ICD-10 training: Coding digestive disorders

August 7, 2014

Physicians should understand the major changes for coding gastrointestinal ailments in the International Classification of Diseases-10th Revision.

Codes for diseases and disorders of the digestive system begin with the letter ‘K’ in ICD-10 and all codes are complete in their description. There is no need to add an additional digit to complete the code to its highest level of specificity for reporting.

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ICD-10 provides categories for gastric ulcer (K25), duodenal ulcer (K26), peptic ulcer, site unspecified (K27), and gastrojejunal ulcer (K28) very similar to the equivalent categories in ICD-9. In both systems, specific codes are listed for acute, chronic, unspecified as acute or chronic (applies only to ulcers without complication), and with and without hemorrhage and/or perforation.

The difference in coding ulcers lies in the need for an additional fifth digit on all ulcer codes in ICD-9 to denote whether the ulcer occurs with or without obstruction. This is no longer considered an axis of coding for gastrointestinal ulcers in ICD-10 and no code descriptions provide specificity in regards to obstruction.

As in ICD-9, a statement of ‘gastroduodenal ulcer’ that is not otherwise specified must be coded to peptic ulcer, site unspecified. Documentation that states only ‘gastrointestinal ulcer’ or erosion is coded to gastrojejunal ulcer. Both systems also include marginal, stomal, and anastomotic ulcer as gastrojejunal.

Gastritis and duodenitis

Gastritis and duodenitis codes in ICD-10 also include the code description in its entirety as without bleeding or with bleeding. ICD-9 requires the addition of a fifth digit to specify with and without hemorrhage.

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The subcategories provided in ICD-10 for coding particular types of gastritis and duodenitis are:

K29.0: Acute gastritis

K29.2: Alcoholic gastritis

K29.3: Chronic superficial gastritis

K29.4: Chronic atrophic gastritis

K29.5: Unspecified chronic gastritis-includes chronic antral and chronic fundal

K29.6: Other gastritis-includes giant hypertrophic, granulomatous, and Menetrier’s disease

K29.7: Gastritis, unspecified

K29.8: Duodenitis

K29.9: Gastroduodenitis, unspecified

ICD-9 provides subcategories for gastric mucosal hypertrophy and eosinophilic gastritis, and one combined subcategory only for unspecified gastritis and gastro­duodenitis. There is no provision in ICD-9 for chronic superficial types. The Alphabetic Index directs to 535.1x Atrophic gastritis for chronic cases, whether follicular or glandular, and to 535.4x Other specified gastritis for superficial cases. In ICD-10, gastric mucosal hypertrophy is coded to other gastritis while eosinophilic gastritis is coded to K52.81, eosinophilic gastritis or gastroenteritis under an entirely different section for noninfective enteritis and colitis.

Next: [Chart] Coding gastric ulcers under ICD-10

 

Next: Ulcerative colitis

 

Ulcerative Colitis

Ulcerative colitis codes have been greatly expanded in ICD-10. All ulcerative colitis codes are now combination codes that require selecting the one that specifies the type of colitis together with its associated complication. For example: K51.012, the code for ulcerative (chronic) pancolitis with intestinal obstruction.

Although there are no specific guidelines for Chapter 11 Diseases of the Digestive System in the ICD-10 draft, it would be appropriate to follow guidelines for combination codes when reporting ulcerative colitis. Multiple coding should not be used when the classification system provides a combination code that clearly identifies all of the elements documented in the diagnosis. When the combination code lacks the necessary specificity in describing the manifestation or complication, an additional code should be used.

Also of note: ICD-9 provides separate subcategories for ulcerative (chronic) enterocolitis (556.0), ulcerative (chronic) ileocolitis (556.1), and universal ulcerative (chronic) colitis. These are all included under one subcategory, K51.0, ulcerative (chronic) pancolitis in ICD-10.

The terminology has changed for the other subcategories in ICD-10. Pseudopolyposis of colon (556.4) is designated as Inflammatory polyps of colon (K51.4) and ulcerative (chronic) proctosigmoiditis (556.3) is designated as ulcerative (chronic) rectosigmoiditis (K51.3).