General Surgery Coding Alert

Question: What is the correct ICD-9 code for a mucous fistula encountered during a transverse colectomy performed by our surgeon?

Ohio Subscriber

Answer: Based on the procedure you mention, we'll assume that this is an intestinal fistula. If that is the case, the proper ICD-9 code is 569.81 (Fistula of intestine, excluding rectum and anus).

ICD-9 lists the following fistula site examples for this code: abdominal wall, enterocolic, enteroenteric, ileorectal. The code excludes fistula of intestine to internal organs.

Prepare for ICD-10: You should begin to familiarize yourself with the ICD-10 code set, which will become effective Oct. 1, 2013. You'll report the same condition in ICD-10 as K63.2 (Fistula of intestine).

Documentation detail needed: This example points out the need for more complete documentation once ICD-10 is in place. You can see that K63.2 has a large "excludes" list, as follows, and you'd need more information than you provided in your question to ensure that you've selected the proper code:

• fistula of duodenum (K31.6)
• fistula of intestine with Crohn's disease (K50.013, K50.113, K50.813, K50.913,)
• fistula of intestine with ulcerative colitis (K51.013, K51.113, K51.213, K51.313, K51.413, K51.513,K51.813, K51.913)

• fistula of anal and rectal regions (K60.-)
• fistula of appendix (K38.3)
• intestinal-genital fistula, female (N82.2-N82.4)
• vesicointestinal fistula (N32.1)