This summary of the common gastrointestinal disorders in primary care will aid you gain ready because that ICD-10 and avoid, say, K30 – indigestion.

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Let"s it is in honest: ICD-10 coding does no make because that the most riveting reading. But as we acquire closer come the launch of ICD-10, the is becoming an important that you understand the password you space most likely to conference so that your documentation has the details necessary for ideal code selection and reimbursement. This rate in our ICD-10 series addresses usual gastrointestinal (GI) codes. (See the series overview.)

To recognize the required documentation and coding because that GI obstacle in ICD-10, it provides sense for primary care physicians come think of their patients together belonging to among two groups: 1) those v a well-known diagnosis or 2) those presenting with indications or symptoms before a documented diagnosis. Let"s deal with the latter team first.


Signs and symptoms including the digestive system and also abdomen


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ICD-10 uses the complying with advice around when to use sign and also symptom codes: “While certain diagnosis codes have to be reported once they are supported through the easily accessible medical document documentation and also clinical understanding of the patient"s health condition, there are instances once signs/symptoms or unspecified codes are the best choices for accurately mirroring the health treatment encounter. … If a definitive diagnosis has not been developed by the end of the encounter, the is suitable to report password for signs and/or symptoms in lieu of a definitive diagnosis.” (For more on this topic, check out "ICD-10 Coding because that the Undiagnosed Problem," FPM, May/June 2014.)


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COMMON GI ICD-10 CODES

This write-up contains numerous code lists and also tables, i beg your pardon are obtainable here because that download as a solitary resource.

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Although signs and symptoms documented during an office visit might or may not result in a final diagnosis of a GI disorder, the connected codes space grouped right into a subsection of thing 18 titled “Symptoms and signs including the digestive system and also abdomen,” password R10–R19.

When utilizing these codes, keep these 3 considerations in mind:Third, a note of clarification: The usual complaint the diarrhea deserve to be coded together either a sign/symptom (“Diarrhea, unspecified,” R19.7) or a disorder (“Functional diarrhea,” K59.1) depending upon your patient"s situation.


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ABDOMINAL and PELVIC pain CODESPainTendernessRebound tendernessSwelling massRigidity

Right upper quadrant

R10.11

R10.811

R10.821

R19.01

R19.31

Left upper quadrant

R10.12

R10.812

R10.822

R19.02

R19.32

Right reduced quadrant

R10.31

R10.813

R10.823

R19.03

R19.33

Left reduced quadrant

R10.32

R10.814

R10.824

R19.04

R19.34

Periumbilical

R10.33

R10.815

R10.825

R19.05

R19.35

Epigastric

R10.13

R10.816

R10.826

R19.06

R19.36

Generalized

R10.84

R10.817

R10.827

R19.07

R19.37


This table deliberately go not encompass codes because that “unspecified.” utilizing unspecified in explicate a physical finding is frequently the result of poor documentation and a red flag for an audit.


ABDOMINAL and PELVIC pain CODESPainTendernessRebound tendernessSwelling massRigidity

Right top quadrant

R10.11

R10.811

R10.821

R19.01

R19.31

Left upper quadrant

R10.12

R10.812

R10.822

R19.02

R19.32

Right reduced quadrant

R10.31

R10.813

R10.823

R19.03

R19.33

Left lower quadrant

R10.32

R10.814

R10.824

R19.04

R19.34

Periumbilical

R10.33

R10.815

R10.825

R19.05

R19.35

Epigastric

R10.13

R10.816

R10.826

R19.06

R19.36

Generalized

R10.84

R10.817

R10.827

R19.07

R19.37


This table deliberately walk not encompass codes because that “unspecified.” making use of unspecified in explicate a physics finding is often the result of bad documentation and also a red flag for an audit.


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OTHER common GI SYMPTOM CODES

Colic

R10.83

Nausea (without vomiting)

R11.0

Vomiting without nausea

R11.11

Nausea v vomiting

R11.2

Heartburn (excludes dyspepsia)

R12

Dysphagia, unspecified

R13.10*

Abdominal distension (bloating)

R14.0

Gas pain

R14.1

Eructation

R14.2

Flatulence

R14.3

Hepatomegaly, not elsewhere classified

R16.0

Absent bowel sounds

R19.11

Hyperactive bowel sounds

R19.12

Change in bowel habit

R19.4

Occult blood in feces/stool

R19.5

Diarrhea

R19.7

Functional dyspepsia (indigestion)

K30

Constipation

K59.00


*Dysphagia is a an excellent example of wherein an unspecified code would certainly be very appropriate. Uneven you room an otolaryngologist, it is likely that her office history and examination will certainly not enable you come differentiate in between the certain dysphagia codes for oral phase, oropharyngeal phase, pharyngeal phase, and pharyngoesophageal phase. This differentiation often requires motility testing or one esophagram.


OTHER typical GI SYMPTOM CODES

Colic

R10.83

Nausea (without vomiting)

R11.0

Vomiting there is no nausea

R11.11

Nausea through vomiting

R11.2

Heartburn (excludes dyspepsia)

R12

Dysphagia, unspecified

R13.10*

Abdominal distension (bloating)

R14.0

Gas pain

R14.1

Eructation

R14.2

Flatulence

R14.3

Hepatomegaly, not somewhere else classified

R16.0

Absent bowel sounds

R19.11

Hyperactive bowel sounds

R19.12

Change in bowel habit

R19.4

Occult blood in feces/stool

R19.5

Diarrhea

R19.7

Functional dyspepsia (indigestion)

K30

Constipation

K59.00


*Dysphagia is a great example of wherein an unspecified code would certainly be very appropriate. Unless you are an otolaryngologist, it is most likely that your office history and examination will certainly not permit you to differentiate in between the certain dysphagia password for oral phase, oropharyngeal phase, pharyngeal phase, and pharyngoesophageal phase. This differentiation regularly requires motility experimentation or one esophagram.


Clinical scenario: A 23-year-old female presents to her office for an urgent visit. Her history includes beginning of generalized ab pain yesterday v nausea yet no vomiting. She last menses was 2 weeks earlier and normal. She supplies oral contraceptives for birth control. The pain has actually now localized come the right lower quadrant, and she has had a couple episodes the diarrhea. Top top examination, she has a low-grade fever, fag tenderness over McBurney"s point, and missing bowel sounds. A pelvic check is negative. You perform a white blood cell counting in the office that mirrors 14,000 white blood cells every mm3 through a left shift. A urine pregnant test is negative. You call the emergency department and also arrange to have actually her evaluate there through a CT scan and also surgery consultation.

Deciding just how to code this office visit presents an amazing dilemma. Friend are reasonably certain the your patient has acute appendicitis, yet there might be various other etiologies such as ovarian torsion or tubal pregnancy. The details diagnosis of acute appendicitis is sustained by the medical record yet not definitive. Therefore, every ICD-10 instructions, it would be much more appropriate to password the signs and also symptoms 보다 the certain diagnosis. You would pick the adhering to codes:R10.823, Rebound ab tenderness, right lower quadrant,

R11.0, Nausea there is no vomiting,

R19.7, Diarrhea, unspecified,

R19.11, lacking bowel sounds,

D72.820, Lymphocytosis (symptomatic).


Specific conditions of the digestive system


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Chapter 11 the the ICD-10 code book is specialized to diseases of the digestive device (K00-K95). Let"s check out some of the diagnoses you"re most likely to view in main care.

Esophagitis. The necessary thing come note around this ar is when to use “other” and also when to use “unspecified.” take into consideration the complying with codes:K20.0, Eosinophilic esophagitis,

K20.8, other esophagitis,

K20.9, Esophagitis, unspecified.

If the esophagitis has actually previously been determined to be eosinophilic, climate obviously friend would usage the K20.0 code. However, the “other” password is no for every other causes of esophagitis however is used when the information in the medical record offers details of another particular diagnosis because that which a particular code does no exist. The “unspecified” code is provided when the information in the clinical record is inadequate to entrust a an ext specific code. The latter situation is an ext likely v esophagitis.

Just once you think it is clear when to usage “other” and “unspecified,” ICD-10 throws friend a curve ball: “For those categories for which an unspecified code is not provided, the ‘other specified’ code may represent both ‘other’ and also ‘unspecified.’”

Gastro-esophageal reflux condition (GERD). Over there are only two codes because that this condition:K21.0, Gastro-esophageal reflux disease with esophagitis,

K21.9, Gastro-esophageal reflux condition without esophagitis.

Reflux esophagitis password to “with esophagitis,” and also esophageal reflux password to “without esophagitis.” If you just put GERD in her documentation, it must be taken into consideration NOS (not otherwise specified) and also default to K21.9.

Barrett"s esophagus. Once you"re following a patience after a definitive diagnosis has been developed by biopsy, friend would usage the complying with codes:K22.70, Barrett"s esophagus without dysplasia,

K22.710, Barrett"s esophagus with low-grade dysplasia,

K22.711, Barrett"s esophagus v high-grade dysplasia,

K22.719, Barrett"s esophagus v unspecified dysplasia.

It is essential to keep in mind that when the test outcomes use a term prefer “consistent with,” this is not considered a definitive diagnosis. Unfortunately, this term shows up on plenty of pathology reports.

Ulcer disease. There are different code teams for esophagus (K22.1), gastric (K25), duodenal (K26), unspecified peptic (K27), and gastrojejunal ulcer (K28). Each team has subcodes because that acute or chronic, and each subgroup more stratifies to with or there is no hemorrhage or perforation, neither, or both. If friend are evaluating a patient prior to endoscopy, you should code the problem of hematemesis (K92.0) fairly than usage an unspecified peptic ulcer code. Only about 50 percent that acute upper GI bleeding is the result of peptic ulcer disease.1 ICD-10 has determined that hematemesis is a disease, not a authorize or symptom.

Hernias. For unclear reasons, return ICD-10 goes to an excellent lengths to encompass laterality (left, right) in every orthopedic code, the does not allow you to designate which next of the body has actually a unilateral hernia. Hernias are classified by ar – inguinal (K40), femoral (K41), umbilical (K42), ventral (K43), diaphragmatic (K44), various other (K45), and also unspecified (K46). Each team has additional codes for through or there is no obstruction, with or without gangrene, and recurrent. ICD-10 additionally includes the alternative “not stated as recurrent,” together opposed to an initial occurrence, yet it differentiates this only for inguinal and femoral hernias. So, if girlfriend only record the location of the hernia in the medical record, her coder (if you have one) can take into consideration that shorthand for NOS (not otherwise specified) and also default to the “without obstruction or gangrene, not stated as recurrent” code.

Most primary care physicians will usage only four of the 45 hernia codes:K40.20, Bilateral inguinal hernia, without obstruction or gangrene, not stated as recurrent,

K40.90, Unilateral inguinal hernia, without obstruction or gangrene, not stated as recurrent,

K42.9, Umbilical hernia there is no obstruction or gangrene,

K43.2, Incisional hernia there is no obstruction or gangrene.

Noninfective enteritis and colitis. This group is minimal to Crohn"s disease, ulcerative colitis, and also non-specific colitis. (Irritable bowel syndrome will come later.) every of the inflammatory bowel obstacle includes particular codes for with and also without complications and the type of complication (bleeding, obstruction, fistula, or abscess). Every is additionally stratified by location. Crohn"s contains the small intestine, huge intestine, both tiny and big intestine, and also unspecified. Ulcerative colitis has pancolitis, proctitis, and also rectosigmoiditis.

The “without complications” codes are listed below:K50.00, Crohn"s condition of little intestine without complications,

K50.10, Crohn"s condition of huge intestine there is no complications,

K50.80, Crohn"s an illness of both small and huge intestine without complications,

K51.00, Ulcerative pancolitis there is no complications,

K51.30, Ulcerative rectosigmoiditis without complications.

Diverticular disease. The acute diverticulitis codes will be offered sparingly in the primary treatment setting. As soon as you view an individual with recognized diverticular an illness who presents with standard diverticulitis findings, girlfriend may choose to empirically treat the patient and also use sign and symptom password or a diverticulitis code such as the following:

K57.30, Diverticulosis of big intestine there is no perforation or abscess without bleeding,

K57.32, Diverticulitis of large intestine without perforation or abscess without bleeding.

Clinical scenario: A 57-year-old male presents with abdominal muscle pain for two days. He has actually no appetite, and also the pain is greatly in the left lower abdomen. Crucial signs paper a temperature the 101.7°F and a soft tachycardia (105 beats per minute). He tells you he generally has a bowel activity every morning yet has not had actually one for the past two days. He had a similar episode 2 years ago that girlfriend empirically treated v antibiotics and also resolved. That underwent a colonoscopy that showed significant diverticulosis. Biopsies were negative for inflammation bowel disease. Today"s physics examination reflects left lower-abdomen tenderness without rebound. Rectal examination reflects no mass and minimal stool, which is heme negative. Bowel sounds space absent. His white blood cell count in the office is 14,000 white blood cells every mm3 with a left shift. You determine that the most likely diagnosis is acute diverticulitis there is no hemorrhage or obstruction. You decision to treat through a liquid diet and broad-spectrum oral antibiotics. You comment on the need for immediate reevaluation with any type of worsening of the symptoms and also arrange a follow-up visit in the office in 24 come 48 hours.

Unlike the attachment example questioned earlier, this diagnosis does not require added imaging and also is typically made based upon the background and examination. Therefore, given the known background of diverticulosis, the past most likely diagnosis the diverticulitis, and also the classic presentation, it would certainly be ideal to diagnose the patient v acute diverticulitis, K57.32.

It also would be exactly to password this based upon the signs and symptoms:R10.32, Left lower-quadrant pain,

R10.814, Left lower-quadrant tenderness,

R19.11, absent bowel sounds,

D72.820, Lymphocytosis.

Irritable bowel syndrome (IBS). Diagnosing IBS can be tricky because there is no standardized meaning of this condition. Numerous physicians monitor the Rome III diagnostic criteria for specifying when an individual must be diagnosed through IBS or various other functional cradle disorders,2 yet the people Health Organization/ICD-10 go not reference these criteria. The civilization Health Organization additionally has not recognized IBS-C (irritable bowel syndrome with constipation) as a stand-alone diagnosis, therefore ICD-10 calls for use that both one IBS code and also a constipation code. However, there are IBS codes for with and without diarrhea. (See “IBS-related codes.”)

Hemorrhoids. These codes are fairly straightforward. Just remember that the level of hemorrhoidal an illness is many often established by background rather 보다 examination.K64.0, first degree hemorrhoids, there is no prolapse external of anal canal,

K64.1, second degree, prolapse through straining yet retract spontaneously,

K64.2, third degree, prolapse v straining and also require hands-on replacement,

K64.3, fourth degree, prolapsed, can not be manually replaced.

Miscellaneous. Finally, there room a couple of common codes provided for various other portions of the digestive system external the alimentary tract:K70.30, alcoholic cirrhosis that the liver there is no ascites,

K76.0, fat liver, not elsewhere classified (includes nonalcoholic fat liver disease; excludes nonalcoholic steatohepatitis, K75.81),

K80.00, Calculus the gallbladder through acute cholecystitis without obstruction,

K80.2, Calculus that gallbladder without cholecystitis,

K81.0, Acute cholecystitis,

K85.0, Idiopathic acute pancreatitis,

K85.2, Alcohol induced acute pancreatitis,

K90.0, Celiac disease.


Breaking the down


Remember that the codes questioned above, those most common in primary care, are just a small fraction of the codes offered for the digestive system. ICD-10 has over 700 ICD-10 password in the chapter committed to illness of the digestive system and also at least an additional 80 in the signs and also symptoms chapter.

Also, remember that the coding scenarios presented in this short article are certain to the out-patient setting, whereby uncertain diagnoses frequently are coded with signs and symptoms codes. Because that inpatient treatment at short-term, acute, long-term, and psychiatric hospitals, an unsure diagnosis is allowed. Every ICD-10, ar II-H, “If the diagnosis documented at the time of discharge is qualified together ‘probable,’ ‘suspected,’ ‘likely,’ ‘questionable,’ ‘possible,’ or ‘still come be ruled out,’ or other comparable terms indicating uncertainty, code the condition as if it existed or to be established. The basis because that these guidelines are the diagnostic workup, species for more workup or observation, and also initial therapeutic strategy that exchange mail most very closely with the established diagnosis.”

If every one of this leaves you feeling frustrated through the ICD-10 rules, remainder assured that you"re no alone. The writer agrees that this coding is K62.9 – pain, anal. Nevertheless, by orienting you yourself to the new codes, you"ll be far better prepared as soon as the code set launches.


ARTICLES IN FPM"S ICD-10 SERIES

You can accessibility the following posts in FPM"s ICD-10 object collection:

"ICD-10: significant Differences for Five common Diagnoses," FPM, September/October 2015.

"ICD-10 Sprains, Strains, and Automobile Accidents," FPM, May/June 2015.

"Digesting the ICD-10 GI Codes," FPM, January/February 2015.

"Coding common Respiratory troubles in ICD-10," FPM, November/December 2014.

"ICD-10 Simplifies Preventive treatment Coding, type Of," FPM, July/August 2014.

"ICD-10 Coding for the Undiagnosed Problem," FPM, May/June 2014.

"How to document and password for Hypertensive illness in ICD-10," FPM, March/April 2014.

"10 steps to Preparing your Office for ICD-10 – Now," FPM, January/February 2014.

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"Getting ready for ICD-10: how It Will influence Your Documentation," FPM, November/December 2013.