Documenting & Coding for Diseases of the Gastrointestinal System

On October 1, 2015, the ICD-9-CM code set that is used to report medical diagnoses in the United States will be replaced with the ICD-10-CM code set. The new code set provides more than 68,000 codes, compared to 13,000 in ICD-9, and introduces alphanumeric category classifications for the first time. As such, ICD-10 is much more proficient at describing current conditions and healthcare practices, and possesses the flexibility to expand as needed to accommodate the changing clinical environment.

Under the ICD-9 nomenclature, codes range from three to five digits while diagnosis coding under the ICD-10 system employs three to seven digits. The expanded number of characters of the ICD-10 code set provides greater specificity as they identify additional detail such as disease etiology, anatomic site, severity, episode of care, and laterality. This newsletter is part of a series by APS Medical Billing that illustrates the changes that will occur in transitioning to the new code set for sample conditions, providing the additional documentation that will be needed to facilitate final code assignment in ICD-10.

In this issue we will take a look at two diseases of the gastrointestinal system – Barrett’s Esophagus and Crohn’s Disease - and provide the additional detail that should be included in the pathologist’s report to direct proper diagnosis code assignment, come October 1, 2015. 

Barrett’s Esophagus

In ICD-9-CM, there is 1 code available for Barrett’s Esophagus which includes the diagnosis of Barrett’s Ulcer.  The ICD-10-CM nomenclature expands the code set to 6, adding codes to specify dysplasia and separately categorizing Barrett’s Ulcer.

Dictation should specify:
• Barrett’s esophagus, syndrome, or disease
  o Without dysplasia
  o With dysplasia
    • Low grade
    • High grade
    • Unspecified
• Barrett’s ulcer
  o Without bleeding
  o With bleeding

ICD-9-CM Code
530.85  Barrett’s esophagus (includes syndrome, ulcer)

ICD-10-CM Code
K22.70   Barrett’s esophagus without dysplasia (includes syndrome; excludes ulcer)
K22.710  Barrett’s esophagus with low grade dysplasia (includes syndrome; excludes ulcer)
K22.711  Barrett’s esophagus with high grade dysplasia (includes syndrome; excludes ulcer)
K22.719  Barrett’s esophagus with dysplasia, unspecified (includes syndrome; excludes ulcer)
K22.10   Ulcer of esophagus without bleeding
K22.11   Ulcer of esophagus with bleeding

Crohn’s Disease

In ICD-9-CM, 4 codes are available for Crohn’s Disease, differentiated by site.  The ICD-10-CM nomenclature expands the code set to 28, also differentiated by site, and now detailing complications for each of those sites.

Dictation should specify:
• Site
  o Small intestine
  o Large intestine
  o Small and large intestine
  o Unspecified
• Without complications
• With complications
  o Rectal bleeding
  o Intestinal obstruction
  o Fistula
  o Abscess
  o Other
  o Unspecified

ICD-9-CM Code
555.0   Crohn’s disease of small intestine

ICD-10-CM Code
K50.00   Crohn’s disease of small intestine without complications 
K50.011  Crohn’s disease of small intestine with rectal bleeding
K50.012  Crohn’s disease of small intestine with intestinal obstruction
K50.013  Crohn’s disease of small intestine with  fistula
K50.014  Crohn’s disease of small intestine with abscess
K50.018  Crohn’s disease of small intestine with other complication
K50.019  Crohn’s disease of small intestine with unspecified complications 

ICD-9-CM Code
555.1   Crohn’s disease of large intestine

ICD-10-CM Code
K50.10   Crohn’s disease of large intestine without complications
K50.111  Crohn’s disease of large intestine with rectal bleeding
K50.112  Crohn’s disease of large intestine with intestinal obstruction
K50.113  Crohn’s disease of large intestine with fistula
K50.114  Crohn’s disease of large intestine with abscess
K50.118  Crohn’s disease of large intestine with other complication
K50.119  Crohn’s disease of large intestine with unspecified complications

ICD-9-CM Code
555.2   Crohn’s disease of small intestine with large intestine

ICD-10-CM Code
K50.80    Crohn’s disease of both small and large intestine without complications
K50.811  Crohn’s disease of both small and large intestine with rectal bleeding
K50.812  Crohn’s disease of both small and large intestine with intestinal obstruction
K50.813  Crohn’s disease of both small and large intestine with fistula
K50.814  Crohn’s disease of both small and large intestine with abscess
K50.818  Crohn’s disease of both small and large intestine with other complication
K50.819  Crohn’s disease of both small and large intestine with unspecified complications

ICD-9-CM Code
555.9   Crohn’s disease of unspecified site

ICD-10-CM Code
K50.90    Crohn’s disease, unspecified, without complications
K50.911  Crohn’s disease, unspecified, with rectal bleeding
K50.912  Crohn’s disease, unspecified, with intestinal obstruction
K50.913  Crohn’s disease, unspecified, with fistula
K50.914  Crohn’s disease, unspecified, with abscess
K50.918  Crohn’s disease, unspecified, with other complication
K50.919  Crohn’s disease, unspecified, with unspecified complications

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