ICD-10 CM Training
Gastroenterology
ICD-10-CM Compliance Dates
• 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
Covered and Non-Covered Entities
• 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
ICD-10 Code Structure
• 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 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 appropriate
OGCR section 1.A.12.a.b
ICD-10 Code 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
Most Common Diagnosis Codes
Encounter for screening for malignant neoplasm of colon
ICD-9 Code
ICD-10 Code
Description
Excludes1
Excludes2
V76.51
Z12.11
Encounter for screening for
malignant neoplasm of
colon
•
N/A
•
examinations
related to
pregnancy and
reproduction (Z30Z36, Z39.-)
encounter for
diagnostic
examination-code
to sign or symptom
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.-)
Documentation Tips
• 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.
Colon & Appendix Benign Neoplasm
ICD-9 Code
ICD-10 Code
Description
Excludes1
211.3
D12.0
Benign neoplasm of cecum
•
benign carcinoid tumors of the
large intestine, and rectum
(D3A.02-)
•
benign carcinoid tumors of the
large intestine, and rectum
(D3A.02-)
benign carcinoid tumor of the
appendix (D3A.020)
There are more specific code choices:
D12.1
Benign neoplasm of
appendix
•
D12.6
Benign neoplasm of colon,
unspecified
•
•
•
K63.5
Polyp of colon
•
•
•
benign carcinoid tumors of the
large intestine, and rectum
(D3A.02-)
inflammatory polyp of colon
(K51.4-)
polyp of colon NOS (K63.5)
adenomatous polyp of colon
(D12.6)
inflammatory polyp of colon
(K51.4-)
polyposis of colon (D12.6)
Excludes2
Abdominal pain
ICD-9 Code
ICD-10 Code
Description
Excludes1
Excludes2
789.00
R10.9
Unspecified
abdominal pain
•
•
•
renal colic (N23)
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
dorsalgia (M54.-)
flatulence and
related conditions
(R14.-)
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 polyps
ICD-9 Code
ICD-10 Code
Description
Excludes1
Excludes2
V12.72
Z86.010
Personal history of colonic
polyps
N/A
•
Code first any follow-up examination after treatment (Z09)
personal history of
malignant neoplasms
(Z85.-)
Documentation Tips
• 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.
Dysphagia, unspecified
ICD-9 Code
ICD-10 Code
Description
Excludes1
Excludes2
787.20
R13.0
Aphagia
•
Psychogenic aphagia (F50.9)
N/A
R13.10**
Dysphagia,
unspecified
•
Psychogenic dysphagia (F45.8)
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 dysphagia
Cervical dysphagia
Neurogenic dysphagia
Dysphagia Documentation Tips
•
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
Family history of malignant neoplasm of digestive organs
ICD-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)
Documentation Tips
• 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.
Diverticular disease of intestine
ICD-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
Documentation Tips
Identify:
• With or without bleeding
• Small and/or large intestine
• Perforation and/or Abscess
Gastro-Esophageal Reflux Disease
ICD-9 Code
ICD-10 Code
Description
Excludes1
Excludes2
530.81
K21.9
Gastro-esophageal
reflux disease
without esophagitis
Newborn
esophageal reflux
(P78.83)
N/A
•
Esophageal
reflux NOS
There are more specific code choice selections below:
530.11
K21.0
Gastro-esophageal reflux disease with esophagitis
GERD Documentation Tips
– Identify with or without esophagitis
Gastroenteritis
ICD-9 Code
ICD-10 Code
Description
Excludes1
Excludes2
787.91
K52.2
Allergic and dietetic
gastroenteritis and colitis
N/A
N/A
N/A
Use additional code to
identify type of food allergy
(Z91.01-, Z91.02-)
K52.89
Other specified
noninfective gastroenteritis
and colitis
N/A
R19.7
Diarrhea, unspecified
•
•
•
•
acute abdomen (R10.0)
functional diarrhea (K59.1)
neonatal diarrhea (P78.3)
psychogenic diarrhea (F45.8)
There are more specific code choice selections below:
558.1
K52.0
Gastroenteritis and colitis due to radiation
535.70
535.71
535.41
K52.81
Eosinophilic gastritis or gastroenteritis
Eosinophilic enteritis
N/A
Barrett's esophagus
ICD-9 Code
ICD-10 Code
Description
Excludes1
Excludes2
530.85
K22.70
Barrett's esophagus
without dysplasia
•
N/A
•
Applicable to:
• Barrett's esophagus
NOS
Barrett's ulcer
(K22.1)
malignant
neoplasm of
esophagus (C15.-)
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
Documentation Tips
Identify:
– With or without dysplasia
– Type of dysplasia
Benign neoplasm of rectum and anal canal
ICD-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
•
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
•
Applicable to:
• Benign neoplasm of
anus NOS
•
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
•
N/A
574.51
K80.51
Calculus of bile duct without cholangitis or cholecystitis with obstruction
retained cholelithiasis
following cholecystectomy
(K91.86)
Gastrointestinal hemorrhage
ICD-9 Code
ICD-10 Code
Description
Excludes1
Excludes2
578.9
K92.2
Gastrointestinal
hemorrhage, unspecified
•
N/A
•
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)
Gastritis
ICD-9 Code
535.00
ICD-10 Code
K29.00
Description
Acute gastritis without
bleeding
Excludes1
Excludes2
•
N/A
•
eosinophilic gastritis or gastroenteritis
(K52.81)
Zollinger-Ellison syndrome (E16.4)
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
535.10
535.40
K29.30
Chronic superficial gastritis without bleeding
535.11
535.41
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
535.20
535.40
K29.60
Other gastritis without bleeding
535.20
535.40
K29.61
Other gastritis with bleeding
535.50
K29.70
Gastritis, unspecified, without bleeding
535.51
K29.71
Gastritis, unspecified, with bleeding
Duodenitis
ICD-9 Code
ICD-10 Code
Description
Excludes1
535.60
K29.80
Duodenitis without bleeding
535.61
K29.81
Duodenitis with bleeding
Excludes2
Gastritis and duodenitis
ICD-9 Code
ICD-10 Code
Description
Excludes1
535.61
K29.81
Gastroduodenitis, unspecified, without bleeding
535.61
K29.81
Gastroduodenitis, unspecified, with bleeding
Excludes2
Gastritis Documentation Tips
• 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
Monitor Claims
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
Claim Denial and Management
• 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
Client Responsibilities
• Client will need to update
–
–
–
–
Templates
Order Sets
Superbills
Favorites
• Future Orders
– Remove ICD-9 code add ICD-10 code
Documentation – Start Now
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
–
–
–
–
–
•
•
Indicate acute or chronic
Indicate underlying or external cause factors
–
–
–
–
•
Exacerbation
Manifestations
Relapse
Status
Stages
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
Official Guidelines for Coding and Reporting
Underdosing
Underdosing 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
Questions
codingresource@g1hs.com
Centers for Disease Control and Prevention (ICD-10-CM)
http://www.cdc.gov/nchs/icd/icd10cm.htm