Gastroenterology Coding Alert

Hint: Know when confirmed diagnosis takes precedence.

No matter how much time you dedicate to your CPT^® and HCPCS Level II code accuracy, you won’t see success with your claims unless you assign the right diagnosis codes. Not only do your diagnoses prove medical necessity, they can also unlock special circumstances like copay waivers, as is the case with colonoscopy screenings.

To ensure that you’re coding your diagnoses correctly, check out the following quiz and determine whether you can assign the right ICD-10 code to the case study described.

Polyps Found During Screening Colonoscopy

Scenario: The physician begins performing a screening colonoscopy on a patient, and finds polyps during the encounter, which he removes. Which diagnosis code(s) apply?

Solution: You’ll need to report two diagnosis codes on your claim to accurately convey the scenario. First, report the screening ICD-10-CM code Z12.11 (Encounter for screening for malignant neoplasm of colon) on the claim. Medicare has been clear that if the patient presents for screening you have to bill the screening with the Z code, even if the physician finds a problem and treats it.

To avoid denials, you should also report the polyp diagnosis code (D12.-, Benign neoplasm of colon, rectum, anus and anal canal) to describe the medical necessity for the polyp removal.

Patient Presents With Diarrhea, Confirmed for COVID-19

Scenario: A patient presents to your practice with a six-day history of diarrhea, lethargy, and a low-grade fever. The patient reports no cough and no exposure to anyone with coronavirus, but on examination, the physician notes some wheezing in their chest. He refers them for a coronavirus test and advises them to take over-the-counter Imodium for the diarrhea, as well as Tylenol for the fever. Three days later, the doctor learns that the patient tested positive for COVID-19. Which ICD-10 code(s) apply?

Solution: Your first diagnosis code should be U07.1 (COVID-19) and your second ICD-10 code should be R19.7 (Diarrhea, unspecified).

Here’s why: When seeing patients with dates of service on or after April 1, you should use U07.1 as your primary or principal diagnosis code, with the manifestation coded afterward, says Betty Ann Price, BSN, RN, president and founder of Professional Reimbursement and Coding Strategies, and an AHIMA-approved ICD-10-CM trainer. “U07.1 needs to be the primary code, even above respiratory distress or respiratory failure — you must put that U code first with dates of service April 1 or after.”

One rationale for reporting the U code first is that, as with all the temporary federal waivers in place for coronavirus reimbursement, it will be important for payers to see the coronavirus code at the front of your claim, which will unlock many of these special payment circumstances, she says.

Intestinal Obstruction Discovered by Radiologist

Scenario: Your gastroenterologist is called to the emergency department to evaluate a patient who is having severe abdominal pain and vomiting. The radiology report arrives and indicates that the patient has a partial intestinal obstruction, but you are unable to explain the cause. Which diagnosis code(s) apply?

Solution: In this situation, you should report K56.600 (Partial intestinal obstruction, unspecified as to cause), which went into effect in October 2017. Because you have the radiology report confirming the obstruction, your documentation supports the confirmation of this code. If you merely had a suspected obstruction, you would report just the signs and symptoms codes, and not the definitive diagnosis.