Gastroenterology Coding Alert

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

When you begin using ICD-10 codes after Oct.1, 2014, you’ll continue to report a diagnosis of gallstone ileus without much deviation from the way you reported this diagnosis with ICD-9 codes.

ICD-9: When your clinician’s diagnosis is gallstone ileus, you’ll have to report it with the ICD-9 code, 560.31 (Gallstone ileus). You use the same diagnosis code if your clinician mentions the diagnosis as “obstruction of the intestine by gallstone.”

Caveat: You cannot use 560.31 if your gastroenterologist identifies the condition as duodenal ileus (537.2) or obstruction of the duodenum (537.3); 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 mesenteric infarction (embolic) (thrombotic) (557.0).

ICD-10: A diagnosis of gallstone ileus that you report with 560.31 with ICD-9 codes crosswalks to K56.3 (Gallstone ileus) in ICD-10. As in ICD-9, you report the same ICD-10 code if your gastroenterologist documents the diagnosis as “obstruction of the intestine by gallstone.”

Catch These Basics Briefly

Documentation spotlight:Some symptoms that you are most likely to encounter in the patient documentation in a patient suffering from gallstone ileus will include abdominal pain, vomiting and constipation. Upon examination, your clinician notes that the patient had a distension of the abdomen with no signs of tenderness on palpation.

Tests: If your gastroenterologist suspects intestinal obstruction, he will order imaging studies such as an x-ray, ultrasound examination, or a CT scan. He will also draw a blood sample to check for infections and to look for electrolyte and metabolic imbalances. The imaging studies, especially the CT scan will help confirm the diagnosis of gallstone ileus.

Although management will involve surgery in most cases, if the gallstone is accessible with an endoscope, your clinician might want to try to remove the stone through that means or destroy the stone through lithotripsy.

Example: Your gastroenterologist reviews a 69-year-old female patient with complaints of vomiting and abdominal pain for the past three days. The patient also has been unable to pass stools for the same period. The patient has no other medical complications and is not under any medication. She has not had any other incidence of previous abdominal problems.

Upon examination, your clinician notes distension of the abdomen but the patient does not experience any tenderness when your gastroenterologist palpates the area. Your clinician also notes absence of bowel sounds which makes him suspect obstruction.

He draws a blood sample and sends it to the lab for analysis to check the CBC, including hemoglobin levels and white blood counts, and a complete metabolic panel to check the albumin levels, liver function tests and for any other electrolyte or metabolic abnormalities.

Your gastroenterologist also orders for an x-ray of the abdominal area and an abdominal CT scan that showed distension of the small intestine with a calcified mass in the ileum.

Based on the history, signs and symptoms, observations on physical examination, lab studies and imaging studies your gastroenterologist arrives at the diagnosis of gallstone ileus.

What to report:You report the evaluation of the patient with an appropriate new patient E/M code such as 99204 (Office or other outpatient visit for the evaluation and management of a new patient…). You’ll report the diagnosis of paralytic ileus with K56.3 if you are using ICD-10 coding system. You’ll turn to 560.31 if you are using the ICD-9 system of codes.