Gastroenterology Coding Alert

Question: The physician performed an EGD and described the distal esophagus as “appearing like a ‘winding staircase.’” Based on this observation and the clinical presentation, the surgeon diagnosed “corkscrew esophagus.” What does that mean, and how should we code the diagnosis?

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Answer: A “corkscrew esophagus” may occur as part of a diffuse esophageal spasm disorder. The physical manifestation appears as the surgeon’s note describes.

If you look at the notes under K22.4 (Dyskinesia of esophagus), you’ll see that corkscrew esophagus is the first condition listed. Therefore, K22.4 is the correct code for this case. Terms related to somewhat similar disorders include “nutcracker esophagus,” “jackhammer esophagus,” or “hypercontractile esophagus.”

The condition may impact a patient’s ability to swallow and can cause severe pain and discomfort. Nuances of these disorders are generally sorted out by esophageal motility 91010 (Esophageal motility (manometric study of the esophagus and/or gastroesophageal junction) study with interpretation and report).