Gastroenterology Coding Alert

Check out which codes you currently report are turning into parent codes.

Starting Oct. 1, 2023, 501 new ICD-10 codes go into effect, and among them are several new K codes and an expanded Z code set for family history.

As gastroenterology coders, you’re probably very familiar with these code sets, which is why we’re giving you a glimpse into what changes you can expect come fall.

Sneak a Peek at the New Appendicitis Codes

Currently, to report acute appendicitis with generalized peritonitis without/with abscess, you’d use K35.20 (Acute appendicitis with generalized peritonitis, without abscess) and K35.21 (Acute appendicitis with generalized peritonitis, with abscess). ICD-10 has converted these to parent codes and added more specific codes to help you report with greater accuracy.

Starting October 1, 2023, your options will be the following:

• K35.200 (Acute appendicitis with generalized peritonitis, without perforation or abscess)
• K35.2001 (Acute appendicitis with generalized peritonitis, with perforation, without abscess)
• K35.209 (Acute appendicitis with generalized peritonitis, without abscess, unspecified as to perforation)
• K35.210 (Acute appendicitis with generalized peritonitis, without perforation, with abscess)
• K35.211 (Acute appendicitis with generalized peritonitis, with perforation and abscess)
• K35.219 (Acute appendicitis with generalized peritonitis, with abscess, unspecified as to perforation)

The addition of these codes will allow for more specific recorded diagnoses. Coding to greater specificity not only helps in tracking the patient’s condition more accurately, it also helps justify the need for medical interventions, provide more precise patient care, and aids in research and epidemiological studies.

Condition refresh: Acute appendicitis with generalized peritonitis refers to a severe and sudden inflammation of the appendix that has led to a widespread infection of the lining of the abdominal cavity. This is a serious condition that requires immediate medical attention, as it can lead to life-threatening complications if left untreated.

Report Bacterial and Fungal Overgrowth More Specifically

You will see another change in K63.8- (Other specified disease of intestine). Currently, K63.81 (Dieulafoy lesion of intestine) and K63.89 (Other specified diseases of intestine) are your only options. Soon, you will see new codes K63.82 (Intestinal microbial overgrowth) and K63.821 821 (Small intestinal bacterial overgrowth), as well as the following billable codes:

• K63.8211 (Small intestinal bacterial overgrowth, Hydrogen-subtype)
• K63.8212 (Small intestinal bacterial overgrowth, hydrogen sulfide-subtype)
• K63.8219 (Small intestinal bacterial overgrowth, unspecified)
• K63.822 (Small intestinal fungal overgrowth)
• K63.829 (Intestinal methanogen overgrowth, unspecified)

When the gastroenterologist uses a breath tests to check for bacterial or fungal overgrowth, this new set of codes will help providers and coders report their findings more specifically.

Be More Precise When Reporting Short Bowel Syndrome

You’ll see another important update, this time in the K90.8- (Other intestinal malabsorption) family. ICD-10 2024 has created a category for short bowel syndrome, so expect to see K90.82 (Short bowel syndrome) and the following billable codes:

• K90.821 (Short bowel syndrome with colon in continuity)
• K90.822 (Short bowel syndrome without colon in continuity)
• K90.829 (Short bowel syndrome, unspecified)

Condition refresh: Short bowel syndrome is a condition characterized by insufficient nutrient absorption and is often seen as a complication to surgeries that remove a large part of the small intestine.

Note: ICD-10 is also adding code K90.83 (Intestinal failure). “In the past this code was reported with the very nonspecific K59.9 (Functional intestinal disorder, unspecified), which is really more appropriate for forms of irritable bowel syndrome that don’t fit one of the subtypes,” explains Glenn D. Littenberg, MD, MACP, FASGE, AGAF, a gastroenterologist and former CPT^® Editorial Panel advisor for ASGE in Pasadena, California. Intestinal failure refers to a rare condition that requires long-term intravenous nutrition.

See Two New Codes for Disorders of Retroperitoneum

You’ll be able to precisely report two serious conditions with the following new codes:

• K68.2 (Retroperitoneal fibrosis)
• K68.3 (Retroperitoneal hematoma)

These conditions typically will require a multidisciplinary team approach, as imaging and possibly surgical specialists could be required.

Condition refresh: A retroperitoneal hematoma is a collection of blood that forms behind the lining of the abdominal cavity. It can occur due to trauma, a ruptured blood vessel, or as a complication of surgery or other medical procedures. Retroperitoneal fibrosis is a rare disorder that occurs when extra fibrous tissue forms in the area behind your stomach and intestines. This extra tissue can cause a variety of symptoms by pressing on the organs and blood vessels in the area.

Know the New Family History Codes

ICD-10 2024 is also expanding Z83.71 (Family history of colonic polyps) into four more specific codes:

• Z83.710 (Family history of adenomatous and serrated polyps)
• Z83.711 (Family history of hyperplastic colon polyps)
• Z83.718 (Other family history of colon polyps)
• Z83.719 (Family history of colon polyps, unspecified)

“Family history codes are for use when a patient has a family member(s) who has had a particular disease that causes the patient to be at higher risk of also contracting the disease,” according to ICD-10-CM official guideline I.C.21.c.4.

Properly documenting a family history of colon polyps helps justify early and more frequent screenings, like colonoscopies, which lead to early detection. Having the option to code a family history of the specific type of polyp helps paint a more detailed picture for the payer, but also for future physicians. Documenting family history “gives the full clinical picture for this visit by identifying the other factors that could influence decision making,” says Chelsea Kemp, RHIT, CCS, COC, CDEO, CPMA, CRC, CCC, CEDC, CGIC, AAPC Approved Instructor, outpatient coding educator/auditor for Yale New Haven Health, New Haven, Connecticut. Until these improvements, a family history of numerous polyps not clearly identified as a specific genetic disorder like APC (adenomatous polyposis coli) or Lynch syndrome could not be very clearly coded.