilical area right since childhood and it had never troubled her in the past although the size of the protrusion had increased significantly following the birth of her third child about 15 years ago.

Upon examination, your gastroenterologist notes significant protrusion of tissue in the umbilical area and observes signs of strangulation of the protruded tissue and some signs of gangrene. He makes a diagnosis of umbilical hernia and orders an abdominal ultrasound and x-ray.

Based on the observations during physical examination and the results of the imaging studies, your gastroenterologist makes a diagnosis of umbilical hernia with gangrene.

Which code applies: You'll report this case with K42.1 (Umbilical hernia with gangrene) once the physician makes the definitive diagnosis. If you report anything prior to the diagnosis (for instance, adding diagnosis codes to lab orders before determining the final diagnosis), you'll bill the appropriate ICD-10 code for the signs and symptoms that prompted the testing, such as R10.815 (Periumbilic abdominal tenderness).

Scenario 2: Alcoholic Cirrhosis

Scenario: Your gastroenterologist assesses a 62-year-old male patient who arrives with complaints of abdominal bloating along with fever, malaise, nausea, vomiting, and severe weight loss occurring over a month-long period. He complains of pain and tenderness in the abdominal area, swollen ankles, and says that he has difficulty breathing. His past medical history reveals alcohol abuse spanning many years, and the patient reports that he currently drinks about 12-15 beers every evening.

Your gastroenterologist assesses the patient and proceeds to perform a physical examination. During the examination, he notes spider nevi, peripheral edema, hepatosplenomegaly with signs of tenderness, abdominal dullness due to ascites and documents signs of jaundice. He also notes some signs of muscle wasting and gyneco­mastia along with clubbing of nails.

Based on the patient's history and physical findings, your gastroenterologist suspects alcoholic cirrhosis of the liver. He orders diagnostic tests such as a complete blood count and liver function tests to measure out albumin and bilirubin levels along with liver enzymes such as AST and ALT levels. He also orders for checks on prothrombin time and globulin levels, orders an ultrasound to help confirm the diagnosis of alcoholic cirrhosis, and opts to perform a percutaneous liver biopsy. He also performs an upper EGD, confirms the presence of esophageal varices, and treats it with a sclerosing agent.

Upon review of the history, signs and symptoms, and results of diagnostic tests, your gastroenterologist arrivesat a diagnosis of alcoholic cirrhosis of the liver with ascites.

Coding  Solution:  Since your gastroenterologist mentions dullness over the abdomen due to ascites with the cirrhosis, report K70.31 (Alcoholic cirrhosis of liver with ascites) for this condition. Again, if the physician needs to report a diagnosis code before coming to the final confirmation of this condition, you'll instead reportthe signs and symptoms that prompted any services or testing.

Scenario 3: Gastritis

Scenario: Your gastroenterologist assesses a 58-year-old male patient who has been suffering from frequent episodes of abdominal pain and bloating for at least seven months. Upon examination, your gastroenterologist notes the presence of epigastric tenderness.

A guaiac-stool test conducted arrives positive for occult blood. Suspecting gastritis, your gastroenterologist then performs an upper EGD with biopsy and removes samples from various sites and sends them to the lab for analysis. Lab results arrive positive for H. pylori and histological examination shows atrophy.

Coding Solution: You will report K29.41 (Chronic atrophic gastritis with bleeding) since the guaiac-stool test was positive, indicating the presence of bleeding; or depending on how the pathologic findings are read, K29.31 (Chronic superficial gastritis with bleeding). Since the cause (H pylori) is known, a second diagnosis B96.81 (Helicobacter pylori [H. pylori] as the cause of diseases classified elsewhere) is also applicable.