Pediatric Coding Alert

Question: Our provider documented a 10-year-old patient as having both diarrhea and colitis. Do I assign codes to both conditions, or is only one code used in this case? And if I do code the diarrhea, does the diarrhea or functional diarrhea code fit this scenario best?

South Carolina Subscriber

Answer: First, let’s determine the difference between the two diarrhea codes: R19.7 (Diarrhea, unspecified) and K59.1 (Functional diarrhea). When we look at the code groups they are assigned under, we can see that code K59.1 describes an intestinal condition characterized by its frequent recurrence, whereas R19.7 describes a symptom.

However, in this particular situation, you would not use either of the codes. That’s because diarrhea is one of the symptoms of colitis, which is coded to K52.9 (Noninfective gastroenteritis and colitis, unspecified). That’s why ICD-10 lists R19.7 and K59. as Excludes1 codes for K52.9.

Guideline alert: ICD-10 guideline II.A instructs you not to use “codes for symptoms, signs, and ill-defined conditions from Chapter 18 … as principal diagnosis when a related definitive diagnosis has been established.” In this case, colitis is a definitive diagnosis, making use of R19.7 unnecessary.