Chapter 11 DIGESTIVE SYSTEM K00 K95. Presented by Jan Halloran CCS

Transcription

1 Chapter 11 DIGESTIVE SYSTEM K00 K95 Presented by Jan Halloran CCS 1

2 The Digestive System 2

3 GASTROINTESTINAL HEMORRHAGE Gastrointestinal (GI) bleeding manifests itself in several ways: Hematemesis (vomiting of blood), which indicates acute upper gastrointestinal hemorrhage Melena (presence of dark-colored blood in stool), which indicates upper or lower GI hemorrhage Occult bleeding (presence of blood in stool that can be seen only on laboratory examination), which indicates upper or lower GI bleeding Hematochezia (presence of bright-colored blood in stool), which indicates lower GI bleeding 3

4 Common Causes of GI Bleeding Codes for these diseases indicate whether there is associated hemorrhage or bleeding: Gastric and intestinal ulcers Diverticular disease - diverticulosis and diverticulitis Gastritis Angiodysplasia Duodenitis and Gastroduodenitis Crohn's disease Ulcerative colitis Examples include the following: K29.01 Acute gastritis with bleeding K Angiodysplasia of duodenum without bleeding 4

5 Diseases of the Esophagus K20.- K21.- K22.- Esophagitis Gastro-esophageal reflux disease (with/out esophagitis) Other diseases of the esophagus K22.0 Achalasia of cardia K22.1 Ulcer K22.2 Obstruction K22.3 Perforation K22.4 Dyskinesia K22.5 Diverticulum K22.6 Gastro-esophageal laceration-hemorrhage syndrome (Mallory-Weiss syndrome) K22.7 Barrett s esophagus (5 th and 6 th digit with and without dysplasia) K22.8 Other specified diseases (Hemorrhage) K22.9 Unspecified 5

6 Hemorrhage of the Esophagus Esophageal Varices Bleeding of the esophagus is coded as K22.8, Other specified diseases of esophagus, unless the bleeding is due to esophageal varices. Esophageal varices are not classified as a disease of the digestive system but as a disease of the circulatory system. They are coded as follows: I85.00 Esophageal varices without bleeding I85.01 Esophageal varices with bleeding When esophageal varices are associated with alcoholic liver disease, cirrhosis of the liver, toxic liver disease, or portal hypertension, dual coding is required, with the underlying condition coded first and a code for secondary esophageal varices (I85.10-I85.11). Examples include: K I85.11 Bleeding esophageal varices with cirrhosis of liver K I85.11 Bleeding esophageal varices in portal hypertension 6

7 Ulcers of the Stomach and Small Intestines K25-K28 Combination codes are provided for gastric, gastrojejunal, and duodenal ulcers that indicate whether there is associated bleeding, associated perforation, or both. These combination codes also distinguish between acute and chronic ulcers. Ulcers of the stomach and the small intestine are often described as peptic without any further identification of the site. The coder should review the medical record for any indication of the site involved; codes from category K27, Peptic ulcer, site unspecified, should not be used when a more specific code can be assigned. Examples of appropriate coding include the following: K25.5 Chronic gastric ulcer with perforation K26.3 Acute duodenal ulcer without hemorrhage or perforation K25.6 Chronic gastric ulcer with both hemorrhage and perforation 7

8 Ulcers of the Stomach and Small Intestines K25-K28 Category and 3 rd Character K25-Gastric ulcer K26-Duodenal ulcer K27-Peptic ulcer K28-Gastrojejunal ulcer 4 th Character 0 Acute, with hemorrhage 1 Acute, with perforation 2 Acute, with both hemorrhage and perforation 3 Acute, without both hemorrhage and perforation 4 Chronic or unspecified, with hemorrhage 5 Chronic or unspecified, with perforation 6 Chronic or unspecified, with both hemorrhage and perforation 7 Chronic, without hemorrhage or perforation 9 unspecified as acute or chronic, without hemorrhage or perforation 8

9 Gastritis and Duodenitis K29 Use additional code to identify alcoholic abuse or dependence (F10.-). Category and 4 th Character K29.0-Acute gastritis K29.2-Alcoholic gastritis K29.3-Chronic superficial gastritis K29.4-Chronic atrophic K29.5-Unspecified chronic gastritis K29.6-Other gastritis K29.7-Gastritis, unspecified K29.8-Duodenitits K29.9-Gastroduodenitis, unspecified 5 th Character 0 without bleeding 1 with bleeding 9

10 Diverticulosis and Diverticulitis A diverticulum is a small pouch or sac opening from a tubular or saccular organ, such as the esophagus, intestine, or urinary bladder. Diverticulosis indicates the presence of one or more diverticula of the designated site. Diverticulitis is the inflammation of existing diverticula. 10

11 Congenital versus Acquired Diverticula Diverticula may be either acquired or congenital. For certain sites, ICD-10- CM assumes that the condition is congenital unless specified otherwise; in other sites, the presumption is that the diverticula are acquired. For example, diverticula of the colon are assumed to be acquired unless specified as congenital; but diverticula of the esophagus are assumed to be congenital unless otherwise specified. The Alphabetic Index (volume 2) lists the following entries for diverticula of the colon and the esophagus: Diverticulum, diverticula... K colon--see Diverticulosis, intestine, large... --congenital Q esophagus (congenital) Q acquired (epiphrenic) (pulsion) (traction) K Meckel's (displaced) (hypertrophic) Q

12 Diverticular Disease of Intestine K57 Category and 4 th character K57.0-Diverticulitis of small intestine with perforation and abscess K57.2- Diverticulitis of large intestine with perforation and abscess 5 th Character 0 without bleeding 1 with bleeding K57.4-Diverticulitis of both small and large intestine with perforation and abscess K57.8-Diverticulitis of intestine, part unspecified, perforation and abscess K57.1-Diverticular disease small intestine without perforation and abscess K57.3-Diverticular disease large intestine without perforation and abscess K57.5-Diverticular disease of both small and large intestine with perforation and abscess 0 Diverticulosis without bleeding 1 Diverticulosis with bleeding 2 Diverticulitis without bleeding 3 Diverticulitis with bleeding K57.9-Diverticular disease of intestine, part unspecified, without perforation and abscess 12

13 Coding Exercise 11.1 Code the following diagnoses: 1. Acute gastric ulcer with massive gastrointestinal hemorrhage 2. Duodenal ulcer, with perforation and hemorrhage 3. Diverticulosis and diverticulitis of right colon 13

14 Coding Answers Exercise Acute gastric ulcer with massive gastrointestinal hemorrhage: K Duodenal ulcer, with perforation and hemorrhage: K Diverticulosis and diverticulitis of right colon: K K

15 Diarrhea A code from categories A00 through A09 are assigned for infectious diarrhea when the organism has been identified. Code A09 is assigned for infectious diarrhea not otherwise specified, or described only as dysenteric diarrhea, endemic diarrhea, or epidemic diarrhea. Check the Alphabetic Index carefully before coding, because diarrhea can be related to a variety of conditions. Symptom code R19.7 is assigned for diarrhea for which no appropriate subterm can be located. Examples of appropriate code assignments include the following: A04.7 Diarrhea due to Clostridium difficile R19.7 Acute diarrhea K52.9 Chronic diarrhea R19.7 Infantile diarrhea K59.1 Functional diarrhea 15

16 Constipation Unspecified constipation is coded to K59.00, but there are two distinct subtypes of constipation recognized: K59.01 Slow transit constipation Constipation that results from a delay in transit of fecal material throughout the colon secondary to smooth muscle K59.02 Outlet dysfunction constipation Constipation results that from difficulty evacuating the rectum during attempts at defecation. Treatment for these two types of constipation is very different. The slow transit type is treated with either laxatives or surgery. Biofeedback is taught for relaxation for the outlet dysfunction constipation. 16

17 Crohn s Disease (Regional Enteritis) K50.- Crohn s disease, one of the principal forms of inflammatory bowel disease, a chronic granulomatous disease of the gastrointestinal tract of unknown etiology; it can involve any part of the tract, but most often is found in the terminal ileum. Characteristics include scarring and thickening of the bowel wall that frequently leads to intestinal obstruction, abscesses, and fistula formation. 17

18 Crohn s Disease Category and 5 th Character K50.00 Crohn s disease of small intestine without complication K50.01-Crohn s disease of small intestine K50.10 Crohn s disease of large intestine without complication K50.11-Crohn s disease of large intestine K50.80 Crohn s disease of both small and large intestine without complication K50.81-Crohn s disease of both small and large intestine K50.90 Crohn s disease, unspecified, without complication K50.91-Crohn s disease, unspecified 6 th Character 1 with rectal bleeding 2 with intestinal obstruction 3 with fistula 4 with abscess 8 with other complication 9 with unspecified complication 18

19 Ulcerative Colitis Category and 4 th Character 5 th Character 6 th Character K51.0-Ulcerative(chronic) Pancolitis K51.2-Ulcerative (chronic) Proctitis K51.3-Ulcerative (chronic) Rectosigmoiditis K51.4-Inflammatory polyps K51.5-Left sided colitis K51.8-Other ulcerative colitis K51.9- Ulcerative colitis, unspecified 0 without complications 1- with complications 1 Rectal bleeding 2 Intestinal obstruction 3 Fistula 4 Abscess 8 Other complication 9 Unspecified complications 19

20 Irritable Bowel Syndrome Irritable bowel syndrome, irritable colon syndrome, a common, chronic, noninflammatory condition characterized by abdominal pain and altered bowel habits (diarrhea or constipation or both), but no detectable pathologic change; there may be spasms of the intestinal muscles. A variant form is characterized by painless diarrhea. K58.0 Irritable bowel syndrome with diarrhea K58.9 Irritable bowel syndrome without diarrhea 20

21 Hemorrhoids and Perianal Thrombosis Category and 4 th Character K64.0 First degree hemorrhoids Hemorrhoid (bleeding) without prolapse outside of anal canal K64.1 Second degree hemorrhoids Hemorrhoids (bleeding) that prolapse with straining, but retract spontaneously K64.2 Third degree hemorrhoids Hemorrhoids (bleeding) that prolapse with straining and require manual replacement back inside anal canal K64.3 Fourth degree hemorrhoids Hemorrhoids (bleeding) with prolapsed tissue that cannot be manually replaced K64.4 Residual hemorrhoidal skin tag External hemorrhoids, NOS Skin tags of anus K64.5 Perianal venous thrombosis External hemorrhoids with thrombosis Perianal hematoma Thrombosed hemorrhoids NOS K64.8 Other hemorrhoids Internal hemorrhoids, without mention of degree Prolapsed hemorroids, degree not specified K64.9 Unspecified hemorrhoids Hemorrhoids (bleeding) NOS Hemorrhoids (bleeding) without mention of degree 21

22 Abscess of Anal and Rectal Regions An abscess is a localized collection of pus within tissues, organs, or confined spaces: K61.0 Anal abscess K61.1 Rectal abscess K61.2 Anorectal abscess K61.3 Ischiorectal abscess K61.4 Intrasphincteric abscess 22

23 Fissure and Fistula of Anal and Rectal Regions Anal fissure is a painful linear ulcer at the margin of the anus: K60.0 Acute anal fissure K60.1 Chronic anal fissure K60.2 Anal fissure, unspecified Fistula is an abnormal passage or communication, usually between two internal organs, or leading from an organ to the surface of the body: K60.3 Anal fistula K60.4 Rectal fistula K60.5 Anorectal fistula 23

24 Signs and Symptoms (R10-R19) Category and 3 rd Character R10.- R11.- R12 R13.- R14.- R15.- R16.- R17 R18.- R19.- Abdominal and pelvic pain Nausea and vomiting Heartburn Aphagia and dysphagia Flatulence and related conditions Fecal incontinence Hepatomegaly and splenomegaly NEC Unspecified jaundice Ascites Other symptoms and signs 24

25 Coding Exercise 11.2 Code the following diagnoses: 1. Perirectal abscess 2. Polyp of rectum 3. Crohn s disease of the small intestines with abscess 25

26 Coding Answers Exercise Perirectal abscess: K Polyp of rectum: K Crohn s disease of the small intestines with abscess: K

27 Biliary System Terms to Know Biliary system a network including the gallbladder and bile ducts Calculus a stone composed of minerals that forms in an organ or duct of the body Cholecystitis is the inflammation of the gallbladder. Cholelithiasis is the presence or formation of gallstones. Choledocholithiasis is the occurrence of calculi in the common bile duct. 27

28 Diseases of the Gallbladder, Biliary Tract and Pancreas K80-K87 Acute and chronic cholecystitis without associated calculus is classified into category K81, with additional characters indicating whether it is: K81.0 Acute cholecystitis K81.1 Chronic cholecystitis K81.2 Acute cholecystitis with chronic cholecystitis K81.9 Cholecystitis, unspecified Combination codes are assigned for cholecystitis, cholelithiasis, and choledocholithiasis to permit reporting these related conditions with a single code. These codes are presented in three groups: K80.0- through K80.2- Calculus of gallbladder K80.3- through K80.5- Calculus of bile duct K80.6- through K80.7- Calculus of both gallbladder and bile ducts 28

29 Pancreatitis and Other Diseases of the Category and 3 rd Character Pancreas K85-K87 4 th Character K85- Acute pancreatitis 0 Idiopathic 1 Biliary 2 Alcohol induced 3 Drug induced 8 Other 9 Unspecified K86- Other diseases of pancreas 0 Alcoholic induced chronic pancreatitis 1 Other chronic pncreatitis 2 Cyst of pancreas 3 Pseudocyst of pancreas 8 Other specified diseases of pncreas K87 Disorders of gallbladder, biliary tract and pancreas in diseases classified elsewhere Code first underlying disease 29

30 Acute Hepatitis with Hepatic Failure K72 Acute hepatitis with hepatic failure codes to category K72.0- (without failure codes to B17.9). Viral and bacterial hepatitis codes (both acute and chronic) are found in Chapter 1 Infectious and Parasitic Diseases. Category and 4 th Character K72.0- Acute and Subacute hepatic failure K72.1- Chronic hepatic failure K72.9- Hepatic failure, unspecified 5 th Character 0 without coma 1 with coma 30

31 Viral Hepatitis B15-B19 Category and 3 rd Character 4 th Character 5 th Character B15- Acute hepatitis A 0 with hepatic coma 1 without hepatic coma B16-Acute hepatitis B 0 with delta-agent with hepatic coma 1 with delta-agent without hepatic coma 2 with delta-agent with hepatic coma 9 with delta-agent without hepatic coma B17-Other acute viral hepatitis B18-Chronic viral hepatitis B19-Unspecified viral hepatitis 0 Acute delta(super)infection of hepatitis B carrier 1-Acute hepatitis C 2 Acute hepatitis E 8 Other specified acute viral hepatitis 9 Acute viral hepatitis, unspecified 0 with delta-agent 1 without delta-agent 2 Hepatitis C 8 other 9 unspecified 0 with hepatic coma 1-hepatitis B 0 without hepatic coma 1 with hepatic coma 0 without hepatic coma 1 with hepatic coma B19-Unspecified viral hepatitis 9 without hepatic coma 31

32 Chronic Hepatitis K73 Category and 3 rd Character 4 th Character K73- Chronic hepatitis 0 Persistent 1 Lobular 2 Active 8 Other 9 Unspecified 32

33 Alcoholic Liver Disease K70 When coding from this category K70, use additional code to identify alcoholic abuse or dependence (F10.-). Category and 4 th Character K70.0 Alcoholic fatty liver K70.1- Alcoholic hepatitis K70.2 Alcoholic fibrosis and sclerosis K70.3- Alcoholic cirrhosis K70.4- Alcoholic hepatic failure 5 th Character 0 without ascites 1 with ascites 0 without coma 1 with coma K70.9 Alcoholic liver disease unspecified 33

34 Hernias of the Abdominal Cavity K40-K46 Hernias are classified by type and site, with combination codes used to indicate any associated gangrene or obstruction. With inguinal and femoral hernias, the codes further subdivide the hernia as unilateral or bilateral and whether it is specified as recurrent; that is, whether it had been repaired during a previous surgery. An incisional hernia is classified as a ventral hernia. Hernias described as incarcerated or strangulated are classified as obstructed. A hernia with both gangrene and obstruction is classified to hernia with gangrene. Careful review of the medical record and attention to instructional notes are important steps in coding these conditions. Coding examples include the following: K40.00 Bilateral inguinal hernia with obstruction (no mention of gangrene) K40.41 Unilateral recurrent inguinal hernia with gangrene K41.11 Gangrenous femoral hernia, recurrent, bilateral K44.1 Diaphragmatic hernia with gangrene K42.0 Umbilical hernia with obstruction K41.30 Incarcerated femoral hernia 34

35 Coding Exercise 11.3 Code the following diagnoses: 1. Acute cholecystitis with calculus of gallbladder and bile duct 2. Incarcerated left inguinal hernia 3. Acute alcoholic hepatitis and early liver cirrhosis with alcohol dependence 35

36 Coding Answers Exercise Acute cholecystitis with calculus of gallbladder and bile duct: K Incarcerated left inguinal hernia: K Acute alcoholic hepatitis and early alcoholic liver cirrhosis with alcohol dependence: K70.10, K F