Radiology Coding Alert

Confirm dysplasia and determine grade of dysplasia.

ICD-9 offers a single simple code, 530.85 (Barrett’s esophagus) for Barrett’s esophagus. When ICD-10 goes into effect, you will have to select from a range of codes depending upon presence or absence of dysplasia. “Barrett’s Esophagus is an excellent example of ICD-10-CM being more descriptive than ICD-9-CM, which in turn results in better patient care,” says Alicia Scott, CPC, CPC-I, Education Director, CodingCertification.Org.

ICD-10 Specifies Dysplasia Options

Under ICD-10, 530.85 will be replaced by the parent code K22.7- (Barrett’s esophagus). But once you’re using ICD-10, you’ll have to look deeper in the patient notes before you can report the Barrett’s esophagus diagnosis.

That’s because ICD-10 codes are more specific than ICD-9, based on the presence or absence of dysplastic changes. So K22.7 expands into a fourth digit classification based on the presence or absence of dysplasia, as follows:

• K22.70 — Barrett’s esophagus without dysplasia
  
• K22.71 — Barrett’s esophagus with dysplasia.
  

In addition, K22.71 expands to a fifth-digit classification based on the dysplasia grade.

“The expansion of ICD-10-CM allows in the 5th and 6th characters to specify low or high grade dysplasia of the esophagus,” says Scott. So if dysplasia is present, you will have to further look through the documentation to see if there is any mention about the degree of dysplasia that is present to correctly report the diagnosis of Barrett’s esophagus. “For ICD-10 additional documentation for code choice is needed to distinguish between Barrett’s esophagus without dysplasia, low grade dysplasia, high grade dysplasia or unspecified dysplasia,” says Christy Hembree, CPC, Team Leader, Summit Radiology Services, Cartersville, GA. You accordingly select from the following codes:

• K22.710 — Barrett’s esophagus with low grade dysplasia
  
• K22.711 — Barrett’s esophagus with high grade dysplasia
  
• K22.719 — Barrett’s esophagus with dysplasia, unspecified.
  

You will have to clearly document the low or high grades of dysplasia. “Low grade dysplasia of the esophagus is when the cells are precancerous but have not achieved the ability to invade or move into other organs,” says Scott. “In high grade dysplasia, there are significant precancerous changes. Regular endoscopic surveillance is an important part of treatment planning.”

It may seem cumbersome but these changes will eventually prove beneficial. “With this expansion, the continuum of care will be easier to identify,” says Scott. “By reporting the elaborate ICD-10 codes, you are notifying the payer of the need for more frequent testing.”

Remember When to Report Barrett’s Esophagus

A diagnosis of Barrett’s esophagus could apply when the surgeon performs an endoscopy of the esophagus and the stomach, such as 43235 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]).

The presence of any suggestive changes might make the surgeon suspect Barrett’s esophagus, and require further investigation.

“If during the endoscopy the [surgeon] sees inflammation, erosions, or irregular salmon colored mucosa, he will perform a biopsy (43239, Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with biopsy, single or multiple) of the lower esophagus,” says Michael Weinstein, MD, former representative of the AMA’s CPT® Advisory Panel.. The surgeon will then send the biopsied specimen to the laboratory for analysis to check for dysplasia, and if present, to check the grade of dysplasia.

Coding tip: You’ll need to use all the patient information, including the pathology report, to assign the final ICD-10 code for Barrett’s esophagus. Work with the surgeon’s office to verify whether samples were sent for further analysis and to ensure you’re coding based on the most accurate diagnosis. “With ICD-10-CM the coder can identify the changes made in the esophagus with proper documentation,” says Scott.

What is Barrett’s esophagus? Barrett’s esophagus is a condition where the inner lining of the esophagus is damaged. The lining changes to one that more closely resembles the intestinal lining, says Scott. This change is triggered by exposure of the esophageal lining to acidic content of the stomach. Chronic acidic reflux is a common cause, says Scott. “Barrett’s esophagus is usually a result of gastro esophageal reflux disorder (GERD) and is a disorder in which the lining of the esophagus is damaged by stomach acid,” says Hembree.