ICD 10 Coding Alert

Be sure to specify the complications or lack thereof in your fifth and sixth digits.

Are you confused when it comes to coding for Crohn’s disease and ulcerative colitis? Though both are a type of inflammatory bowel disease, there is a lot of difference between the disease processes. Know the various coding options available, and how to choose the right diagnosis code for the patient’s unique set of signs and symptoms, with an eye for different options with specificity of location and complications.  

Basics: Crohn’s disease involves chronic inflammation of almost any part of the gastrointestinal tract, though it most commonly affects the small intestine and colon. Also known as regional enteritis, the disease causes symptoms including fever, diarrhea, stomach cramps, vomiting, and weight loss where it affects all the layers of the intestinal wall.

Ulcerative colitis affects the colon primarily, and it affects only the lining of the colon. Here again the patient may complain of persistent diarrhea along with cramps, pain and bloody stools.

Coding for ulcerative colitis and Crohn’s disease may pose challenges as there are so many options available to pick from. Here is how to simplify the coding conundrums and reach the precise code once you have identified the needful information from your providers’ notes.

“Although symptoms of Crohn’s and ulcerative colitis are similar, keep in mind that Crohn’s disease can occur anywhere between the mouth and the anus while ulcerative colitis occurs only in colon,” says Catherine Brink, BS, CMM, CPC, CMSCS, CPOM, president, Healthcare Resource Management, Inc. Spring Lake, NJ.

Nail the First 4 Characters with Exact Location of Pathology

Do not get overwhelmed with 28 code options for Crohn’s and 49 for ulcerative colitis. “Symptoms and anatomical position of symptoms are key,” says Brink.

To begin your journey of coding up to the highest specificity possible, pick at the first four digits to begin with. “You will be relying on your physician to be specific is describing which areas of the intestinal tract that are involved and whether the primary condition is Crohn’s disease or ulcerative colitis,” says Michael Weinstein, MD, former representative of the AMA’s CPT® Advisory Panel.

Location for Crohn’s disease: First identify the location of the pathology and pick from one of these options:

• K50.0-- (Crohn’s disease of small intestine…)
• K50.1-- (Crohn’s disease of large intestine…)
• K50.8-- (Crohn’s disease of both small and large intestine…)
• K50.9-- (Crohn’s disease unspecified…).

Location for ulcerative colitis: There are seven types of variations of ulcerative colitis based on the precise location of pathology. Here, again, you may pick one of these code sub categories:

• K51.0-- (Ulcerative [chronic] pancolitis…)
• K51.2-- (Ulcerative [chronic] proctitis…)
• K51.3-- (Ulcerative [chronic] rectosigmoiditis…)
• K51.4-- (Inflammatory polyps of colon…)
• K51.5-- (Left sided colitis…)
• K51.8-- (Other ulcerative colitis…)
• K51.9-- (Ulcerative colitis unspecified…).

Is there any specific thing a coder should keep in mind while choosing these subcategories? Can there be a scenario where choosing between the Crohn’s disease and ulcerative colitis may seem difficult? If you don’t see either condition specifically mentioned then the inflammation could be from a different etiology like ischemic colitis, infectious colitis, or drug-related side-effects, Weinstein says. There are multiple different aspects that a coder must pay attention to, says Joanne Schade-Boyce, MS, BSDH, CPC, ACS, AHIMA Approved I-10-CM / PCS Trainer and Ambassador, FairCode Associates, LLC, Marco Island, FL.

Ratchet Up the 5th Character for Complications

Remember: Regardless of whether you are coding for Crohn’s disease or ulcerative colitis, while a fifth character of “0” signifies no complications, “1” signifies presence of complications.

• 0 (…without complications)
• 1 (… with complications).

If there were no complications in the case, you can arrive at your final code with a fifth digit of “0.” However, if there were complications as well, choose a fifth digit as “1,” and move on to sixth digit options for denoting complications.

Tackle the Precise Complication with the Correct Sixth Character

So, your provider documented presence of complications in his notes. You will need to code for the complications by choosing form one of the most appropriate options given below. These sixth digit options apply equally well to both Crohn’s disease and ulcerative colitis.

• 1 (…with rectal bleeding)
• 2 (…with intestinal obstruction)
• 3 (…with fistula)
• 4 (…with abscess)
• 8 (…with other complication)
• 9 (…with unspecified complications).

Example 1: A patient complains of symptoms of chronic diarrhea, abdominal cramps. After an evaluation for possible infectious causes, the patient undergoes a diagnostic colonoscopy. The provider diagnoses the patient with ulcerative pancolitis. However, he does not mention any complications. The right code here would be K51.00 (Ulcerative [chronic] pancolitis without complications).

Example 2: The provider identifies a patient as having Crohn’s disease, and the location of inflammation is small intestine. The patient also complains of bleeding per rectum. The code to report would be K50.011 (Crohn’s disease of small intestine with rectal bleeding).

Example 3: The provider mentions a diagnosis of Regional enteritis NOS. There is no mention of any complications whatsoever. The correct code here would be K50.90 (Crohn’s disease, unspecified, without complications).

Be Ready To Accept Changes

“Both Crohn’s disease and ulcerative colitis can evolve over time,” says Weinstein. “In other words the areas of involvement identified initially may change. A patient with Crohn’s disease of the large intestine may later be found to have small intestine involvement also. It is not unusual for the diagnosis codes to change depending on the patient’s symptoms and findings. Additionally, it is even possible that what appeared to be a pathology confirmed diagnosis of ulcerative colitis initially will at a future time be more consistent with Crohn’s disease. Do not be surprised if your physician uses a different diagnosis for the patient’s condition from visit to visit depending on the current signs, symptoms, and radiologic or colonoscopy findings.”