6-ICD10 SpecialtyTips Gastrointestinal - We Know the ... Gastrojejunal’(peptic)’(K28.$)’ • Glottis’(J38.7)’ • Intestine(K63.$)Specify’by’site’ • Peptic’(siteunspecified)’(K27.$)’

ICD-‐10 SPECIALTY TIPS

GASTROINTESTINAL | 1 of 4

SPECIALTY TIP #6 Gastrointestinal Specificity of the anatomical region under treatment is one of the key issues in coding for the gastrointestinal system in ICD-‐10.

• Colon polyps topped the list of documentation challenges for the GI system • For many GI conditions (for cancer, diseases of the mouth, esophagus, and stomach) ICD-‐10 asks for additional

documentation of: o The use, abuse, history of, dependence of, or exposure to tobacco o Alcohol abuse and dependence

Colonoscopies

Colonoscopies should be easy to code, but they present challenges because of the varying coverage by different payers, conflicting guidelines regarding coding, and by the lack of detail in documentation regarding the intent of the procedure.

Documentation to include: o What is the intent of the patient’s procedure?

§ See the definitions below. • Is the condition a history of or a continuing condition? • If a history of polyps, were they adenomatous? • When was the last colonoscopy? • For Anesthesiology, document if the screening colonoscopy was converted to a diagnostic or

therapeutic procedure – this will affect the modifier used for Medicare patients § Without this information, it is left to the coder’s discretion to determine whether to code as a

screening/surveillance, as a follow-‐up, or as a diagnostic procedure

Patients with a history of colon polyps

• Medicare Administrative Contractors (MACs) will begin accepting the Z86.010 code for screening colonoscopies for patients with a personal history of polyps (Z86.010) by Nov. 12, 2015. They were denying as a non-‐covered service after the ICD-‐10 implementation of the new codes.

• CMS will issue updated edits to MACs instructing them to allow colonoscopy screening code G0105 to be reported with ICD-‐10 code Z86.010.

Encounter Scenario ICD-‐10 Additional Information

Colon polyps

Site specific: • Cecum (D12.0) • Ascending (D12.2) • Transverse (D12.3) • Descending (D12.4) • Sigmoid (D12.5) • Rectosigmoid Junction (D12.7) • Rectum (D12.8) • Anus and anal canal (D12.9)

Adenomatous? (D12.6) Inflammatory (K51.40):

•With abscess (K52.414) •Complication (51.419) •Fistula (KK51.413) •Intestinal obstruction (K51.412) •Rectal bleeding (K51.411)

Alcohol Abuse (F10.1-‐) Dependence (F10.2-‐) Use Unspecified (F10.9-‐)

• Document any pertinent related disorders (in remission, intoxication, withdrawal, mood disorder, etc.)

Tobacco

Exposure to (environmental) (Z77.22) History of (Z87.89) Occupational exposure to (Z57.31) Dependence (F17.-‐) Use (Z72.0)

• May influence health status • For nicotine dependence:

•Cigarettes, chewing tobacco, other tobacco produce? •If known, designate whether in remission, withdrawal, or uncomplicated



• CMS has already updated the ICD-‐10 listing for National Coverage Decision (NCD) 210.3, Colorectal Cancer Screening Tests.

https://www.cms.gov/Medicare/Prevention/PrevntionGenInfo/Downloads/MPS_QuickReferenceChart_1.pdf

Definitions

Screening Colonoscopy

Z12.11

A screening test is a test provided to a patient in the absence of signs or symptoms. A screening colonoscopy is a service performed on an asymptomatic person for the purpose of testing for the presence of colorectal cancer or colorectal polyps. Whether a polyp or cancer is ultimately found does not change the screening intent of that procedure. As part of the Affordable Care Act (ACA), Medicare and most third-‐party payors are required to cover services given an A or B rating by the U.S. Preventive Services Task Force (USPSTF) without a co-‐pay or deductible.

Surveillance Colonoscopy

Z12.11, Z86.010 Both acceptable

codes for Medicare

Surveillance involves testing people who have previously had colorectal cancer or are at increased risk. Because their chance of having cancer is higher, more extensive or more frequent tests are recommended. A surveillance colonoscopy is a high-‐risk screening per AGA and AHA diagnostic coding clinic.

Follow-‐Up Colonoscopy

Z08 or Z09 with applicable history codes or absence

of organs

The follow-‐up codes (Z08/Z09) are used to explain continuing surveillance following completed treatment of a disease, condition, or injury. They imply that the condition has been fully treated and no longer exists. They should not be confused with aftercare codes that explain current treatment for a healing condition or its sequelae. Follow-‐up codes may be used in conjunction with history codes to provide the full picture of the healed condition and its treatment. The follow-‐up code is sequenced first, followed by the history code.

Diagnostic Colonoscopy

Abnormal finding, sign or symptom codes

Diagnostic colonoscopy is a test performed as a result of an abnormal finding, sign or symptom (such as abdominal pain, bleeding, diarrhea, etc.). Medicare and most payors do not waive the co-‐pay and deductible when the intent of the visit is to perform a diagnostic colonoscopy.

Patients at high risk for developing colorectal cancer are eligible once every 24 months. Those not considered high-‐risk are eligible for screening every 10 years.

High Risk • A close relative (sibling, parent or child) who has had colorectal cancer or an adenomatous polyp.

• A family history of familial adenomatous polyposis.

• A family history of hereditary nonpolyposis colorectal cancer.

• A personal history of adenomatous polyps.

• A personal history of colorectal cancer.

• Inflammatory bowel disease, including Crohn’s disease and ulcerative colitis.

Documentation Issues Found During the abeo Coding Audit

Condition Additional Information

Abdominal Pain

Generalized? (R10.84) Acute abdomen? (R10.0) Tenderness? (10.8-‐) Colic? (R10.83) Specify Quadrant for pain or tenderness: • Right or left • Upper or lower • Periumbilic

• Epigastric • Generalized

Pelvic and Perineal? (R10.1)



Abscess, anal rectal region

Region: • Anal (K61.0) • Rectal (K61.1) • Anorectal (K61.2) • Ischiorectal (K61.3) • Intrashincteric (K61.4)

Alcohol dependence Use, abuse, or dependence of alcohol? Blood alcohol level if applicable? With other related disorders (withdrawal, intoxication, in remission, mood disorder, etc.)?

Anemia

Due to? Aplastic? Acute or Chronic? Due to? Type (large selection to choose from): • Hemorrhagic (Acute or Chronic) • Idiopathic • Iron Deficiency • Nutritional • Blood Loss, etc.

Appendicitis Acute, chronic or recurrent? With or without generalized or localized peritonitis?

Barrett's esophagus Presence or absence of dysplasia?

Bleeding, post-‐op Specific to intraoperative or postprocedural Specific to system / location

Colon cancer Site specific Use, abuse, or dependence of alcohol?

Crohn's disease

Large intestine or small intestine? Specific to: • With bleeding? • With obstruction? • With fistula? • With abscess? • With other complication? • With or without unspecified complications?

Diverticulitis

Specific to site: • Small intestine • Large intestine • Both small and large intestine With or without bleeding? With or without perforation, abscess, or peritonitis?

Diverticulosis Small, large intestine or both? With or without bleeding?

Esophagitis

Due to GI reflux disease? Eosinophilic? Reflux? Ulcerative, with or without bleeding? Use additional code to identify alcohol abuse and dependence

Foreign body esophagus ICD-‐10 is specific to food, gastric contents, other foreign objects or unspecified foreign body

Gastric cancer

Code specific to: • Cardia • Fundus • Body • Pyloric • Pylorus

• Lesser or greater curvature • Wall-‐anterior or posterior • Corpus • Prepylorus • Overlapping

Gastritis

Acute or Chronic? If Chronic -‐ superficial or atrophic? Alcoholic? Hypertrophic? Nervous? Spastic? Eosinophilic? Due to diet deficiency? With or without bleeding?



GERD With or without esophagitis?

Hemorrhage of gastrointestinal tract, unspecified

Acute? Hematemesis? (K92.0) Melena? (K92.1) Unspecified GI hemorrhage (K92.2)

Intestinal obstruction, unspecified

With adhesions? (K56.5) Congenital? (Q41.9) Postoperative? (K91.3) Reflux? (56.0) Volvulus (K56.2)

Liver cancer Asks for additional code to identify alcohol abuse and/or dependence Hepatitis B or C?

Morbid obesity BMI needed. Any additional comorbid conditions or complications?

Pancreatitis

Acute or Chronic? • Specify type: •Alcohol induced •Biliary •Drug induced •Gallstone •Idiopathic •Specified Cystic? (K86.1) Gangrenous? (K85.8) Interstitial? (Chronic) (K86.1) Acute (85.8) Recurrent (Chronic)/Relapsing? (K86.1)

Post-‐op complication Specify complication: • Hemorrhage, seroma, stitch dehiscence, etc.? Intraoperative or post-‐operative?

Status post gastric bypass (banding) for obesity

Bariatric surgery status – banding, bypass (Z98.84)

Ulcer

Site: • Duodenum (K26.-‐) • Epiglottis (J38.7) • Esophagus (peptic) (K22.1-‐) Due to? • Gallbladder or duct (K82.8) • Gastrojejunal (peptic) (K28.-‐) • Glottis (J38.7)

• Intestine (K63.-‐) Specify by site • Peptic (site unspecified) (K27.-‐) • Retrosigmoid (K63.-‐) • Rectum (K62.6) • Stomach (K25.-‐) • Stomatitis (K12.1)

Acute or Chronic? With or without hemorrhage? With or without perforation?

The information provided is intended to be a general summary and not intended to take place of either written law or regulations.

Documents

6-ICD10 SpecialtyTips Gastrointestinal - We Know the ... Gastrojejunal’(peptic)’(K28.$)’ • Glottis’(J38.7)’ • Intestine(K63.$)Specify’by’site’ • Peptic’(siteunspecified)’(K27.$)’