Radiology Coding Alert

Obstruction will no longer guide your choice of right codes.

When reporting duodenal ulcers in ICD-9, you have been guided by three key parameters. “Bleeding, perforation, and obstruction are currently the guide to report for ulcers,” says Alicia Scott, CPC, CPC-I, Education Director, CodingCertification.Org. Adjust your focus to perforation and hemorrhage to arrive at the proper ICD-10 code. Your physician may diagnose a duodenal ulcer based on history, a thorough examination, signs and symptoms such as pain in the abdominal area under the sternum (that might be precipitated by intake of food or hunger), retching, vomiting and bloating.

Your physician may also undertake an endoscopy (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]) or a breath test (for detection of H. pylori (83013, Helicobacter pylori; breath test analysis for urease activity, non-radioactive isotope [e.g., C-13] and 83014, Helicobacter pylori; drug administration) to arrive at the diagnosis of a duodenal ulcer (532.xx, Duodenal ulcer).

Reporting Duodenal Ulcers in ICD-9

Under ICD-9 classification, duodenal ulcers are reported with a fourth and a fifth digit depending on a number of factors such as chronicity, presence or absence of hemorrhage, perforation and obstruction.

How ICD-10 is Different?

When ICD-9 transforms to ICD-10, the descriptors present in ICD-10 will almost be the same as the descriptors that are now present in ICD-9.

“The codes are very similar in ICD-9 and ICD-10 with the big difference being that the fifth digit classification, i.e. based on the presence or absence of obstruction,” says Christy Hembree, CPC, Team Leader, Summit Radiology Services, Dallas, TX. The only change of note is that the fifth digit classification (based on the presence or absence of obstruction) has been combined to give a single code without mention about the presence or absence of obstruction. ICD-10 gives a single code without mention about the presence or absence of obstruction. Therefore, coders will no longer have to worry about the mention of an obstruction in ICD-10, says Hembree. “If obstruction is indeed diagnosed, K31.5 can be added to clarify the additional diagnosis,” says Scott.

Tip: While reporting for duodenal ulcers, two codes in ICD-9 will now be represented by a single code in ICD-10 as presence or absence of obstruction no longer forms the basis for classification. “The rationale for this change is supported by past coding statistics according to which obstruction is known in around 5 percent cases of peptic ulcer disease. Hence, ICD-10 moves to a higher specificity,” says Scott.

As per this, ICD-10 code K26.4 (Chronic or unspecified duodenal ulcer with hemorrhage) will replace ICD-9 codes 532.40 (Chronic or unspecified duodenal ulcer with hemorrhage without obstruction) and 532.41(Chronic or unspecified duodenal ulcer with hemorrhage with obstruction).

Check out the following list for more examples of how two ICD-9 codes for duodenal ulcers are represented by a single ICD-10 “K” code in 2013:

• ICD-9: 532.50 (Chronic or unspecified duodenal ulcer with perforation without obstruction) and 532.51 (Chronic or unspecified duodenal ulcer with perforation with obstruction) ICD-10: K26.5 (Chronic or unspecified duodenal ulcer with perforation)
• ICD-9: 532.60 (Chronic or unspecified duodenal ulcer with hemorrhage and perforation without obstruction) and 532.61 (Chronic or unspecified duodenal ulcer with hemorrhage and perforation with obstruction) ICD-10: K26.6 (Chronic or unspecified duodenal ulcer with both hemorrhage and perforation)
• ICD-9: 532.00 (Acute duodenal ulcer with hemorrhage without obstruction) and 532.01 (Acute duodenal ulcer with hemorrhage with obstruction) ICD-10: K26.0 (Acute duodenal ulcer with hemorrhage)
• ICD-9: 532.10 (Acute duodenal ulcer with perforation without obstruction) and 532.11 (Acute duodenal ulcer with perforation with obstruction), ICD-10: K26.1 (Acute duodenal ulcer with perforation).

Remember: ICD-9 codes will no longer be accepted for dates of service on or after Oct 1, 2014. Learn more at www.cms.gov/ICD10/ and www.cdc.gov/nchs/icd/icd10cm.htm#10update.