Gastroenterology Coding Alert
Reason for Admission Determines Code
Question: A patient with Crohn's disease was admitted to the hospital for a gastrointestinal (GI) bleed. Nothing in the file directly states that the GI bleed is from the Crohn's Disease. Do I need to report the GI bleed first or the Crohn's disease? Wyoming Subscriber Answer: Since the reason for the admission is GI` bleed, you would report the GI bleed as your primary code: 578.9 (Gastrointestinal hemorrhage: Hemorrhage of gastrointestinal tract, unspecified). You typically code first the main reason for the patient's visit unless ICD-9 includes an exception note, according to ICD-9 guidelines. You should report Crohn's disease as the secondary code: 555.9 (Regional enteritis) which includes "Crohn's disease NOS" (not otherwise specified). Code for the Crohn's disease even if the file says it isn't directly related to the GI bleed because Crohn's disease is an underlying condition that affects the patient's recovery, status, severity of the condition, etc. Watch out: Since your record offers no further information about the Crohn's disease, you're going to use NOS code 555.9. Payers often prefer greater specificity, which can help support a higher level of hospital care (99221-99223, Initial hospital care for the evaluation and management of a patient) when medically necessary. If the physician specifies the area of the Crohn's disease, then you would use the more specific codes: • 555.0 -- Regional enteritis; small intestine • 555.1 -- Regional enteritis; large intestine.
Gastroenterology Coding Alert
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