Gastroenterology Coding Alert

Be sure to denote the complications or lack thereof in your fifth and sixth digits.

As the official date for ICD-10 transition has been announced as Oct. 1, 2015, ICD-10 updates will keep you ahead of the curve. Crohn’s disease, a type of inflammatory bowel disease (IBD), is a chronic inflammatory condition that may affect any part of the gastrointestinal tract but is found mostly in the ileum, the cecum and the colon. Also known as regional enteritis, the disease causes symptoms including fever, diarrhea, stomach cramps, vomiting, and weight loss. Crohn’s disease causes increased susceptibility to develop colorectal and small intestine cancer.

Coding for Crohn’s under ICD-9 has been relatively simple with four codes (555.0-555.9) sufficing for describing the various aspects of the disease. ICD-10 crosses over to K50 and further extends this code set to 28 different options with specificity of location and then complications. 

For locations, you’ll start by differentiating by the fourth digit:

Then you’ll go an extra step with the fifth and six digits: 

• K50.-0 -- without complications
• K50.-11 -- with rectal bleeding
• K50.-12 -- with intestinal obstruction
• K50.-13 -- with fistula
• K50.-14 -- with abscess
• K50.-18 -- with other complication
• K50.-19 -- with unspecified complications.

Go More In-Depth

For reporting the disease for small intestine, you are currently reporting 555.0 (Regional enteritis of small intestine). In ICD-10, the scope of description expands substantially into 7 subsets from K50.0 to K50.019. The fourth digit (0) is the location marker for small intestine, and you will use the fifth and sixth digits for specifying any complication or lack thereof. 

You will code K50.00 (Crohn’s disease of small intestine without complications) for the most basic Crohn’s condition of the small intestine. If there are complications, you will use fifth and sixth digits. K50.01 will represent the parent code for Crohn’s with complications. The further subsets will be K50.011 to K50.019 depending upon presence of complications ranging from bleeding, fistula, abscesses to obstructions.

The large intestine is represented currently by the code 555.1 ( Regional enteritis of large intestine). Next year onward, you will have to report K50.10 (Crohn’s disease of large intestine without complications) and K50.110 to K50.119 for the complications as discussed above. 

In case of Crohn’s disease in both the small and large intestines, you have a simple code 555.2 ( Regional enteritis of small intestine with large intestine) to report it in ICD-9. In ICD-10, you will submit K50.80 (Crohn’s disease of both small and large intestine without complications) and K50.8xx (11-19) will show the type of complication in the disease.

Sometimes, the enteritis may be at an unspecified location. In ICD-9, report such encounters with 555.9 (Regional enteritis of unspecified site). Even ICD-10 has kept a provision for such occurrences with a code K50.90 (Crohn’s disease, unspecified, without complications). Of course, for co-morbidities and complications, you will submit K50.9xx with 11-19 completing the fifth and sixth digits.