Gastroenterology Coding Alert

Hint: Distinguish from gallstone ileus or duodenal ileus to correctly nail the diagnosis.

When your gastroenterologist diagnoses paralytic ileus, you’ll be relieved to know that there is not much variation in the way you’ll report this diagnosis using ICD-10 codes except for a few changes to the list of inclusions and exclusions currently in use with the ICD-9 system of codes.

ICD-9: When your gastroenterologist makes a diagnosis of paralytic ileus, you’re used to using 560.1 (Paralytic ileus) in ICD-9. You’ll use the same diagnosis code when your gastroenterologist mentions the diagnosis as adynamic ileus, paralysis of the intestine or the colon and for ileus of the bowel, colon or the intestine.

Caveats:  You cannot report 560.1 if your gastroenterologist diagnoses duodenal ileus (537.2) or an obstruction of the duodenum (537.3). You cannot use 560.1 if the diagnosis is gallstone ileus (560.31). The other exclusions to 560.1 comprise inguinal hernia with obstruction (550.1), intestinal obstruction complicating hernia (552.0-552.9), neonatal intestinal obstruction (277.01, 777.1-777.2, 777.4) or a mesenteric embolism, thrombosis or infarction (557.0).

Observe Changes to Exclusion and Inclusion Lists in ICD-10

When ICD-10 system of codes comes into effect, the ICD-9 code 560.1, used to report a diagnosis of paralytic ileus, crosswalks to K56.0 (Paralytic ileus). You’ll use the same code if your gastroenterologist reports the diagnosis as paralysis of bowel, paralysis of colon or paralysis of the intestine.

You cannot use K56.0 if the diagnosis is gallstone ileus (K56.3), ileus NOS (K56.7) or obstructive ileus NOS (K56.69).

Pay Heed to These Basics Briefly

Documentation spotlight: When your gastroenterologist arrives at a diagnosis of paralytic ileus, some of the signs and symptoms that you are most likely to see in the documentation of the patient will include abdominal pain, bloating, reduced appetite, vomiting and nausea. Your gastroenterologist might note signs of disturbances to passing of stools and flatus.

Upon examination, your gastroenterologist might note distension of the abdomen and in many cases might note tenderness of the distended area. One of the most important physical findings that might point your gastroenterologist to diagnose paralytic ileus upon physical examination might include the absence of bowel sounds.

Although there are many causes for paralytic ileus to occur, one of the most significant causes that you will see is that the patient will have undergone  a recent abdominal or an intestinal surgery and the paralytic ileus could be an adverse complication that occurs following the surgery.

If your gastroenterologist suspects paralytic ileus, he may draw blood samples to check for infections, electrolyte and other metabolic imbalances. He might also order an x-ray to confirm the diagnosis of paralytic ileus and to check for the presence of any obstructions.

Example: Your gastroenterologist reviews a 66-year-old female patient with complaints of bloating and abdominal pain. She also complains that her problem has become progressive over the past few days and she is also suffering from vomiting and frequent bouts of nausea. She says that she has of late had trouble passing of stools and experiences pain upon exertion. When questioned, she says that she has been taking opoid analgesics for the previous eight months or so following a knee problem for which she had undergone a surgery.

Upon examination, your gastroenterologist notes significant distension and tenderness of the affected area. Upon percussion, your gastroenterologist notes the absence of bowel sounds. He draws a blood sample and sends it to the lab for analysis to check the CBC including white blood counts, albumin levels and for any other electrolyte or metabolic abnormalities.

Your gastroenterologist also orders an x-ray of the abdominal area. The radiograph reveals dilation of the intestine.

Based on the history, signs and symptoms, observations on physical examination, lab studies and imaging studies your gastroenterologist arrives at the diagnosis of paralytic ileus caused by the long term usage of the opoid analgesics.

What to report: You’ll report the diagnosis of paralytic ileus with K56.0 if you are using ICD-10 coding system. You’ll turn to 560.1 if you are using the ICD-9 system of codes.