Gastroenterology Coding Alert

Observe minor changes to the inclusion lists for esophagitis.

Acid reflux and heartburn are common symptoms that can be associated with many different conditions, one such being eosinophilic esophagitis, an inflammatory condition of the esophagus. Since acid reflux is a common condition seen by your gastroenterologist, you will need to know how to report problems like eosinophilic esophagitis when ICD-10 codes come into effect.

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You will need to be aware of what symptoms will make your gastroenterologist suspect a diagnosis of eosinophilic esophagitis. But your gastroenterologist will only be able to arrive at a final diagnosis of eosinophilic esophagitis based on findings of history, examination, observational findings during endoscopy and laboratory findings of a biopsy specimen.

Some symptoms that will trigger your gastroenterologist to suspect eosinophilic esophagitis include dysphagia (R13.14, Dysphagia, pharyngoesophageal phase), heartburn (R12, Heartburn), abdominal discomfort (R10.9, Unspecified abdominal pain) and chest pain (R07.9, Chest pain,unspecified).

Although these symptoms might be suggestive of eosinophilic esophagitis, you will also see the same type of symptoms in a patient suffering from gastroesophageal reflux disease (GERD) and other related conditions like Barrett's esophagus.

Your gastroenterologist will confirm a diagnosis of eosinophilic esophagitis by performing diagnostic procedures such as an EGD (esophagogastroduodenoscopy) or an esophagoscopy. You will report the procedures using 43235 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]) or 43200 (Esophagoscopy, rigid or flexible; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]) respectively.

Your gastroenterologist might also resort to taking biopsy samples of the esophagus during the endoscopy. Depending on the extent of the scope, you can report 43202 (Esophagoscopy, rigid or flexible; with biopsy, single or multiple) if your gastroenterologist is only visualizing the esophagus or 43239 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with biopsy, single or multiple) if your gastroenterologist views beyond the pyloric channel.

Reporting Eosinophilic Esophagitis in ICD-9

When using ICD-9 codes, you will report esophagitis with 530.1 (Esophagitis). This diagnosis code includes all types of esophagitis, namely, chemical, peptic, postoperative and regurgitant, but does not include tuberculous esophagitis (017.8, Tuberculosis of esophagus).

The code further expands using a fifth digit classification that is specific for the type of esophagitis. Based on the type of esophagitis, 530.1 expands into five different codes. When your gastroenterologist arrives at a diagnosis of eosinophilic esophagitis, you will report 530.13 (Eosinophilic esophagitis).

Observe no Descriptor Changes to Eosinophilic Esophagitis in ICD-10

When you begin using ICD-10 codes, you will have to report esophagitis with K20 (Esophagitis). If the esophagitis has been caused as a result of alcohol dependence, you will need to use an additional code to identify the causative factor using F10._ (Alcohol related disorders). K20 does not include regurgitant type of esophagitis as it does in ICD-9 codes. K20 expands into three different codes using a fourth digit expansion:

• K20.0 (Eosinophilic esophagitis)
• K20.8 (Other esophagitis) that includes abscess of the esophagus
• K20.9 (Esophagitis, unspecified) that includes esophagitis NOS (Not otherwise specified)

Example: A 55-year-old male patient arrives at your gastroenterologist's office with complaints of dysphagia and heartburn. He had been previously assessed for similar complaints in the past and had been prescribed proton pump inhibitors for the acid reflux complaints and the heartburn symptoms that he had been experiencing. He complained of gradual increase in the symptoms of dysphagia and his heartburn symptoms not alleviating despite the regular intake of his prescribed medications.

Your gastroenterologist undertakes a thorough evaluation of the patient and decided to perform an EGD. Based on the findings of the esophagus, he proceeds to perform a biopsy of the inflamed esophagus. You report the procedure with 43239. Based on laboratory findings of the biopsied specimen, your gastroenterologist is able to confirm the diagnosis of eosinophilic esophagitis. You code the diagnosis with K20.0.