Gastroenterology Coding Alert

Hint: Identify who is high risk.

When a patient presents for a screening colonoscopy (G0105), one of the Medicare-allowed diagnoses that you could list for the procedure is 556.0 (Ulcerative enterocolitis). The general term ulcerative colitis refers to a condition of severe inflammation of the colon or large bowel in which ulcers form in the walls of the colon. Diarrhea, and bloody stools mixed with pus are common in this condition.

ICD difference: When ICD-9-CM changes to ICD-10-CM in Oct. 1, 2013, code 556.0 will become K51.80 (Other ulcerative colitis without complications). This new code will define the presence of ulcerative colitis on a patient, but without complications.

Underneath the K51 (Ulcerative colitis) category, you will see a note telling you to "use additional code to identify manifestations, such as pyoderma gangrenosum (L88)." Also, an Excludes1 note says that you will never report this condition with Crohn's disease [regional enteritis] (K50.-).

Documentation: Before you code G0105, you will check the patient's chart, specifically the history and physical, as well as the op note, to ensure proper documentation supports the criteria (See previous article 3 Tips Guard Your Colonoscopy Screening Claims Against Costly Denials for the list). If the patient does not meet any of the criteria, you will consider the patient average risk for colorectal cancer. The risk factor will determine the procedure code.

Coder tips: You have several high risk indications for follow-up colonoscopy at intervals more frequent than the every ten year routine screening colonoscopy. Patients with forms of ulcerative colitis (K51.80-K51.90 in ICD-10) and Crohn's Disease (K50.00-K50.90) have an increased risk of developing colon cancer and may need follow-up colonoscopy as often as every two years depending on prior findings and activity of the disease. This increased risk of cancer and polyps may be present even when the disease is inactive and does not require regular medication.