Basic ICD 10-CM/PCS and ICD-9-CM Coding, - PowerPoint Presentation

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Basic ICD 10-CM/PCS and ICD-9-CM Coding, 2015 Edition

Chapter

12

: Diseases of the Digestive System

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Learning Objectives

Review the chapter’s learning objectives

At the conclusion of this chapter, what must you know about the coding of diseases of the digestive system and related procedures?

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Diseases of the Digestive System

Chapter 9 of ICD-9-CM

Oral cavity, salivary glands, and jaw (520–529)

Esophagus, stomach, and duodenum (530–537)

Appendicitis (540)

Hernia of abdominal cavity (550–553)

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Diseases of the Digestive System (continued)

Chapter 9 of ICD-9-CM

Noninfectious enteritis and colitis (555–558)

Other diseases of intestine and peritoneum

(560–569)

Other diseases of digestive system (570–579)

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Diseases of Oral Cavity, Salivary Glands, and Jaws

Expanded ICD-9-CM codes to describe types of

Dental caries

Abrasions and erosions

Gingival and periodontal disease

Dentofacial anomalies

Diseases of supporting structures

Diseases of oral soft tissues

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Diseases of Oral Cavity, Salivary Glands, and Jaws (continued)

Need for updated dental codes to support use of electronic records in dental offices and provide better tracking of patient conditions and their outcomes

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Diseases of Oral Cavity, Salivary Glands, and Jaws (continued)

Mucositis can occur as a side-effect of antineoplastic treatment and other medications

Mucosal surfaces susceptible to damage

528.00–528.09, Oral mucositis

538, Gastrointestinal mucositis

Other codes in other chapters

478.11, Nasal mucositis

616.82, Mucositis of cervix, vagina, and vulva

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Gastrointestinal Ulcers

In ICD-9-CM, ulcers coded according to anatomic site

A diagnosis of “peptic ulcer” does not specify the site, so it is an unspecified code

Gastric ulcer (531)

Duodenal ulcer (532)

Peptic ulcer, site unspecified (533)

Gastrojejunal ulcer (534)

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Gastrointestinal Ulcers (continued)

Fourth digit

Acute or chronic or unspecified condition

Presence of hemorrhage or perforation

Fifth digit

Presence or absence of obstruction or blockage

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Gastritis and Duodenitis

ICD-9-CM Category 535, Gastritis and Duodenitis

Fourth digit

Types of gastritis and duodenitis

Acute, atrophic, alcoholic, and others

Fifth digit

Presence or absence of hemorrhage

Second code for associated gastrointestinal hemorrhage is unnecessary

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Hernias of the Abdominal Cavity

Hernia is the protrusion of a loop or knuckle of organ or tissue through an abdominal opening

Hernias are coded according to site:

Inguinal, femoral,

Hiatal, Ventral,

Incisional, umbilical

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Hernias of the Abdominal Cavity (continued)

Inguinal hernia (ICD-9-CM category 550)

Hernia of an intestinal loop into the inguinal canal

Fifth digit indicates

Unilateral, bilateral, or unspecified

Recurrent type

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Hernias of the Abdominal Cavity (continued)

Femoral, umbilical, ventral/abdominal, and diaphragmatic/hiatal describe different anatomic sites

Femoral

Hernia of a loop of intestine into the femoral canal

Umbilical

Part of the intestine protrudes at the umbilicus

Ventral/abdominal

Intestine or some other internal body structure protrudes through the abdominal wall

Diaphragmatic/hiatal

Part of the stomach protrudes through the esophageal hiatus of the diaphragm

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Hernias of the Abdominal Cavity (continued)

Physicians will further specify the status of the hernia as:

Reducible

The hernia can be manipulated to return the displaced structures back into position

Irreducible

The displaced structures cannot be returned or reduced by manipulation

An irreducible hernia may be described as “strangulated” or ‘incarcerated,” which means the blood supply to the contents of the hernia sac is restricted and this may cause gangrene. This is a surgical emergency.

“With obstruction” indicates that irreducibility, incarceration, or strangulation is present

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Hernias of the Abdominal Cavity (continued)

Femoral, umbilical, ventral/abdominal, diaphragmatic/hiatal hernias coded according to their clinical presentation with ICD-9-CM:

With gangrene (551)

Obstructed, without mention of gangrene (552)

Without obstruction or gangrene (553)

Fifth digit indicates

Unilateral, bilateral, or unspecified

Recurrent type

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Noninfectious Enteritis and Colitis

Regional enteritis (ICD-9-CM category 555)

Crohn’s disease

Chronic inflammatory disease

Fourth digit

Specific site affected

Small intestine

Large intestine

Small and large intestine

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Gastroenteritis

Gastroenteritis is classified by cause

Some conditions appear in Chapter 1 of

ICD-9-CM

003.0, Salmonella gastroenteritis

005.9, Gastroenteritis due to food poisoning

008.8, Viral gastroenteritis, NEC

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Gastroenteritis (continued)

Other gastroenteritis conditions appear in Chapter 9 of ICD-9-CM

556.9, Ulcerative gastroenteritis

558.3, Allergic gastroenteritis and colitis

558.9, Other and unspecified noninfectious gastroenteritis and colitis

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Peritonitis and Retroperitoneal Infections

andCD-9-CM

codes

Generalized (acute) peritonitis, 567.21

Peritoneal abscess of specific location, such as

Mesenteric or subphrenic, 567.22 or retroperitoneal, 567.38

Choleperitonitis, 567.81, result of bile in the peritoneal cavity

Sclerosing mesenteritis, 567.82

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Cholecystitis and Cholelithiasis

Two ICD-9-CM categories available

574, Cholelithiasis

Gallbladder stones: cholelithiasis

Bile duct stones: choledocholithiasis

575, Other disorders of gallbladder

Gallbladder inflammation with gallstones or bile duct stones is classified to category 574

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Cholecystitis and Cholelithiasis (continued)

ICD-9-CM Category 574, Cholelithiasis

Fourth digit describes:

Existence of stones or calculus

Presence of associated acute or chronic cholecystitis

Fifth digit describes:

Presence or absence of obstructions

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Cholecystitis and Cholelithiasis (continued)

ICD-9-CM Category 575 includes gallbladder inflammation without stones or calculus

575.0, Acute Cholecystitis

575.1, Other Cholecystitis

Other disorders of gallbladder

575.2, Obstruction of gallbladder

575.3, Hydrops of gallbladder

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Cholecystitis and Cholelithiasis (continued)

Fifth digit for ICD-9-CM subcategory 575.1 describes type of condition

575.10, Cholecystitis unspecified

575.11, Chronic cholecystitis

575.12, Acute and chronic cholecystitis

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Gastrointestinal Hemorrhage

Hemorrhage of the upper and lower GI tract

ICD-9-CM codes:

578.0, Hematemesis

578.1, Melena or blood in stool

578.9, GI hemorrhage, unspecified

Read the excludes note:

Many digestive system codes include presence of hemorrhage

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Gastrointestinal Hemorrhage (continued)

Use of ICD-9-CM category 578 codes is limited to patients where a GI bleed is documented but bleeding site or cause is identified

This is not the same as occult blood or guaiac positive stool, ICD-9-CM code 792.1, Non-specific abnormal findings in other body substances, stool contents

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Gastrointestinal Procedures

and ICD-9-CM

Volume 3 codes

Laparoscopic

and

open repair of hernia

Surgery is the only treatment and cure for most hernia

Open repair made through an incision

Unilateral and bilateral repairs

Codes

53.01–53.04

and

53.11

–

53.16

Laparoscopic repair

Unilateral and bilateral repairs

Codes

17.11

–

17.13

and

17.21

–

17.24

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Gastrointestinal

Procedures (

ICD-9-CM continued)

Closed endoscopic biopsies

Closed endoscopic excision of lesions

Gastrointestinal ostomies

Stomach (gastrostomy)

Colon (colostomy)

Ileum (ileostomy)

Other (jejunostomy, duodenostomy, or feeding enterostomy)

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Gastrointestinal

Procedures ICD-9-CM

(continued)

Intestinal resection and anastomosis

Partial excision of small and large bowel

Note instructions after codes 45.5, 45.6, 45.7

Code any synchronous anastomosis or enterostomy: 45.90–45.95 or 46.10–46.39

End-to-end anastomosis is not coded

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Laparotomy

and

ICD-9-CM Volume 3

Incision into the abdominal wall

Exploratory laparotomy

Reopening of recent laparotomy

Drainage of intraperitoneal abscess or hematoma

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Laparotomy (continued)

Excludes note under ICD-9-CM code 54.11

Exploration incidental to intra-abdominal surgery: omit code

Code only the definitive procedure, such as appendectomy, cholecystectomy, etc.

Laparotomy is considered the operative approach

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Adhesion Barrier

Application or administration of an adhesion barrier, ICD-9-CM code 99.77

Temporary bioresorbable membrane to assist in the prevention of postoperative adhesions

The membrane is placed in the surgical wound by the surgeon

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Chapter 11 of ICD-10-CM, Diseases of the Digestive System, K00

–

K94

Diseases of oral cavity and salivary glands

Disease of esophagus, stomach and duodenum

Diseases of appendix

Hernia

Noninfective enteritis and colitis

Diseases of peritoneum and retroperitoneum

Diseases of liver

Disorders of gallbladder, biliary tract and pancreas

Other diseases of digestive system

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Chapter 11 of ICD-10-CM, Diseases of the Digestive System, K00

–

K94

New subchapters added to the chapter, for example, diseases of the liver

Term “hemorrhage” is used when referring to ulcers

Term “bleeding” is used when classifying gastritis, duodenitis, diverticulosis and diverticulitis

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Chapter 11 of ICD-10-CM, Diseases of the Digestive System, K00

–

K94

Category K50, Crohn’s disease, expanded to the fourth,

fifth,

and sixth character level

Fourth character specifies the site

Fifth character indicates whether or not a complication is present

Sixth character classifies the specific complication

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Coding Guidelines and Instructional Notes for Chapter 11 of ICD-10-CM

Use additional code notes are used, for example, use additional code to identify manifestations with ulcerative colitis

Additional codes should be assigned for associated conditions and external causes

Instructions added to code first underlying conditions

No chapter-specific digestive system guidelines exist in ICD-10-CM Official Guidelines

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Coding Overview for Chapter 11 of ICD-10-CM

ICD-10-CM codes do not include the diagnosis of “obstruction” for digestive system ulcer codes

ICD-10-CM include codes for acute and chronic types of ulcers with and without hemorrhage and performation

New codes for hernias of the abdominal cavity include bilateral and unilateral conditions, with or without obstruction and gangrene

Ulcerative colitis and regional enteritis codes include the accompanying complications within each code

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Coding Overview for Chapter 11 of ICD-10-CM

Complications of artificial openings of the digestive system are included

Codes exist for intraoperative and postprocedural complications as well as hemorrhage, hematoma, and accidental puncture and laceration

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Coding Overview for Chapter 11 of ICD-10-CM

New sections in Chapter 11

Diseases of liver (

K70

–

K77

)

Disorders of gallbladder, biliary tract and pancreas (

K80

–

K87

)

Include subcategories for specified disorders