Gastroenterology Coding Alert

Look at detailed exclusions list to differentiate other causes of cirrhosis.

If your gastroenterologist diagnoses alcoholic cirrhosis of the liver after Oct.1, 2014, be ready to check patient documentation in detail — you will need to assess presence or absence of ascites as it will alter the ICD-10 code that you will select to correctly report the condition.

Capture Single Code for All Stages of Alcoholic Cirrhosis in ICD-9

Under ICD-9, you will have to report the condition using 571.2 (Alcoholic cirrhosis of liver). When you are reporting the diagnosis, you have to use a single code to report the condition, regardless of the presence or absence of ascites. "Other ICD-9 codes exist to report cirrhosis complications like ascites (789.59), hepatic encephalopathy (572.2), and portal hypertension (572.3)," says Michael Weinstein, MD, gastroenterologist at Capital Digestive Care in Washington, D.C., and former representative of the AMA’s CPT^® Advisory Panel. This means that just a look at the cirrhosis diagnosis code will not be helpful in assessing the progress of the condition. The inclusions for this diagnosis code comprise Florid cirrhosis and Laennec’s cirrhosis.

Observe More Reporting Options Depending on Disease Progress in ICD-10

When using ICD-10 codes, 571.2 in ICD-9 crosswalks to K70.3 (Alcoholic cirrhosis of the liver) in ICD-10. K70.3 further undergoes a 5^th digit expansion into two codes depending on the presence or absence of ascites. This enables you to provide detailed coding thus giving a correct idea about the progression of the alcoholic ascites. Depending on the presence or absence of ascites, you can choose from the following two codes to report the diagnosis of alcoholic cirrhosis using ICD-10 codes:

K70.30 – Alcoholic cirrhosis of liver without ascites

K70.31 – Alcoholic cirrhosis of liver with ascites

Reminder: Under ICD-10 code sets, you will have to also use an additional code to help identify alcohol abuse and dependence (F10.-). The list of exclusions will comprise jaundice NOS (R17), hemochromatosis (E83.11-), Reye’s syndrome (G93.7), viral hepatitis (B15 – B19) and Wilson’s disease (E83.0).

Note Down These Basics Briefly

Some of the signs and symptoms that you are most likely to see in the documentation for an alcoholic cirrhosis patient include fever, nausea, vomiting, poor appetite, weight loss, malaise and abdominal bloating with abdominal pain. Upon examination, your gastroenterologist might note telangiectasia, dyspnea, hepatosplenomegaly, signs of jaundice, peripheral edema and dullness on percussion over the abdomen due to ascites.

Although history and physical findings are some of the major criteria on which your gastroenterologist will depend on to diagnose alcoholic cirrhosis of the liver, he will order out some diagnostic tests such as CBC, screening tests to rule out other conditions (see exclusions list) and liver function tests to confirm the diagnosis and to assess the progress of the condition.

In addition, your gastroenterologist might resort to ultrasonography, MRI or an abdominal CT and in some cases, even a liver biopsy to ascertain the diagnosis and to check for signs of liver cirrhosis. He will also resort to an upper EGD procedure to check for the presence of esophageal varices that is suggestive of cirrhosis.

Example: Your gastroenterologist assesses a 63-year-old male patient who arrives with complaints of abdominal bloating along with fever, malaise, nausea, vomiting and severe weight loss occurring over a quick span of time. He complains of pain and tenderness in the abdominal area and says that he has difficulty in breathing. His past medical history reveals alcohol abuse spanning many years.

Your gastroenterologist assesses the patient and proceeds to perform a physical examination. During the examination, he notes spider nevi, peripheral edema, hepatosplenomegaly with signs of tenderness, abdominal dullness due to ascites and documents signs of jaundice. He also notes some signs of muscle wasting and gynecomastia along with clubbing of nails.

Based on history and physical findings, your gastroenterologist comes to the conclusion of diagnosis of alcoholic cirrhosis of the liver. He orders diagnostic tests such as CBC, liver function tests to measure out albumin and bilirubin levels along with liver enzymes such as AST and ALT levels. He also orders for checks on prothrombin time and globulin levels. He also orders for an ultrasonogram to help confirm the diagnosis of alcoholic cirrhosis and opts to perform a percutaneous liver biopsy. He also performs an upper EGD and confirms the presence of esophageal varices and treats it with a sclerosing agent.

Upon review of the history, signs and symptoms and results of diagnostic tests, your gastroenterologist arrives at a diagnosis of alcoholic cirrhosis of the liver with ascites.

What to report: You will have to report the upper EGD with 43243 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate with injection sclerosis of esophageal and/or gastric varices) and the liver biopsy with 47000 (Biopsy of liver, needle percutaneous). You will have to report the diagnosis with 571.2 if you are using ICD-9 code sets.

Since your gastroenterologist mentions dullness over the abdomen due to ascites, report K70.31 if you are using ICD-10 codes to report the diagnosis.