Gastroenterology Coding Alert

K52.82 now includes codes for 4 new types of proctocolitis.

ICD-10-CM coding can be a challenging experience, especially with the plethora of new and more specific codes expected this fall.

“It is not possible to rank (or prioritize) code changes in terms of importance,” says Michael Weinstein, MD, former representative of the AMA’s CPT^® Advisory Panel. Work yourself through one step at a time.

The K52 category (Other and unspecified noninfective gastroenteritis and colitis) especially seems to have quite a few changes in store for you. It’s time to start familiarizing yourself with what you’ll be facing, come October 1.

Heed These Revisions to Noninfective Gastroenteritis and Colitis

Diagnosis K52.81 (Eosinophilic gastritis or gastroenteritis), the excludes1 note depicting “eosinophilic esophagitis (K20.0)” stands deleted, and this condition now features a newly added excludes2 note.

Also, K52.82 (Eosinophilic colitis) has new additions to the detailed descriptors that ask you to include:

• Allergic proctocolitis
• Food-induced eosinophilic proctocolitis
• Food protein-induced proctocolitis
• Milk protein-induced proctocolitis.

Further, K52.89 (Other specified noninfective gastroenteritis and colitis), will no longer include “Collagenous Colitis, Lymphocytic colitis, Microscopic colitis (collagenous or lymphocytic)” in the detailed descriptor.

A little confusion here: Diagnosis K52.2 (Allergic and dietetic gastroenteritis and colitis) has a brand new excludes2 note which reads:

• Allergic eosinophilic colitis (K52.82)
• Allergic eosinophilic esophagitis (K20.0)
• Allergic eosinophilic gastritis (K52.81)
• Allergic eosinophilic gastroenteritis (K52.81)
• Food protein-induced proctocolitis (K52.82).

On having a close look, you might wonder why K52.81 is associated with two descriptors- “Allergic eosinophilic gastritis” and “Allergic eosinophilic gastroenteritis.” The actual single descriptor is “Eosinophilic gastritis or gastroenteritis,” so it would be best to go by that for now.

As for K52.82, the excludes2 note mentions descriptors such as “Allergic eosinophilic colitis” and “Food protein-induced proctocolitis.” However, the actual descriptor of K52.82 is only “Eosinophilic colitis”, with four proctocolitis conditions in the detailed descriptor. While some feel the inclusion of more than one condition for the same diagnosis is just a matter of ICD-10 being super specific, others are of the view that we go by the official descriptor of the code, as we await further clarifications  from CMS on this.

It’s Raining New Codes for Gastroenteritis and Colitis

You will have a wide variety of new codes to pick from when reporting gastroenteritis or colitis, beginning October 1. To code food protein induced enterocolitis, you have the following to choose from:

• K52.21 (Food protein-induced enterocolitis syndrome)
• K52.22 (Food protein-induced enteropathy)
• K52.29 (Other allergic and dietetic gastroenteritis and colitis).

That’s not all. You will now have a variety of specific options to choose from, based on the type/cause of colitis. The flipside is you will need to be very clear regarding the cause of colitis before picking on a code.

• K52.3 (Indeterminate colitis)
• K52.83 (Microscopic colitis)
• K52.831 (Collagenous colitis)
• K52.832 (Lymphocytic colitis)
• K52.838 (Other microscopic colitis)
• K52.839 (Microscopic colitis, unspecified).

In the case of necrotizing enterocolitis, we will have greater specificity with new codes that require specific mention of the stage of the disease process:

• K55.3 (Necrotizing enterocolitis) 
  Excludes1: necrotizing enterocolitis of newborn (P77.-) Excludes2: necrotizing enterocolitis due to Clostridium difficile (A04.7)
• K55.30 (Necrotizing enterocolitis, unspecified) 
  Necrotizing enterocolitis, NOS
• K55.31 (Stage 1 necrotizing enterocolitis) 
  Necrotizing enterocolitis without pneumatosis, without perforation
• K55.32 (Stage 2 necrotizing enterocolitis) 
  Necrotizing enterocolitis with pneumatosis, without perforation
• K55.33 (Stage 3 necrotizing enterocolitis) 
  Necrotizing enterocolitis with perforation 
  Necrotizing enterocolitis with pneumatosis and perforation.

Lessons learned: “While some of the additional granularity of codes may not seem pertinent to some practices there is scientific rationale for being able to track some of these conditions with more specificity,” says Weinstein.

Editor’s note: Look out for more gastroenterology code updates in the next issue.