Gastroenterology Coding Alert

Question: I’m trying to select the most accurate diagnosis code for a polyp removal, but I’m not sure which to use. The patient record describes the mass as a “polyp located high in the colon.” I’m wary of using an unspecified code, but none of the other D12.- codes seem appropriate.

Florida Subscriber

Answer: When coding polyp removal, knowing the specific location is essential to coding to the highest specificity. In this situation, you’ll need to ask the provider for more detailed documentation.

There is nothing inherently wrong with reporting D12.6 (Benign neoplasm of colon, unspecified), but this code should only be used if the provider does not have details. The provider in the above scenario does have the location, they just didn’t use the technical term for the exact location. The ICD-10-CM codes are location-specific, so given that this information is likely just a query away, D12.6 would not be correct.

As you have probably noticed, there are six polyp codes just for the colon region:

• D12.0 (Benign neoplasm of cecum)
• D12.1 (… appendix)
• D12.2 (… ascending colon)
• D12.3 (… transverse colon)
• D12.4 (… descending colon)
• D12.5 (… sigmoid colon)

Anatomy refresh: The colon starts with the cecum in the lower right abdomen, and the appendix projects from the end. From the cecum, the colon then moves upward, and that section is called the ascending colon. It then bends, running across the abdomen, which is called the transverse colon. It bends again toward the lower left abdomen, and that section is called the descending colon. The sigmoid colon is where the colon then curves then turns into the rectum.

Even if you’re familiar with colon anatomy, you never want to assume to which part of the colon the gastroenterologist referred. Always ask the provider for clarification if the documentation is unclear. Note also that if the pathology report isn’t back, the generic polyp code K63.5 (Polyp of colon) could be used, which is not region-specific.