ICD 10 Coding Alert

Get ready for more specific pancreatitis codes.

The CDC has posted a preliminary list of ICD-10-CM changes for October 1 (aka ICD-10-CM 2017), and just in case you don’t want to sort through about 2,000 new codes, we’ve narrowed down the list to seven main areas gastroenterology coders need to know.

Be warned: The list is not yet final. “The code lists that have been posted on the CMS and CDC websites are NOT the final list. The Addenda to be published in June is the complete, final list of code changes going into effect this October,” says Sue Bowman, MJ, RHIA, CCS, FAHIMA, Senior Director of Coding Policy and Compliance at AHIMA.

Resource: To review the complete list, head to ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Publications/ICD10CM/2017/NewICD10CMCodes_FY2017.txt.

1. Read Up on These New/Revised GI Tumors Diagnoses

You’ve got new options for GI tumors.

Stromal tumor: “You’ve got some great additions, especially the stromal tumor codes,” rejoices Jan Rasmussen, CPC, PCS, ACS-GI, ACS-OB, owner/consultant of Professional Coding Solutions, Holcombe, Wisc. They are:

• C49.A0 (Gastrointestinal stromal tumor, unspecified site)
• C49.A1 (Gastrointestinal stromal tumor of esophagus)
• C49.A2 (Gastrointestinal stromal tumor of stomach)
• C49.A3 (Gastrointestinal stromal tumor of small intestine)
• C49.A4 (Gastrointestinal stromal tumor of large intestine)
• C49.A5 (Gastrointestinal stromal tumor of rectum)
• C49.A9 (Gastrointestinal stromal tumor of other sites).

Malignant carcinoid tumor: You have some revisions to note for malignant carcinoid tumors. They are:

• You’ll revise C7A.094 (Malignant carcinoid tumor of the foregut NOS) to (Malignant carcinoid tumor of the foregut, unspecified).
• You’ll revise C7A.095 (Malignant carcinoid tumor of the midgut NOS) to (Malignant carcinoid tumor of the midgut, unspecified).
• You’ll revise C7A.096 (Malignant carcinoid tumor of the hindgut NOS) to (Malignant carcinoid tumor of the hindgut, unspecified).

Benign carcinoid tumor: You’ll also have similar revisions to these benign carcinoid tumor diagnoses:

• You’ll revise D3A.094 (Benign carcinoid tumor of the foregut NOS) to (Benign carcinoid tumor of the foregut, unspecified).
• You’ll revise D3A.095 (Benign carcinoid tumor of the midgut NOS) to (Benign carcinoid tumor of the midgut, unspecified).
• You’ll revise D3A.096 (Benign carcinoid tumor of the hindgut NOS) to (Benign carcinoid tumor of the hindgut, unspecified).

2. For Colonoscopies, Highlight These Updates

You will need to implement both a revision and additions affecting colonoscopies. “These are useful for post colonoscopy complications,” says Michael Weinstein, MD, former representative of the AMA’s CPT^® Advisory Panel.

You should revise D78.22 (Postprocedural hemorrhage and hematoma of the spleen following other procedure) to (Postprocedural hemorrhage of the spleen following other procedure).

You will also add these two codes:

• D78.31 (Postprocedural hematoma of the spleen following a procedure on the spleen)
• D78.32 (Postprocedural hematoma of the spleen following other procedure).

3. Check Out These New Enteritis/Colitis Codes

As of October 1, you will delete K52.2 (Allergic and dietetic gastroenteritis and colitis) and add:

• K52.21 (Food protein-induced enterocolitis syndrome)
• K52.22 (Food protein-induced enteropathy)
• K52.29 (Other allergic and dietetic gastroenteritis and colitis).

Additionally, you’ll add these colitis codes:

• K52.3 (Indeterminate colitis)
• K52.831 (Collagenous colitis)
• K52.832 (Lymphocytic colitis)
• K52.838 (Other microscopic colitis)
• K52.839 (Microscopic colitis, unspecified).

4. Investigate These Intestinal Vascular Issue Diagnoses

On October 1, you will delete K55.0 (Acute vascular disorders of intestine) and instead, add the following options:

• K55.011 (Focal [segmental] acute [reversible] ischemia of small intestine)
• K55.012 (Diffuse acute [reversible] ischemia of small intestine)
• K55.019 (Acute [reversible] ischemia of small intestine, extent unspecified)
• K55.021 (Focal [segmental] acute infarction of small intestine)
• K55.022 (Diffuse acute infarction of small intestine)
• K55.029 (Acute infarction of small intestine, extent unspecified)
• K55.031 (Focal [segmental] acute [reversible] ischemia of large intestine)
• K55.032 (Diffuse acute [reversible] ischemia of large intestine)
• K55.039 (Acute [reversible] ischemia of large intestine, extent unspecified)
• K55.041 (Focal [segmental] acute infarction of large intestine)
• K55.042 (Diffuse acute infarction of large intestine)
• K55.049 (Acute infarction of large intestine, extent unspecified)
• K55.051 (Focal [segmental] acute [reversible] ischemia of intestine, part unspecified)
• K55.052 (Diffuse acute [reversible] ischemia of intestine, part unspecified)
• K55.059 (Acute [reversible] ischemia of intestine, part and extent unspecified)
• K55.061 (Focal [segmental] acute infarction of intestine, part unspecified)
• K55.062 (Diffuse acute infarction of intestine, part unspecified)
• K55.069 (Acute infarction of intestine, part and extent unspecified).

5. Capture These Enterocolitis Changes

You’ve got new codes that will deal with intestinal infectious and vascular issues. You’ll add:

• K55.30 (Necrotizing enterocolitis, unspecified)
• K55.31 (Stage 1 necrotizing enterocolitis)
• K55.32 (Stage 2 necrotizing enterocolitis)
• K55.33 (Stage 3 necrotizing enterocolitis)

6. Add These IBS/Constipation Dx

• You’ll add these IBS and constipation codes:
• K58.1 (Irritable bowel syndrome with constipation)
• K58.2 (Mixed irritable bowel syndrome)
• K58.8 (Other irritable bowel syndrome)
• K59.03 (Drug induced constipation)
• K59.04 (Chronic idiopathic constipation).

Then you’ll delete K59.3 (Megacolon, not elsewhere classified), and then add K59.31 (Toxic megacolon) and K59.39 (Other megacolon).

“While many of [these] new codes give great detail to a condition, it has been my experience physician’s very rarely give the coder that much detail either in their clinic notes or their operative reports. Most often we get ischemia bowel or IBS with none of the detail,” Rasmussen says.

7. Finally, Pick Apart These Pancreatitis Codes

“ICD-10-CM will add granularity to pancreatitis codes,” Weinstein says. You will be denoting whether the patient exhibits necrosis or infection.

First, you’ll delete K850 (Idiopathic acute pancreatitis), and then add:

• K85.00 (Idiopathic acute pancreatitis without necrosis or infection)
• K85.01 (Idiopathic acute pancreatitis with uninfected necrosis)
• K85.02 (Idiopathic acute pancreatitis with infected necrosis).

You’ll also delete K85.1 (Biliary acute pancreatitis) and then add:

• K85.10 (Biliary acute pancreatitis without necrosis or infection)
• K85.11 (Biliary acute pancreatitis with uninfected necrosis)
• K85.12 (Biliary acute pancreatitis with infected necrosis).

You should also delete K85.2 (Alcohol induced acute pancreatitis) and add:

• K85.20 (Alcohol induced acute pancreatitis without necrosis or infection)
• K85.21 (Alcohol induced acute pancreatitis with uninfected necrosis)
• K85.22 (Alcohol induced acute pancreatitis with infected necrosis).

You will also delete K85.3 (Drug induced acute pancreatitis), and then add:

• K85.30 (Drug induced acute pancreatitis without necrosis or infection)
• K85.31 (Drug induced acute pancreatitis with uninfected necrosis)
• K85.32 (Drug induced acute pancreatitis with infected necrosis).

Similarly, delete K85.8 (Other acute pancreatitis) and add:

• K85.80 (Other acute pancreatitis without necrosis or infection)
• K85.81 (Other acute pancreatitis with uninfected necrosis)
• K85.82 (Other acute pancreatitis with infected necrosis).

Finally, you will strike through K85.9 (Acute pancreatitis, unspecified) and add:

• K85.90 (Acute pancreatitis without necrosis or infection, unspecified)
• K85.91 (Acute pancreatitis with uninfected necrosis, unspecified)
• K85.92 (Acute pancreatitis with infected necrosis, unspecified).

You’ll also have these pancreatic changes:

• Delete K86.8 (Other specified diseases of pancreas) and add K86.81 (Exocrine pancreatic insufficiency) and K86.89 (Other specified diseases of pancreas).
• Delete K90.4 (Malabsorption due to intolerance, not elsewhere classified) and add K90.41 (Non-celiac gluten sensitivity) and K90.49 (Malabsorption due to intolerance, not elsewhere classified).