Gastroenterology Coding Alert

New options for pancreatitis let you code based on presence of necrosis

October is here and so is the first annual round of ICD-10 updates. Tighten your seat belt, and get started on the road to impeccable reporting. Read on for the lowdown on what’s new in intestinal, hepatic and pancreatic disease reporting.

Rejoice Over New Options for Acute Vascular Disorders of Intestines

You’ll find many changes to coding for ischemia and infarction of large and small intestine. “Look for greater specificity on these types of conditions,” says Lisa Center, CPC, Physician Practice Manager, Via Christi Hospital Pittsburg, Inc. Pittsburg, KS.

The rationale for change: Previously, code subcategory K55.0-, (Acute vascular disorders of intestine…) included one solitary code. You used K55.0 to report almost any type of fulminant ischemic colitis, intestinal infarction, ischemia, necrosis, or even mesenteric embolism. But not anymore. Now, you have four new fifth character options that specifically cater to the diagnosis of acute ischemia or infarction of small or the large intestines.

• K55.01- (…acute [reversible] ischemia of small intestine…)
• K55.02- (…acute infarction of small intestine…), covers gangrene of the small intestine and necrosis of the small intestine as well.
• K55.03- (…acute [reversible] ischemia of large intestine…) covers acute fulminant ischemic colitis and subacute ischemic colitis
• K55.04- (…acute infarction of large intestine…), covers gangrene and necrosis of the large intestine too.

Plus, each one of these codes comes with three new sixth character options:

• 1 (Focal segmental)
• 2 (Diffuse)
• 9 (Acute)

The result: One code becomes twelve more detailed codes in ICD-10 2017.

Coding example: To code for acute intestinal infarction of the large intestine, diffuse in nature, prior to October 2017, you would simply choose K55.0 (Acute vascular disorders of intestine).

Now that the ICD-2017 update has taken effect, you have a very precise code for this condition — K55.042 (Diffuse acute infarction of large intestine).

Heed These Changes in Hepatic Failure

In the category K72 (Hepatic failure, not elsewhere classified) you will need to be aware that Includes note “acute hepatitis NEC, with hepatic failure” has been deleted. Plus, the Excludes1 note “viral hepatitis with hepatic coma (B15-B19)” has been deleted, and been replaced with Excludes2 note “viral hepatitis with hepatic coma (B15-B19).” This means that going

forward, you may code viral hepatitis with hepatic coma along with hepatic failure, not classified elsewhere.

Subcategory K72.0- (Acute and subacute hepatic failure…) now also covers acute non-viral hepatitis, NOS. In the subcategory K75.0- (Abscess of liver…) you will notice addition of new Excludes2:

• Acute or subacute hepatitis NOS (B17.9)
• Acute or subacute non-viral hepatitis (K72.0)
• Chronic hepatitis NEC (K73.8)

Pancreatitis Sees Major Revisions and Addition of New Codes

In the code category K85.- (Acute pancreatitis…) take note that the following conditions in the includes note have been incorporated into new, more specific codes:

• abscess of pancreas
• acute necrosis of pancreas
• gangrene of (gangrenous) pancreas
• hemorrhagic pancreatitis
• infective necrosis of pancreas
• suppurative pancreatitis

You will now be able to report more specific codes for these types of pancreatitis K85.0- (Idiopathic acute pancreatitis…), K85.2- (Alcohol induced acute pancreatitis…), K85.3- (Drug induced acute pancreatitis…), K85.8- (Other acute pancreatitis…), and K85.9- (Acute pancreatitis, unspecified…) with greater specificity subsequent to three new fifth character options of:

• 0 (… without necrosis or infection)
• 1 (… with uninfected necrosis)
• 2 (… with infected necrosis)

In the category K85.1- (Biliary acute pancreatitis…), existing code K85.10 (Biliary acute pancreatitis without necrosis or infection) is joined by two new code options:

• K85.11 (Biliary acute pancreatitis with uninfected necrosis)
• K85.12 (… with infected necrosis)

By creating specific codes to report the absence or presence of infected or uninfected necrosis, CMS gives you the freedom and precision of choosing from over 15 new codes, for better accuracy.

With such a proliferation of codes, providers will need to be more vigilant in the documentation of details, so as to enable the coders reach a precise code for the diagnosis. We need to “focus the education on the physicians and the method of reporting these diagnoses,” says Michael Weinstein, MD, former representative of the AMA’s CPT^® Advisory Panel. More detailed documentation will help you choose the exact code from the many options available.

Final takeaway: “It is best to be prepared so practices should have been aware of any changes, deleted codes well before the deadline,” says Catherine Brink, BS, CMM, CPC, CMSCS, CPOM, president, Healthcare Resource Management, Inc. Spring Lake, NJ. Make certain to update your superbill and any other documents that include the old codes.