Basic ICD-10-CM/PCS Coding 2013 Edition

1. Basic ICD-10-CM/PCS Coding2013 Edition Chapter 14: Diseases of the Digestive System (K00–K95)

2. Learning Objectives • Review the chapter’s learning objectives and key terms • At the conclusion of this chapter, what must you know about the coding of diseases of the digestive system and related procedures?

3. Chapter 11 of ICD-10-CM, Diseases of the Digestive System, K00–K94 Chapter 11 includes diseases arranged in the following blocks: Diseases of oral cavity and salivary glands Disease of esophagus, stomach and duodenum Diseases of appendix Hernia Noninfective enteritis and colitis Diseases of peritoneum and retroperitoneum Diseases of liver Disorders of gallbladder, biliary tract and pancreas Other diseases of digestive system

4. Chapter 11 of ICD-10-CM, Diseases of the Digestive System, K00–K94 This chapter contains commonly coded gastrointestinal (GI) conditions that occur from infections of the mouth and upper GI tract as well as diseases of the appendix, gallbladder, appendix, small bowel, colon, and liver. Combination codes exist for acute and chronic status Blood loss is described as hemorrhage when referring to ulcers while bleeding is used to describe gastritis, duodenitis, diverticulosis and diverticulitis

5. Chapter 11 of ICD-10-CM, Diseases of the Digestive System, K00–K94 Combination codes describe the specific sites of hernias and associated conditions Complications of artificial openings of the digestive system including colostomy, enterostomy, and gastrostomy as well as malfunctions included here Intraoperative and postprocedural complications specific to the digestive system are included in Chapter 11

6. Coding Guidelines for Chapter 11 of ICD-10-CM There are no chapter-specific guidelines for Chapter 11 in the ICD-10-CM Official Guidelines for Coding and Reporting

7. Instructional Notes for Chapter 11 of ICD-10-CM “Use additional code to identify” notes appear throughout the chapter to identify the use of substances that have an influence on the diseases of the digestive system, such as alcohol abuse and dependence and tobacco. Certain digestive conditions are the result of other diseases and “code first underlying disease, if known” instructions apply.

8. Coding Diseases in Chapter 11 of ICD-10-CM Diseases of oral cavity and salivary glands Codes describe types of dental caries, abrasions and erosions, gingival and periodontal disease as well as disorders of teeth and supporting structures Oral mucositis can occur as an adverse effect of antineoplastic treatment and other medications Use additional code for adverse effect instruction appears to identify the antineoplastic and immunosuppressive drugs or other drugs (T36–T50) with fifth or sixth character 5

9. Coding Diseases in Chapter 11 of ICD-10-CM Gastrointestinal ulcers Codes exist for gastric, duodenal, gastrojejunal ulcers and peptic ulcers of an unspecified site Fourth-digit subcategories describe acute and chronic ulcers with the presence of hemorrhage or perforation “Use additional code” notes appear to identify the concurrent condition, if applicable, for alcohol abuse and dependence

10. Coding Diseases in Chapter 11 of ICD-10-CM Gastritis and duodenitis Gastritis is the inflammation of the stomach lining Duodenitis is the inflammation of the duodenal portion of the small intestine Fourth and fifth-digits describe types of gastritis and duodenitis, including the severity or etiology of the condition

11. Coding Diseases in Chapter 11 of ICD-10-CM A hernia is a protrusion of a loop or knuckle of an organ or tissue through an abdominal opening. Different types and sites of hernia exist: Inguinal Femoral Hiatal Diaphragmatic Ventral Incision Umbilical

12. Coding Diseases in Chapter 11 of ICD-10-CM Hernia may be “reducible” which means the physician can manipulate the displaced structure(s) back into position Irreducible hernia may also be known as an incarcerated hernia which is a hernia of the intestine which cannot be returned or reduced by manipulation Strangulated hernia is an incarcerated hernia that is so tightly constricted as to restrict the blood supply to the contents of the hernial sac and possibly cause gangrene of the contents, such as the intestines and requires surgery

13. Coding Diseases in Chapter 11 of ICD-10-CM ICD-10-CM uses the term “obstruction” to indicate that incarceration, irreducibility or strangulation is present with the hernia If the hernia has both gangrene and obstruction, it is coded as a hernia with gangrene. A hernia may be a unilateral or bilateral condition A hernia may be a recurrent condition

14. Coding Diseases in Chapter 11 of ICD-10-CM Crohn’s disease, also known as regional enteritis, is defined as a chronic inflammatory disease commonly affecting the distal ileum and colon ICD-10-CM codes for Crohn’s disease identify the specific site affected, such as small or large intestine. Codes also identify associated clinical manifestations of rectal bleeding, intestinal obstruction, fistula or abscess and other complications

15. Coding Diseases in Chapter 11 of ICD-10-CM Gastroenteritis is an inflammation of the stomach and intestine characterized by diarrhea, nausea, vomiting, and abdominal cramps. It may be caused by toxins, allergens, or dietary sources as well as bacteria, amoebae, parasites, viruses, reactions to drugs, or enzyme deficiencies Codes identify noninfectious origins in Chapter 11 that include toxic, allergic, and dietetic etiology

16. Coding Diseases in Chapter 11 of ICD-10-CM Peritonitis, other disorders of peritoneum and disorders of retroperitoneum Peritonitis can be caused by a bacteria or virus or other factors such as ruptured internal organs, trauma, or childbirth “Use additional code” instruction exists with peritonitis codes to identify the infectious agent responsible Codes exist for specific types of peritonitis, peritoneal and retroperitoneal abscess, mesenteritis, and peritoneal adhesions among other conditions

17. Coding Diseases in Chapter 11 of ICD-10-CM Cholecystitis is inflammation of the gallbladder Cholelithiasis is the presence of calculi in the gallbladder Choledocholithiasis is the presence of stones in the bile ducts Codes describes calculus in the gallbladder and bile duct or both with or without the presence of cholecystitis or cholangitis Codes describe acute and chronic cholecystitis without the presence of calculi

18. Coding Diseases in Chapter 11 of ICD-10-CM Gastrointestinal hemorrhage Category K92 is limited to cases when a GI bleed is documented but no bleeding site or cause is identified such as melena (stool) or hematemesis (vomit) or unspecified as to where it was present An Excludes1 note appears to identify that code K92.2 is not appropriate with any of the conditions included in the Excludes1 note

19. Coding Procedures in Chapter 11 of ICD-10-PCS ICD-10-PCS Tables form 0D1–0DY Root operations include Bypass, change, destruction, dilation, division, drainage Excision, extirpation, fragmentation, insertion, inspection Occlusion, reattachment, release, removal, repair Replacement, reposition, resection, supplement Restriction, revision, transfer, and transplantation

20. Coding Procedures in Chapter 11 of ICD-10-PCS Laparoscopic and open repair of hernia Open hernia repairs are performed through an incision with sutured tissue repair Laparoscopic repair is performed through a small incision to allow the laparoscope to be inserted to perform the internal repair Main term in the Index is herniorrhaphy When synthetic substitute (mesh) is used for the hernia repair, the root operation is “supplement”

21. Coding Procedures in Chapter 11 of ICD-10-PCS Closed endoscopic biopsies and endoscopic excision of lesions A biopsy is taken to determine the pathology of a lesion Main term for a biopsy depends on the method, that is, excision or drainage with the seventh character as the qualifier of X used for diagnostic An excision of a lesion can be performed through an endoscope as well. The seventh character (Z) for the qualifier is used instead

22. Coding Procedures in Chapter 11 of ICD-10-PCS A stoma is an artificial opening between two cavities or between a cavity or tube and the exterior It might be called a “ostomy” in the GI tract: Gastrostomy Colostomy Ileostomy Root operation “bypass” is used for these procedures and is defined as altering the route of passage of the contents of a tubular body part

23. Coding Procedures in Chapter 11 of ICD-10-PCS Index entry of “bypass” or the title of the procedure leads the coder to Table 0D1 Fourth character identifies the body part where the ostomy started Fifth character identifies the approach for the procedures, such as open, percutaneous endoscopic or via natural or artificial opening endoscopic Sixth character identifies if a synthetic or tissue substitute is used Seventh character identifies where the new passage route is directed, for example, cutaneous is there is an opening in the skin

24. Coding Procedures in Chapter 11 of ICD-10-PCS Intestinal resection is a colectomy or colon resection performed to removed portions of the large intestine to treat the disease Procedures may be performed through an incision (open) or done through a laparoscope Root operation is either “excision” or “resection” to classify these procedures ICD-10-PCS Table 0DB and 0DT are used Fourth character identifies the body part excised or resected Fifth characters identifies the approach Sixth character and seventh character of “Z” is used as there is no device or qualifier applicable

25. Coding Procedures in Chapter 11 of ICD-10-PCS Laparotomy is an incision into the abdominal wall/ If the laparotomy is for the purposes of opening the cavity, the definitive procedure performed in the cavity is coded with the approach “open” with the definitive procedure coded If the laparotomy is for exploratory purposes only, the root operation “inspection” is used with the approach “open”

26. Exercises Practice coding the conditions included in Chapter 11 of ICD-10-CM for diseases of the digestive system as well as the procedures used to treat these conditions by completing the review exercises for Chapter 14.