Gastroenterology Coding Alert

Heads up: Single ICD-9 code spans to eight codes in ICD-10

When ICD-10 goes into effect in 2013, you will need to pay more attention to detail when reporting hemorrhoids. You should specifically look for the type of hemorrhoid as chossing the right code is principally based on the type of hemorrhoid i.e. internal, external or unspecified. So, you will need to know if the hemorrhoid is of internal or external type to correctly report it. When details about the type of hemorrhoid are not available you will need to report the condition under unspecified category.

In ICD-10 both hemorrhoids and perianal venous thrombosis are placed under one classification (K64, Hemorrhoids and perianal venous thrombosis) and this list includes piles too. However, this list does not include hemorrhoids complicating pregnancy (O22.40, Hemorrhoids in pregnancy) and hemorrhoids complicating childbirth and the puerperium (O87.2, Hemorrhoids in the puerperium)

While reporting internal hemorrhoids, you need to know the stage or the grade of the hemorrhoid. If the grade is not specified, then you need to report the condition under a different code. The presence or absence of prolapse also helps you decide the code.

For external hemorrhoids, the presence of skin tags and thrombosis forms the important information on which you can report the condition.

You have one-to-one codes for reporting hemorrhoids, both external and internal. Same applies to hemorrhoids that are thrombosed and the formation of residual skin tags (Table 1).

However, under ICD-10, depending on the grade, a single ICD 10 code is used to describe many different codes under ICD-9 (Table 2 shows example for first degree hemorrhoids). All these ICD-9 codes can also be used to represent K64.1 (Second degree hemorrhoids), K64.2 (Third degree hemorrhoids), and K64.3 (Fourth degree hemorrhoids) depending on the stage of the hemorrhoids.

In case of external hemorrhoids without complication and external hemorrhoids that form residual skin tags, it is reported under a single ICD 10 code (Table 3). In case of thromobosed external hemorrhoids, you report the condition using K64.5 (Perianal venous thrombosis).