Gastroenterology Coding Alert

Capture complications and add more precision to your reporting.

As Crohn's disease is a fairly common condition that you would encounter in your gastroenterologist's practice, you will need to understand how to report it using ICD-10 codes when they come into effect.The key? Look at the complications associated with Crohn's disease to arrive at the appropriate diagnostic codes.

Review these Basics: Your gastroenterologist arrives at a diagnosis of Crohn's disease on the basis of a thorough history, medical examination, signs and symptoms, tests, and diagnostic procedures.

You will need to know what symptoms give a cue to your gastroenterologist for the suspicion and diagnosis of Crohn's disease. "We diagnose Crohn's on endoscopy. So, if the patient is suspected of Crohn's at the initial office visit, then only the symptoms are reported," says Linh Nguyen, CPC, Medical Coder-Gastroenterology Associates, Evansville, Indiana.

Symptoms of Crohn's disease can include chronic diarrhea (R19.7, Diarrhea, unspecified), chronic severe lower abdominal pain (R10.9, Unspecified abdominal pain), blood in stool (K92.1, Melena), chronic nausea with or without vomiting (R11.2, Nausea with vomiting, unspecified), and weight loss," says Heather Copen, RHIT, CCS-P, Financial Advocate-Goshen OB/GYN and Goshen GI, IU Health-Goshen Physicians,Goshen, Indiana. "You report signs and symptoms until Crohn's disease is confirmed."

Your gastroenterologist will also perform diagnostic procedures such as a colonoscopy (45378, Colonoscopy, flexible, proximal to splenic flexure; diagnostic, with or without collection of specimen[s] by brushing or washing, with or without colon decompression [separate procedure]) or colonoscopy with biopsy (45380, Colonoscopy, flexible, proximal to splenic flexure; with biopsy, single or multiple) to confirm the diagnosis of Crohn's disease. These diagnostic measures will also help check for location of the problem and for possible complications.

Reporting Crohn's Disease in ICD-9

Under ICD-9, Crohn's disease is reported with 555.x. The fourth digit specifies the location in which the condition is reported. In ICD-9, 555.x transforms to four codes depending on location.

Location Guides Your Code Choices

When ICD-10 comes into effect, you can report Crohn's disease based on location as it is currently done when you are reporting using ICD-9. However, you will have to check for presence of complications such as rectal bleeding, intestinal obstruction, fistula, abscess or any other complications that are mentioned in the documentation as the code for Crohn's disease is further expanded using the fifth digit depending on the presence of specified or unspecified complications.

Example 1:Your gastroenterologist conducts a colonoscopy to arrive at a diagnosis of Crohn's disease of the large intestine. During the procedure, rectal bleeding was also noted. Under ICD-9, you will report the diagnosis with 555.1 (Regional enteritis of large intestine). Under ICD-10, you will have to report the condition using K50.111 (Crohn's disease of large intestine with rectal bleeding).

Example2: If you read in the note that based on results of tests and observations found in colonoscopy, your gastroenterologist arrived at a diagnosis of Crohn's disease of the large intestine and during the procedure, no other complications of significance were noted, you report the diagnosis with 555.1 under ICD-9. Under ICD-10, you will have to report the condition using K50.10 (Crohn's disease of large intestine without complications).

Editor's Note: For charts that crosswalk ICD-9 and ICD-10 codes for Crohn's, please email the editor, Sachin Thimmaiah, sthimmaiah@codinginstitute.com.