Gastroenterology Coding Alert

Hint: The presence of hemorrhage is still the final key to right code selection.

Your gastroenterologist might frequently see patients for bleeding in the stools which could be caused by angiodysplasia of the colon. Nailing an angiodysplasia diagnosis in ICD-9 and ICD-10 hinges on the presence or absence of hemorrhage.

Depending on presence or absence of hemorrhage, angiodysplasia can be reported using the following two codes in ICD-9:

·         569.84 — Angiodysplasia of intestine (without hemorrhage)

·         569.85 — Angiodysplasia of intestine with hemorrhage

Reminder: The ICD-9 codes 569.84 and 569.85 are specific to reporting angiodysplasia of the intestine. If your gastroenterologist diagnoses angiodysplasia of the stomach or the duodenum, you cannot use these two codes. Instead, depending on the presence or absence of hemorrhage, you will have to report the diagnosis with 537.82 (Angiodysplasia of stomach and duodenum [without hemorrhage]) or 537.83 (Angiodysplasia of stomach and duodenum with hemorrhage) if the location of the vascular deformity is in the stomach or duodenum.

Observe Minor Descriptor Changes in ICD-10

When you begin using ICD-10 codes, a diagnosis of angiodysplasia of the colon will again rely on the presence or absence of hemorrhage, as in ICD-9.

In ICD-10, you will have two codes to report angiodysplasia of the colon:

·         K55.20 — Angiodysplasia of colon without hemorrhage

·         K55.21 — Angiodysplasia of colon with hemorrhage

As in ICD-9 codes, you cannot report angiodysplasia of stomach and duodenum with K55.20 or K55.21. Instead, taking note of hemorrhage, you will report a diagnosis of angiodysplasia of the stomach or duodenum using K31.811 (Angiodysplasia of stomach and duodenum with bleeding) or K31.819 (Angiodysplasia of stomach and duodenum without bleeding).

Note: Although a dieulafoy lesion of the intestine is a hemmorhagic lesion, you should not report this condition using K55.21 if you are using ICD-10 codes or 569.85 in ICD-9 system. You have a separate code in ICD-9 and ICD-10 to report this condition. You will report 569.86 (Dieulafoy lesion [hemorrhagic] of intestine) while using ICD-9 and K63.81 (Dieulafoy lesion of intestine) if you are using ICD-10 codes.

Review These Basics Briefly

Documentation spotlight: When your gastroenterologist arrives at a diagnosis of angiodysplasia of the colon, some of the signs and symptoms that you are most likely to see in the documentation of the patient will include episodes of blood in stools (hematochezia or melena). The bleeding is usually very minimal or in some cases, your gastroenterologist might note massive bleeding in the patient documentation. Your gastroenterologist will note that the bleeding that occurred in the past resolved on its own spontaneously. On the other hand, your gastroenterologist might diagnose angiodysplasia of the colon in a totally asymptomatic patient in whom he conducted a screening colonoscopy.

Upon examination, your gastroenterologist might note the presence of tachycardia and signs of hypotension if the bleeding was recent and massive. If your gastroenterologist suspects a diagnosis of angiodysplasia based on history, he will perform tests such as a complete blood count, hemoglobin count and guaiac stool tests. Usually in a patient with angiodysplasia of the colon, you will note that the patient also suffers from iron deficiency anemia and guaiac stool tests are positive if there is bleeding.

Your gastroenterologist may use colonoscopy to arrive at the diagnosis of angiodysplasia. He will also perform selective mesenteric angiography to aid in the diagnosis. “Your gastroenterologist will look to perform selective mesenteric angiography if an angiodysplasia is suspected but not clearly identified during a colonoscopy,” says Michael Weinstein, MD, Gastroenterologist at Capital Digestive Care in Washington, D.C., and former representative of the AMA’s CPT^® Advisory Panel. 

Example: Your gastroenterologist reviews a 68-year-old male patient for complaints of passing fresh blood in the stools. He says that he has had these symptoms before although the bleeding was much less and had resolved by itself spontaneously. He also complains of feeling tired, irritable, having a reduced appetite, and suffering from headaches that are causing him to feel dizzy.

Your gastroenterologist performs a thorough physical examination and notes the presence of tachycardia, inflamed tongue and cold extremities. He withdraws a blood sample and sends it to the lab for analysis. He also performs a digital rectal examination and withdraws stool sample that he sends for a guaiac stool test.

The lab tests reveal the presence of a microcytic hypochromic anemia (iron deficiency anemia) and guaiac stool tests are positive for occult blood.

Your gastroenterologist performs colonoscopy that reveals multiple vascular lesions in the proximal ascending colon. He identifies a lesion that has active bleeding and uses a Nd:YAG laser to obliterate the bleeding. Based on these observations, your gastroenterologist arrives at a diagnosis of angiodysplasia.

What to report: If you are reporting the guaiac stool test, use 82272 (Blood, occult, by peroxidase activity [e.g., guaiac], qualitative, feces, 1-3 simultaneous determinations, performed for other than colorectal neoplasm screening). For the colonoscopy, report 45382 (Colonoscopy, flexible, proximal to splenic flexure; with control of bleeding [e.g., injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator]).

Use K55.21 once ICD-10 is effective and 569.85 for ICD-9 coding system. If, during the course of the evaluation, your gastroenterologist ordered a mesenteric angiography, then the radiologist will use 75726 to report the service (Angiography, visceral, selective or supraselective [with or without flush aortogram], radiological supervision and interpretation).