Radiology Coding Alert

Use definitive code sets when calculi are present in the gall bladder and the biliary duct.

Have you nailed down proper ICD-10-CM 2014 cholelithiasis coding? Check your progress by reviewing the answers to the quiz on page 51.

Answer 1: The correct answer is option d. 

When reporting a diagnosis of cholelithiasis using ICD-10 codes, you’ll base your code selection on presence or absence of cholecystitis, chronicity, and on the presence and absence of obstruction. If this seems familiar, that’s because this is how you currently select your ICD-9 codes. 

Answer 2: The correct answer is option a.

ICD-9: When your clinician diagnoses cholelithiasis, you begin your code choice with 574 (Cholelithiasis). Depending on if your clinician identifies cholecystitis, 574 will expand into the following three choices:

• 574.0 -- Calculus of gallbladder with acute cholecystitis
• 574.1 -- Calculus of gallbladder with other cholecystitis
• 574.2 -- Calculus of gallbladder without mention of cholecystitis.

All these three above mentioned codes expand using a 5th digit expansion into another two codes depending on the presence or absence of obstruction. For example, 574.0 expands into the following code choices depending on the presence or absence of obstruction:

• 574.00 -- Calculus of gallbladder with acute cholecystitis without obstruction
• 574.01 -- Calculus of gallbladder with acute cholecystitis with obstruction.

Reminder: You have to use the above-mentioned choices when your clinician identifies calculi in the gallbladder. If the calculi are found in the biliary duct, you would use the code ranges, 574.7x-574.9x again depending on the chronicity of cholecystitis and on the presence or absence of obstruction. 

Note: Gallstones may occur in the gallbladder and bile duct at the same time, so these sets of codes are not mutually exclusive. In some patients, you might correctly choose a code from both.

ICD-10: When you begin to use ICD-10 codes, 574 that you use in ICD-9 to identify a diagnosis of cholelithiasis crosswalks to K80 (Cholelithiasis). As in ICD-9, depending on the presence or absence of cholecystitis, you have three code choices:

• K80.0 -- Calculus of gallbladder with acute cholecystitis
• K80.1 -- Calculus of gallbladder with other cholecystitis
• K80.2 -- Calculus of gallbladder without cholecystitis.

Again, as in ICD-9, K80.0 and K80.2 expand further into two code choices depending on the presence or absence of obstruction. For example, K80.2 expands into the following code choices:

• K80.20 -- Calculus of gallbladder without cholecystitis without obstruction
• K80.21 -- Calculus of gallbladder without cholecystitis with obstruction.

Answer 3: The correct answer is option b.

The ICD-10 code K80.1 expands into six code choices depending on chronicity of the cholecystitis and on the presence or absence of obstruction. This allows you to accurately choose a code that helps identify the condition more appropriately. So, the six codes that K80.1 expands into include:

• K80.10 -- Calculus of gallbladder with chronic cholecystitis without obstruction
• K80.11 -- Calculus of gallbladder with chronic cholecystitis with obstruction
• K80.12 -- Calculus of gallbladder with acute and chronic cholecystitis without obstruction
• K80.13 -- Calculus of gallbladder with acute and chronic cholecystitis with obstruction
• K80.18 -- Calculus of gallbladder with other cholecystitis without obstruction
• K80.19 -- Calculus of gallbladder with other cholecystitis with obstruction.

Answer 4: The correct answer is option b.

If your radiologist identifies cholelithiasis and choledocholithiasis, you have definitive code choices to report the condition in both ICD-9 as well as ICD-10. In such a case, again, depending on the presence or absence of obstruction and on chronicity of identified cholecystitis, you have to report either K80.6 (Calculus of gallbladder and bile duct with cholecystitis) or K80.7 (Calculus of gallbladder and bile duct without cholecystitis).

Answer 5: The correct answer is option d.

Some symptoms that you are most likely to encounter in the patient documentation in a patient suffering from calculi in gall bladder or bile ducts include pain in right upper abdominal area, nausea, vomiting and fever. The clinical note may mention signs like tachycardia, pain and tenderness in the right upper quadrant, and palpable gallbladder in the right upper quadrant upon physical examination.

Tests: Based on symptoms and observations made during the physical examination, your physician may perform an ultrasound examination to check for the presence of gallstones and to check for cholecystitis. He might also include other studies including a hepatobiliary scintigraphy along with blood tests to check for presence of bile duct obstruction and to rule out other conditions.

Also, look for a positive Murphy’s sign in the clinical note. Your physician will document a positive Murphy’s sign when he elicits pain in the right upper quadrant (RUQ) of the patient’s abdomen.

Since the history and symptoms of the patient along with observations made upon physical examination is suggestive of gallstones and inflammation of the gallbladder, your physician will also do lab tests for WBC counts, ALT, AST, alkaline phosphatase and bilirubin levels.