Gastroenterology Coding Alert

Hint: Use different ICD-10 code for a diagnosis of intussusception of the appendix

When your clinician diagnoses intussusception of the colon under ICD-10, you can rest easy, as you’ll find selecting a code is similar to the way you report the condition using ICD-9 system.

ICD-9: You’ll use 560.0 (Intussusception) when your clinician diagnoses intussusception. You will use the same diagnosis code if your gastroenterologist documents the condition as intussusception of colon, intestine or the rectum or as invagination of the intestine or colon.

Caveats: You cannot report 560.0 if the diagnosis is intussusception of the appendix (543.9). You also cannot use this ICD-9 code if your clinician diagnoses chronic duodenal ileus (537.2); obstruction of the duodenum (537.3); inguinal hernia with obstruction (550.1); intestinal obstruction complicating hernia (552.0-552.9); mesenteric embolism, infarction or thrombosis (557.0); or neonatal intestinal obstruction (277.01, 777.1-777.2, 777.4).

ICD-10: When you begin using ICD-10 codes a diagnosis of intussusception that you will report using the ICD-9 code 560.0 will crosswalk to K56.1 (Intussusception). As in ICD-9, you will use the same diagnosis code if your gastroenterologist diagnoses the condition as intussusception or invagination of bowel, intestine, colon or rectum. However, you cannot report K56.1 if your clinician makes a diagnosis of intussusception of the appendix. This is captured using K38.8.

Focus on These Basics Briefly

Documentation spotlight: When your gastroenterologist diagnoses intussusception of the bowel, some of the signs and symptoms that you are more likely to see in patient documentation will include abdominal pain, vomiting, occult blood, lethargy, and jelly-like dark stools. Your clinician will usually document that the pain the patient experiences will be severe and intermittent with absolute relief in between.

Upon examination your gastroenterologist might note the presence of a sausage-like palpable abdominal mass in the right hypochondrium with the presence of abdominal distension. Your clinician might also observe that the patient is lethargic, feverish, and often presents with paleness of the skin. Your clinician will also note emptiness of the right lower quadrant that is referred to as Dance sign.

Your clinician might ask for lab studies such as stool tests; CBC, differential counts and check for presence of electrolyte imbalance. Your gastroenterologist will also order for imaging studies such as abdominal x-ray, ultrasonography or CT scan of the abdominal areas to help clinch the diagnosis of intussusception. In children, your clinician might also opt for contrast enema with barium or air to confirm the diagnosis of intussusception.

Example: Your gastroenterologist recently reviewed a two-and-half year-old male patient who was brought in by his mother with complaints of severe abdominal pain. The child’s mother told the gastroenterologist that the child had this pain intermittently and it was so severe that the child would kick his legs in the air whenever the pain increased. She also told our clinician that the child developed an upper respiratory tract infection around ten days ago and the symptoms of abdominal pain had been occurring from the night before. She added that the child appeared to be fatigued and complained that he had been throwing up every now and then.

Upon examination, the clinician noted paleness of the skin and observed that the child looked very lethargic and fatigued. He noted distension of the abdomen and noted emptiness in the lower right quadrant that made him suspect obstruction. He ordered for an abdominal x-ray and ultrasound. He also asked for CBC, differential count and stool test.

Based on observations made from history, signs and symptoms and interpretations of imaging studies and lab tests, your gastroenterologist was able to arrive at a diagnosis of intussusception.

What to report: You report the evaluation of the patient with 99223 (Initial hospital care, per day, for the evaluation and management of a patient, which requires these 3 key components…). You report the diagnosis with 560.0 if you are using ICD-9 code sets and report K56.1 if you are using the ICD-10 coding system.