Gastroenterology

ICD-10 CM Training

• ICD-10-CM will be valid for dates of service on or after October 1, 2015– Outpatient dates of service of October 1, 2015 and

beyond. – Inpatient hospital service claims, is effective for dates of

discharge after September 30, 2015

ICD-10-CM Compliance Dates

• Covered Entities– Everyone covered by the Health Insurance Portability

Accountability Act (HIPPA)

• Non-Covered Entities– Worker’s Compensation– Auto Insurance– Non covered HIPAA entities are exempt but are

encouraged to adapt the new code set

Covered and Non-Covered Entities

• 21 Chapters• Alpha-numeric codes; not case-sensitive

– Codes begin with Alpha letter, A-Z, excluding U– Common errors

• I verses 1• O verses 0

• “X” Placeholder• 3 to 7 characters

– Decimal following 3rd character

ICD-10 Code Structure

• Placeholder “X”– Used for future expansion of a code– Fills in empty characters when a 6th and/or 7th character

apply– The placeholder may be used in different scenarios but

should never serve as the final character.

Example: W19.XXXA Unspecified fall, Initial Encounter

ICD-10 Code Structure

• 7th Character– Provides specified information regarding the clinical visit– Is required for certain categories and must be reported in

the seventh position– May be alpha or numeric– Has different meanings depending on the coding category

ICD-10 Code Structure

• Laterality– Some ICD-10-CM codes indicate laterality, specifying

whether the condition occurs on the left, right or is bilateral.

– If no bilateral code is provided and the condition is bilateral, assign separate codes for both the left and right side.

– If the side is not identified in the medical record, assign the code for the unspecified side.

OGCR section 1.B.13

ICD-10 Code Structure

• “Other” Codes– Codes titled “other” or “other specified” are for use when

the information in the medical record provides detail for which a specific code does not exist.

• “Unspecified” Codes– Codes titled “unspecified” are for use when the

information in the medical record is insufficient to assign a more specific code.

OGCR section 1.A.9.a.b

ICD-10 Code Structure

• Excludes Notes– Excludes1

• A type 1 Excludes note is a pure excludes note• It means “NOT CODED HERE”• The code excluded should never be used at the same time• When two conditions cannot occur together

– Excludes2• Represents “Not included here”• The condition excluded is not part of the condition represented

by the code• It is acceptable to use both the code and the excluded code

together, when appropriateOGCR section 1.A.12.a.b

ICD-10 Structure

• “Code First” and “Use Additional Code”– ICD-10 has a coding convention that requires the

underlying condition be sequenced first followed by the manifestation.

– These instructional notes indicate the proper sequencing order of the codes.

OGCR section 1.A.13

• The “-” indicates there are additional reporting options

ICD-10 Code Structure

Most Common Diagnosis Codes

Encounter for screening for malignant neoplasm of colonICD-9 Code ICD-10 Code Description Excludes1 Excludes2

V76.51 Z12.11 Encounter for screening for malignant neoplasm of colon

• examinations related to pregnancy and reproduction (Z30-Z36, Z39.-)

• encounter for diagnostic examination-code to sign or symptom

N/A

There are more specific code choice selections below:

Z12.10

Z12.12

Z12.13

Use additional code to identify any family history of malignant neoplasm (Z80.-)

• Nonspecific abnormal findings disclosed at the time of these examinations are classified to categories R70-R94.

• Screening is the testing for disease or disease precursors in asymptomatic individuals so that early detection and treatment can be provided for those who test positive for the disease.

Documentation Tips

Colon & Appendix Benign NeoplasmICD-9 Code ICD-10 Code Description Excludes1 Excludes2

211.3 D12.0 Benign neoplasm of cecum • benign carcinoid tumors of the large intestine, and rectum (D3A.02-)

There are more specific code choices:

D12.1 Benign neoplasm of appendix

• benign carcinoid tumors of the large intestine, and rectum (D3A.02-)

• benign carcinoid tumor of the appendix (D3A.020)

D12.6 Benign neoplasm of colon, unspecified

• benign carcinoid tumors of the large intestine, and rectum (D3A.02-)

• inflammatory polyp of colon (K51.4-)

• polyp of colon NOS (K63.5)K63.5 Polyp of colon • adenomatous polyp of colon

(D12.6)• inflammatory polyp of colon

(K51.4-)• polyposis of colon (D12.6)

Abdominal painICD-9 Code ICD-10 Code Description Excludes1 Excludes2

789.00 R10.9 Unspecified abdominal pain

• renal colic (N23) • dorsalgia (M54.-)• flatulence and

related conditions (R14.-)

There are more specific code choice selections below:

789.00 R10.0 Acute abdomen

789.09 R10.10 Upper abdominal pain, unspecified

789.01 R10.11 Right upper quadrant pain

789.02 R10.12 Left upper quadrant pain

789.06 R10.13 Epigastric pain

789.09 R10.2 Pelvic and perineal pain

789.09 R10.30 Lower abdominal pain, unspecified

789.03 R10.31 Right lower quadrant pain

789.04 R10.32 Left lower quadrant pain

789.05 R10.33 Periumbilical pain

789.61 R10.81- Other abdominal pain

789.61 R10.82- Rebound abdominal tenderness

Abdominal Pain Documentation Tips

• Document specific location:– LLQ, LUQ, RUQ, RLQ – Periumbilical – Epigastric – Generalized (R10.84)– Colic (R10.83)– Acute abdominal pain (R10.0)– Abdominal tenderness (R10.811-R10.819)– Rebound abdominal pain (R10.821-R10.829)

Personal history of colonic polypsICD-9 Code ICD-10 Code Description Excludes1 Excludes2

V12.72 Z86.010 Personal history of colonic polyps

N/A • personal history of malignant neoplasms (Z85.-)

Code first any follow-up examination after treatment (Z09)

• There are two types of history Z codes, personal and family. Personal history codes explain a patient’s past medical condition that no longer exists and is not receiving any treatment, but that has the potential for recurrence, and therefore may require continued monitoring.

• Personal history codes may be used in conjunction with follow-up codes and family history codes may be used in conjunction with screening codes to explain the need for a test or procedure. History codes are also acceptable on any medical record regardless of the reason for visit. A history of an illness, even if no longer present, is important information that may alter the type of treatment ordered.

Documentation Tips

Dysphagia, unspecifiedICD-9 Code ICD-10 Code Description Excludes1 Excludes2

787.20 R13.0 Aphagia • Psychogenic aphagia (F50.9)

• Psychogenic dysphagia (F45.8)

N/A

R13.10** Dysphagia, unspecified

N/A

**Code first, if applicable, dysphagia following cerebrovascular disease (I69. with final characters -91)

There are more specific code choice selections below:

787.21 R13.11 Dysphagia, oral phase

787.22 R13.12 Dysphagia, oropharyngeal phase

787.23 R13.13 Dysphagia, pharyngeal phase

787.24 R13.14 Dysphagia, pharyngoesophageal phase

787.29 R13.19 Other dysphagiaCervical dysphagiaNeurogenic dysphagia

• Document phase:– Oral – Oropharyngeal – Pharyngeal – Pharyngo-esophageal

• Document if sequelae of nontraumatic hemorrhage: – specify type:

• Subarachnoid• Intracerebral • Intracranial

• Document if sequelae of: – Cerebral infarction – Cerebrovascular disease

Dysphagia Documentation Tips

Family history of malignant neoplasm of digestive organsICD-9 Code ICD-10 Code Description Excludes1 Excludes2

V16.0 Z80.0 Family history of malignant neoplasm of digestive organs

N/A N/A

Code also any follow-up examination (Z08-Z09)

• Z80.3 is considered unacceptable as a principal diagnosis as it describes a circumstance which influences an individual's health status but not a current illness or injury, or the diagnosis may not be a specific manifestation but may be due to an underlying cause.

• Family history codes are for use when a patient has a family member(s) who has had a particular disease that causes the patient to be at higher risk of also contracting the disease.

• Personal history codes may be used in conjunction with follow-up codes and family history codes may be used in conjunction with screening codes to explain the need for a test or procedure. History codes are also acceptable on any medical record regardless of the reason for visit. A history of an illness, even if no longer present, is important information that may alter the type of treatment ordered.

Documentation Tips

Diverticular disease of intestineICD-9 Code ICD-10 Code Description Excludes1 Excludes2

562 K57.9- Diverticular disease of intestine, part unspecified,

• congenital diverticulum of intestine (Q43.8)

• Meckel's diverticulum (Q43.0)

• diverticulum of appendix (K38.2)

There are more specific code choice selections below:

K57.0- Diverticulitis of small intestine with perforation and abscess

K57.1- Diverticular disease of small intestine without perforation or abscess

K57.2- Diverticulitis of large intestine with perforation and abscess

K57.3- Diverticular disease of large intestine without perforation or abscess

K57.4- Diverticulitis of both small and large intestine with perforation and abscess

K57.5- Diverticular disease of both small and large intestine without perforation or abscess

K57.8- Diverticulitis of intestine, part unspecified, with perforation and abscess

Identify:• With or without bleeding• Small and/or large intestine• Perforation and/or Abscess

Documentation Tips

Gastro-Esophageal Reflux DiseaseICD-9 Code ICD-10 Code Description Excludes1 Excludes2

530.81 K21.9 Gastro-esophageal reflux disease without esophagitis

• Esophageal reflux NOS

Newborn esophageal reflux (P78.83)

N/A

There are more specific code choice selections below:

530.11 K21.0 Gastro-esophageal reflux disease with esophagitis

– Identify with or without esophagitis

GERD Documentation Tips

GastroenteritisICD-9 Code ICD-10 Code Description Excludes1 Excludes2

787.91 K52.2 Allergic and dietetic gastroenteritis and colitis

Use additional code to identify type of food allergy (Z91.01-, Z91.02-)

N/A N/A

K52.89 Other specified noninfective gastroenteritis and colitis

N/A N/A

R19.7 Diarrhea, unspecified • acute abdomen (R10.0)• functional diarrhea (K59.1)• neonatal diarrhea (P78.3)• psychogenic diarrhea (F45.8)

N/A

There are more specific code choice selections below:

558.1 K52.0 Gastroenteritis and colitis due to radiation

535.70535.71535.41

K52.81 Eosinophilic gastritis or gastroenteritisEosinophilic enteritis

Barrett's esophagusICD-9 Code ICD-10 Code Description Excludes1 Excludes2

530.85 K22.70 Barrett's esophagus without dysplasia

Applicable to:• Barrett's esophagus

NOS

• Barrett's ulcer (K22.1)

• malignant neoplasm of esophagus (C15.-)

N/A

There are more specific code choice selections below:

K22.710 Barrett's esophagus with low grade dysplasia

K22.711 Barrett's esophagus with high grade dysplasia

K22.719 Barrett's esophagus with dysplasia, unspecified

Identify:– With or without dysplasia– Type of dysplasia

Documentation Tips

Benign neoplasm of rectum and anal canalICD-9 Code ICD-10 Code Description Excludes1 Excludes2

211.4 D12.7 Benign neoplasm of rectosigmoid junction

N/A N/A

211.4 D12.8 Benign neoplasm of rectum • benign carcinoid tumor of the rectum (D3A.026)

N/A

211.4 D12.9 Benign neoplasm of anus and anal canal

Applicable to:• Benign neoplasm of

anus NOS

• benign neoplasm of anal margin (D22.5, D23.5)

• benign neoplasm of anal skin (D22.5, D23.5)

• benign neoplasm of perianal skin (D22.5, D23.5)

N/A

Calculus of bile duct without cholangitis or cholecystitis ICD-9 Code ICD-10 Code Description Excludes1 Excludes2

574.50 K80.50 Calculus of bile duct without cholangitis or cholecystitis without obstruction

• retained cholelithiasis following cholecystectomy (K91.86)

N/A

574.51 K80.51 Calculus of bile duct without cholangitis or cholecystitis with obstruction

Gastrointestinal hemorrhageICD-9 Code ICD-10 Code Description Excludes1 Excludes2

578.9 K92.2 Gastrointestinal hemorrhage, unspecified

Applicable to:• Gastric hemorrhage

NOS• Intestinal hemorrhage

NOS

• neonatal gastrointestinal hemorrhage (P54.0-P54.3)

• acute hemorrhagic gastritis (K29.01)

• hemorrhage of anus and rectum (K62.5)

• angiodysplasia of stomach with hemorrhage (K31.811)

• diverticular disease with hemorrhage (K57.-)

• gastritis and duodenitis with hemorrhage (K29.-)

• peptic ulcer with hemorrhage (K25-K28)

N/A

Gastritis ICD-9 Code ICD-10 Code Description Excludes1 Excludes2

535.00 K29.00 Acute gastritis without bleeding

• eosinophilic gastritis or gastroenteritis (K52.81)

• Zollinger-Ellison syndrome (E16.4)

N/A

There are more specific code choice selections below:

535.01 K29.01 Acute gastritis with bleeding

535.30 K29.20 Alcoholic gastritis without bleeding

535.31 K29.21 Alcoholic gastritis with bleeding

535.10535.40

K29.30 Chronic superficial gastritis without bleeding

535.11535.41

K29.31 Chronic superficial gastritis with bleeding

535.10 K29.40 Chronic atrophic gastritis without bleeding

535.11 K29.41 Chronic atrophic gastritis with bleeding

535.10 K29.50 Unspecified chronic gastritis without bleeding

535.11 K29.51 Unspecified chronic gastritis with bleeding

535.20535.40

K29.60 Other gastritis without bleeding

535.20535.40

K29.61 Other gastritis with bleeding

535.50 K29.70 Gastritis, unspecified, without bleeding

535.51 K29.71 Gastritis, unspecified, with bleeding

DuodenitisICD-9 Code ICD-10 Code Description Excludes1 Excludes2

535.60 K29.80 Duodenitis without bleeding

535.61 K29.81 Duodenitis with bleeding

Gastritis and duodenitisICD-9 Code ICD-10 Code Description Excludes1 Excludes2

535.61 K29.81 Gastroduodenitis, unspecified, without bleeding

535.61 K29.81 Gastroduodenitis, unspecified, with bleeding

• Document acuity: – - Acute or Chronic

• Differentiate between: – Gastritis – Gastroduodenitis– Duodenitis

• Document type: – Alcoholic – Superficial – Atrophic

• Document any related hemorrhage • Document any alcohol or drug use, abuse, dependence or past history • Specify name of medication or drug with purpose of its use

Gastritis Documentation Tips

On October 01, 2015 we will monitor claims for date of service rules

• Outpatient claims cannot have crossover dates • Outpatient claims will be coded according to date of

service• Inpatient facility claims will be coded per date of discharge

We will monitor claims to resolve any unanticipated problems with the submission process

Monitor Claims

• We will monitor for claim denials• We will monitor editing trends for ICD-10 Coding

guidelines• We will provide feedback to the physicians regarding

supporting documentation requirements • We will monitor WC or Liability carriers for published

rules on use of ICD-9 or ICD-10 code sets

Claim Denial and Management

• Client will need to update – Templates– Order Sets– Superbills– Favorites

• Future Orders– Remove ICD-9 code add ICD-10 code

Client Responsibilities

All Conditions treated or assessed must be documented in the medical record. In addition to the documentation tips reviewed, below are more areas to document that will ensure proper ICD-10-CM code selection.

• Site specificity• Document notation of qualifiers

– Exacerbation– Manifestations– Relapse– Status– Stages

• Indicate acute or chronic• Indicate underlying or external cause factors

– Medication– Smoke– Accidents– Mechanical failure

• Laterality– Bilateral– Right – Left

Documentation – Start Now

• Episode of Care for injuries, poisoning, external causes and other conditions– Initial Encounter

• Use while the patient is receiving active treatment of the condition– Active treatment includes surgical treatment, an emergency encounter, and

evaluation and treatment by a new physician

– Subsequent Encounter• Used on encounter after the patient has received active treatment of

the condition and is receiving routine care for the condition during the healing or recovery phase.

– Medication adjustments, aftercare, device adjustments, cast change

– Sequela• Used for complications or conditions that arise as a direct result of a

condition, late effect

Documentation – Start Now

• Combination codes that capture– Etiology and manifestation– Related conditions– Disease, injury or other medical condition and

complications– Disease or other medical conditions and common signs or

symptoms

• Add ICD-10 Codes to patient Problem List

Documentation – Start Now

UnderdosingUnderdosing refers to taking less of a medication than is prescribed by a provider or a manufacturer’s instruction. For underdosing, assign the code from categories T36-T50 (fifth or sixth character “6”).

Codes for underdosing should never be assigned as principal or first-listed codes. If a patient has a relapse or exacerbation of the medical condition for which the drug is prescribed because of the reduction in dose, then the medical condition itself should be coded.

Noncompliance (Z91.12-, Z91.13-) or complication of care (Y63.6-Y63.9) codes are to be used with an underdosing code to indicate intent, if known.

OGCR Section 1.C.19.e.5.c

Official Guidelines for Coding and Reporting

codingresource@g1hs.com

Centers for Disease Control and Prevention (ICD-10-CM)http://www.cdc.gov/nchs/icd/icd10cm.htm

Questions