Gastroenterology Coding Alert

Dig deeper into the code descriptor to explore what the K57 category contains.

Are you confident of your ICD-10 coding skills? Grade yourself with these coding scenarios that stress on the importance of reading through a complete descriptor of a code.

Is There A Direct Code For Ischemic Colitis?

Question 1: The provider report says the patient is suffering from ischemic colitis. What code can you report here?

If you hope to report the most specific code, you will need to extract a little more information from the records.

Although this diagnosis will belong to the K55 category (Vascular disorders of intestine), you will need to ask whether the case is acute, subacute or chronic.

If you find that the case is a recent onset or an acute fulminant ischemic colitis or subacute ischemic colitis, you will choose the code K55.0, (Acute vascular disorders of intestine). The other conditions that are covered by this code include mesenteric vessel embolism, infarction, and thrombosis.

However, if the documentation suggests that it is a longstanding or a chronic case of ischemic colitis, you may pick up K55.1 (Chronic vascular disorders of intestine).

As a last resort, if you are not able to find any such indications in the record, you may have to choose the unspecified code — K55.9 (Vascular disorders of intestine, unspecified).

Search Your Coding Option for Diverticulitis of Colon

Question 2: What are your coding options for a diverticular disease of colon?

This diagnosis belongs to the category K57 (Diverticular disease of the intestine). If the records provide you with little else, you may have to turn to an NOS code — K57.30 (Diverticulosis of large intestine without perforation or abscess without bleeding). It covers your diagnosis as ‘diverticular disease of colon NOS’.

Suppose you find that the patient also has peritonitis along with the diverticulitis of colon, you can think of some other code option as well. Depending on the presence or absence of bleeding you may choose from:

• K57.20 (Diverticulitis of large intestine with perforation and abscess without bleeding)
• K57.21 (Diverticulitis of large intestine with perforation and abscess with bleeding)

Reason: The code subcategory K57.2- (Diverticulitis of large intestine with perforation and abscess…) includes ‘diverticulitis of colon with peritonitis.’

Don’t Let the IBS Codes Irritate You

Question 3: How would you code a spastic colon?

You won’t find your answer if you search the index under either ‘colon’ or ‘spastic.’

A spastic colon is better known as an irritable bowel syndrome, and therefore the appropriate code category is K58.- (Irritable bowel syndrome…). If the patient is also suffering from chronic diarrhea, the correct code will be K58.0 (Irritable bowel syndrome with diarrhea).

That said, suppose the patient does not complain of diarrhea, or in another scenario you do not have any information whether or not the patient has diarrhea. In either of the situations, you can report K58.9 (Irritable bowel syndrome without diarrhea), as this code also includes ‘irritable bowel syndrome NOS.’

Take It Easy On Coding For Indigestion

Question 4: How would you approach a coding diagnosis of indigestion along with a mention of the symptom of heartburn?

ICD-10-CM code K30 (Functional dyspepsia) includes the diagnosis of indigestion. This is a single code of three characters, and does not require a fourth character.

However, as the Excludes1 note for K30 mentions heartburn, R12, so you would only report K30 here. An Excludes1 note means that these two codes can never be coded together, code either one or the other. You would prefer the definitive diagnosis, says Michael Harris CPC-I, CCS, CPC, Coding Compliance Manager with Mount Sinai Medical Center in New York. On the other hand, an Excludes2 note means that both diagnoses may be coded together if they are both present, he says.

Final takeaway: “The ICD-10 coding system has expanded by nearly 500 percent,” says Michael Weinstein, MD, former representative of the AMA’s CPT^® Advisory Panel. “Many symptoms and diagnoses which previously were lumped into single ICD-9 codes have now been divided up into their own separate codes. It is important to look for the most specific code that describes your physician’s assessment of the patient and to avoid old habits of using broad terms and common codes.”