Gastroenterology Coding Alert

You won't have tons of new gastroenterology ICD-9 codes to learn by Oct. 1, but you should become familiar with the following anal sphincter, dysphagia and ascites codes. If you're not using the most specific code, your claim could land in hot water.

You've got a new anal sphincter tear code to add to your cache of possible choices. As of Oct. 1, you will start using 569.43 (Anal sphincter tear [healed] [old]).

Red flag: When you learn new codes, you shouldn't overlook the notations underneath. For instance, the information under 569.43 provides another description for this code, "Tear of anus, nontraumatic." Also, ICD-9 specifies that you should use an additional code for any associated fecal incontinence (787.6). Code 569.43 excludes anal fissure (565.0) and a healed or old anal sphincter tear that complicates delivery (654.8).

Note: An anal sphincter tear is not the same as sphincter dysfunction. For that condition, you'll continue to use 569.49 (Other specified disorders of rectum and anus; other).

ICD-9 2007 offered only one dysphagia code, 787.2 (Dysphagia), so your coding could not identify the malfunctioning part of the swallowing cycle, says Jackie Miller, RHIA, CPC, senior coding consultant for Coding Strategies Inc. in Powder Springs, Ga. As of Oct. 1, this code will no longer exist.

Instead, you'll have six new codes to use in its place. They will help you report this "difficulty swallowing" condition with greater specificity:

• 787.20 -- Dysphagia, unspecified

• 787.21 -- Dysphagia, oral phase-

• 787.22 -- Dysphagia, oropharyngeal phase

• 787.23 -- Dysphagia, pharyngeal phase

• 787.24 -- Dysphagia, pharyngoesophageal phase

• 787.29 -- Other dysphagia.

Watch out: More specific codes can create problems if your physicians' documentation doesn't match your new options.

Solution: Give your physicians a job aid listing the more specific codes, says South Carolina reimbursement and coding professional Erin Goodwin, CPC, CMC. Send an e-mail or memo with the new codes, and let them know that better documentation has the double benefit of helping you do your job more efficiently and backing up what you billed when the payer asks for records, she says.

Example: An 87-year-old female presents to the emergency department with a two- to three-day history of difficulty swallowing after returning from a trip to Paraguay. Your GI physician performs a consultation, during which the patient describes the inability to swallow liquids or solids without a choking feeling in her throat.

Although her speech is normal and the gastroenterologist documents no signs of a stroke, when observed trying to swallow water, she was able to hold the liquid in her mouth and made appropriate motion to swallow. She then coughs and drools most of the water from her mouth.

The GI decides on a plan that includes upper endoscopy, and you should report the symptoms as dysphagia, oropharyngeal phase using new-for-2008 ICD-9 code 787.22 to show medical necessity for the consultation.

The ICD-9 2008 list adds two codes for ascites in Chapter 16 (Symptoms, Signs, and Ill-Defined Conditions):

• 789.51 -- Malignant ascites

• 789.59 -- Other ascites.

What this is: Malignant ascites is excess fluid, containing cancer cells, in the space between the tissues lining the abdomen and abdominal organs (the peritoneal cavity).

The new malignant ascites code is an improvement because ICD-9 2007 indexes malignant ascites under 197.6 (Secondary malignant neoplasm of respiratory and digestive systems; retroperitoneum and peritoneum), but the 197.6 entry doesn't reference ascites, Goodwin says. Snag: Code 789.51 is in the ICD-9 manual's signs and symptoms chapter rather than being listed in a malignant code category.

Example: A 52-year-old female presents with worsening abdominal distension and a 15-pound weight gain during the past month. She has a known history of ovarian cancer that was unsuccessfully resected a few months earlier. The increasing distension has made breathing difficult. The GI reviews the prior records and performs an abdominal sonogram, confirming the presence of ascites. Your physician decides to perform a large- volume paracentesis (removal of abdominal fluid, 49080, Abdominal paracentesis; initial) to provide the patient some relief from her discomfort.

In this case, you will have several appropriate diagnosis codes to use when the new codes take effect. They include 183.0 (Ovarian cancer), 789.07 (Abdominal pain; generalized), 786.05 (Shortness of breath), and new ascites code 789.51. You should attach 789.51 to 49080.