Gastroenterology Coding Alert

Get ready to learn changed disease terminologies.

As the transition date to ICD-10 comes near, better understanding of the documentation and a better communication with your GI will help you negotiate the vastly expanded universe of gastrodiagnostic codes. As the codes get super specific, we give you the lowdown on how to deal with ulcerative colitis coding beginning Oct. 1, 2015. 

Background: The general term ulcerative colitis refers to a condition of severe inflammation of the colon or large bowel in which ulcers form on the surface of the colon. Diarrhea and bloody stools mixed with pus are common in this condition.

Learn the Current Crosswalks

Currently, when your GI encounters a patient with diarrhea with blood or pus and abdominal discomfort, you often end up with an ulcerative colitis diagnosis. You have a range of ICD-9 codes in the section 556 that you can choose from for your diagnosis depending mostly on the involved region of the colon. There are nine subsections within 556 (Ulcerative enterocolitis) from 556.0 to 556.9.

In ICD-10, you will have to look under section K51 (Ulcerative colitis) for cross-matching your current ICD-9 and also much more specific codes. In general the old codes crosswalk to a new code in a one to one fashion with some changes in terminology. You have K51.0 (Ulcerative [chronic] pancolitis), K51.2 (Ulcerative [chronic] proctitis), K51.3 (Ulcerative [chronic]rectosigmoiditis), K51.4 (Inflammatory polyps of colon), K51.5 (Left sided colitis), K51.8 (Other ulcerative colitis), and K51.9 (Ulcerative colitis, unspecified).

Note: You’ll see alterations in the code descriptors and terminology from ICD-9 to ICD-10. So, universal colitis becomes pancolitis; proctosigmoiditis changes to rectosigmoiditis; and pseudopolyposis will now be described as inflammatory polyps of colon.

Without considering any disease complication, the crosswalks from current ICD-9 codes to ICD-10 will look like this for ulcerative colitis:

• 556.0 (Ulcerative [chronic]enterocolitis) or 556.1 (Ulcerative [chronic] ileocolitis) or 556.8 (Other ulcerative colitis) -- K51.80 (Other ulcerative colitis without complications)
• 556.2 (Ulcerative [chronic]proctitis) --K51.20 (Ulcerative [chronic]proctitis without complications)
• 556.3 (Ulcerative [chronic] proctosigmoiditis) -- K51.30 (Ulcerative [chronic] rectosigmoiditis without complications)
• 556.4 (Pseudopolyposis of colon) -- K51.40 (Inflammatory polyps of colon without complications) 
• 556.5 (Left-sided ulcerative [chronic] colitis) -- K51.50 (Left sided colitis without complications)
• 556.6 (Universal ulcerative [chronic] colitis) -- K51.00 (Ulcerative [chronic] pancolitis without complications)
• 556.9 (Ulcerative colitis unspecified) -- K51.90 (Ulcerative colitis, unspecified, without complications).

Complication Decides Further Specificity

The fifth digit in colitis codes will denote whether cases have any added complications (1 for yes and 0 for no complications). After the confirmation of a complication, you will choose from the following options for deciding the sixth and final digit to complete the diagnostic code:

1 — with rectal bleeding
2 — with intestinal obstruction
3 — with fistula
4 — with abscess
8 — with other complication
9 — with unspecified complications.

Coding scenario: When a patient presents for a screening colonoscopy (G0105, Colorectal cancer screening; colonoscopy on individual at high risk), one of the Medicare-allowed diagnoses that you could list for the procedure is 556.0 (Ulcerative enterocolitis). 

Under ICD-10-CM beginning Oct. 1, 2015, you will code K51.80 (Other ulcerative colitis without complications). This new code will define the presence of ulcerative colitis on a patient, but without complications.

You will also have to use “additional code to identify manifestations, such as pyoderma gangrenosum (L88)” as required by CCI edits for K51.

Example 2: A patient presents to your GI with frequent episodes of rectal bleeding and urgency and tenesmus. The GI takes a medical history and performs a colonoscopy to rule out other problems that may present similar symptoms, such as irritable bowel syndrome, Crohn’s disease, or diverticulitis and diagnoses proctosigmoiditis with bleeding. Currently, you report 556.3 to code the diagnosis. In ICD-10, you will code K51.311 (Ulcerative [chronic] rectosigmoiditis with rectal bleeding).