Gastroenterology Coding Alert

Question: An EGD with biopsy (43239) comes back with a finding of acute and chronic esophagitis. ICD-9 2002 has a new code for acute esophagitis, 530.12. The ICD-9 alphabetic index tells me to use 530.10 for chronic esophagitis. When I look up that code in the tabular list, however, there is no mention of chronic esophagitis; the real description is esophagitis, unspecified. This seems to contradict the finding of acute esophagitis. Any suggestions on which code(s) I should report?

Georgia Subscriber
 
Answer: You are correct that there is no specific code for chronic esophagitis, and it has been lumped in the catchall category of "unspecified." You should bill both codes because it is possible to have both findings, but list acute esophagitis as the primary diagnosis because it is the more specific finding. It's also more likely to be a covered diagnosis for the procedure than unspecified esophagitis is.
 
With acute esophagitis, the tissue is actively inflamed. Chronic esophagitis means that the tissue has been inflamed in the past but is not now. It's possible for a patient to have both findings if two parts of the esophagus were biopsied and one is actively inflamed while the other is not.
 
Your situation is a good example of why you should never rely on the ICD-9 alphabetic index (volume 2) for a diagnosis code. Let the alphabetic index direct you to the tabular list (volume 1), which goes into much greater detail.

Reader Questions and You Be the Coder answered by Linda Parks, MA, CPC, lead coder at Atlanta Gastroenterology Associates, a 23-physician practice.