General Surgery Coding Alert

Surgeons will need to document more detail.

When you start coding Crohn's disease with ICD-10 in Oct. 2013, you'll go from four codes to 28. That's because the new diagnosis code set provides far more specificity, requiring you to indicate if the surgeon finds complications, and if so, what those complications are.

Check Out Chart for Language Change

Even before you get to the fifth and sixth digits that add complication information, you'll need to get familiar with the shift in code number and code definitions from ICD-9 to ICD-10. You'll notice that ICD-9 lumps Crohn's under "regional enteritis" with a note, "includes Crohn's disease." Look at the following chart to see the differences between the two code sets:

Gather Complication Data

The chart shows a nice one-to-one correspondence, but ICD-10 won't let you off that easy when you're coding for Crohn's. You won't report the four digit codes from the chart -- instead, you'll need to add a fifth, and maybe a sixth digit.

Fifth digit: As an extension of any of the four digit ICD-10 Crohn's codes, you'll need to add a fifth digit of "0" -- meaning "without complications" -- or "1" -- meaning "with complications."

Sixth digit: If you report a "1" for the fifth digit because the patient has complications, you can't stop there. You'll also need to add a sixth digit to specify the complication, as follows:

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1 -- with rectal bleeding

2 -- with intestinal obstruction

3 -- with fistula

4 -- with abscess

8 -- with other complications.

For example: K50.013 is Crohn's disease of small intestine with fistula.