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Diseases of the Digestive System and Related Procedures

Learn about the coding of diseases of the digestive system and related procedures in ICD-10-CM/PCS and ICD-9-CM. This chapter covers diseases of the oral cavity, salivary glands, jaws, esophagus, stomach, duodenum, appendix, hernia, enteritis, colitis, and more.

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Diseases of the Digestive System and Related Procedures

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  1. Basic ICD 10-CM/PCS and ICD-9-CM Coding, 2015 Edition Chapter 12: Diseases of the Digestive System

  2. 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?

  3. 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)

  4. 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)

  5. 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

  6. 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

  7. 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

  8. 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)

  9. 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

  10. 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

  11. 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

  12. 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

  13. 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

  14. 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

  15. 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

  16. 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

  17. 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

  18. 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

  19. 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

  20. 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

  21. 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

  22. 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

  23. 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

  24. 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

  25. 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

  26. 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

  27. 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)

  28. 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

  29. Laparotomy and ICD-9-CM Volume 3 • Incision into the abdominal wall • Exploratory laparotomy • Reopening of recent laparotomy • Drainage of intraperitoneal abscess or hematoma

  30. 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

  31. 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

  32. 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

  33. 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

  34. 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

  35. 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

  36. 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

  37. 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

  38. 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

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