Gastroenterology Coding Alert

Also: Many ICD-9 additions should bolster neonatal, pediatric Dx coding.

A patient has had his colon removed. Now your physician is treating a patient for an inflammation of the pouch, a surgically created chamber to contain waste before excretion. But how do you code it? Ileitis (555.0, Regional enteritis; small intestine)? Colitis (555.1, Regional enteritis; large intestine)?

In 2010, ICD-9 solves this and other diagnosis-coding conundrums, especially if your gastroenterologist treats newborns or infants.

"The more specific the codes, the better for all," says Gwenn S. O'Keeffe, MD, CEO and founder of Pediatrics Now LLC (www.pediatricsnow.com) in Massachusetts. "We can be more specific with what the child actually has which benefits the family, the medical record, and our ability to be paid fairly and correctly."

"Sometimes we need vague codes, sometimes specific -- both are important -- but we do need more specific codes for those diagnoses unique to kids," O'Keeffe adds.

Here are some of the new-for-2010 codes that are of particular interest to gastroenterologists and their coders: 209.72 (Secondary neuroendocrine tumor of liver): A secondary neoplasm indicates a primary cancerous site has metastasized or spread by direct extension to surrounding tissues -- in this case, to the liver. This occurs through lymphatic fluid, invasion of blood vessels, or implantation as tumor cells, reports Holly Cassano, CPC, PMCC, a coder and physician educator at Cleveland Clinic Hospital in Weston, Fla.

"This category is connected to a new personal history code, as well," she says. ICD-9 will revise V10.9 (Unspecified personal history of malignant neoplasm) to include two four-digit codes:

• V10.90 -- Personal history of unspecified type of malignant neoplasm

• V10.91 -- Personal history of malignant neuroendocrine tumor.

569.71 (Pouchitis): Pouchitis is inflammation of the lining of a small bowel pocket surgically created to hold bowel movements in patients who have had their colon removed, Cassano says. Symptoms of pouchitis are often similar to those of ulcerative colitis, including diarrhea, abdominal pain, bleeding, fever, joint pain, and increased stool frequency.

Your physician will diagnose pouchitis by noting symptoms in a patient who has a pouch and with a flexible sigmoidoscopy and biopsy (45331, Sigmoidoscopy, flexible; with biopsy, single or multiple).

Another new pouch-related code your physician will be able to call upon is 569.79 (Other complications of intestinal pouch), such as a pouch fistula.

569.87 (Vomiting of fecal matter): Fecal vomiting is often a consequence of intestinal obstruction (560.xx) or a gastrocolic fistula (537.4, Fistula of stomach or duodenum) and is a warning sign of a potentially serious problem.

995.24 (Failed moderate sedation during procedure): This could be a second diagnosis to explain a modifier 53(Discontinued procedure). Gastroenterologists usually use moderate sedation on a patient when they perform an EGD or colonoscopy. Moderate sedation is a drug-induced depression of consciousness during which patients respond purposefully to verbal commands.

New Codes for Newborns, Infants

Next year's ICD-9 includes several new codes of particular interest to gastroenterologists who treat newborns and infants:

756.72 (Omphalocele): A birth defect of the abdominal wall. The intestines, liver, and occasionally other organs remain outside of the abdomen in a sac because of a defect in the development of the muscles of the abdominal wall, Cassano says. The omphalocele can be mild, with only a small loop of intestines outside the abdomen, or severe, containing most of the abdominal organs.

756.73 (Gastroschisis): Gastroschisis is a birth defect in which an infant's intestines stick out of the body through one side of the umbilical cord, Cassano says. Babies with this type of hernia have a hole in the abdominal wall, usually on the right side of the umbilical cord. The child's intestines can be easily seen.

The condition is similar to an omphalocele in appearance. An omphalocele, however, is a birth defect in which the infant's intestine or other abdominal organs stick out of the belly button area. Prenatal ultrasonography often identifies the gastroschisis.

Treatment for gastroschisis is surgery. A surgeon will put the bowel back into the abdomen and close the defect.

779.34 (Failure to thrive in newborn): Failure to thrive is when an infant doesn't gain enough weight as it ages. The baby may lack developmental markers such as rolling over, smiling, or cooing. Your gastroenterologist could be part of a team that diagnoses and treats an infant who's not thriving. "Many things could contribute to failure to thrive syndrome," Cassano says, including diseases that keep the body from absorbing or using nutrients or those that keep the body from properly using what is eaten, metabolic disorders like hypoglycemia (775.6, Neonatal hypoglycemia), bad parenting, or even a tumor or parasite.

A baby could have a swallowing disorder, such as 787.24 (Dysphagia, pharyngoesophageal phase).

779.32 (Bilious vomiting in newborn): When a newborn vomits bile with no previously known gastrointestinal disorders, it may be a sign of a loop of bowel that has abnormally twisted on itself (560.2, Volvulus) or another intestinal obstruction.

789.7 (Colic): Colic is continual or persistent crying for no apparent reason, typically lasting between two and four hours a day for at least five days a week. Colic is not uncommon -- as many as one in five babies have this condition. One theory is that colicky babies cry because of discomfort caused by abdominal gas.