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Digesting the ICD-x GI Codes

This overview of the common gastrointestinal disorders in primary care will help you get ready for ICD-10 and avoid, say, K30 – indigestion.

Fam Pract Manag. 2015 Jan-Feb;22(1):19-24.

Author disclosure: no relevant financial affiliations disclosed.

This content conforms to AAFP CME criteria. Meet FPM CME Quiz.

Article Sections

Introduction
Signs and symptoms involving the digestive arrangement and abdomen
Specific diseases of the digestive system
Breaking it downwards
References

Let's exist honest: ICD-10 coding does not brand for the most riveting reading. But every bit we become closer to the launch of ICD-10, it is becoming critical that y'all empathise the codes y'all are most likely to see so that your documentation includes the details necessary for proper code option and reimbursement. This installment in our ICD-10 series addresses mutual gastrointestinal (GI) codes. (See the series overview.)

To understand the required documentation and coding for GI disorders in ICD-x, it makes sense for primary intendance physicians to recollect of their patients as belonging to 1 of two groups: i) those with a known diagnosis or 2) those presenting with signs or symptoms prior to a documented diagnosis. Allow'due south address the latter grouping first.

Signs and symptoms involving the digestive system and abdomen

Abstract
Signs and symptoms involving the digestive system and belly
Specific diseases of the digestive system
Breaking it down
References

ICD-10 offers the following advice most when to use sign and symptom codes: "While specific diagnosis codes should be reported when they are supported by the bachelor medical record documentation and clinical knowledge of the patient's health condition, there are instances when signs/symptoms or unspecified codes are the best choices for accurately reflecting the wellness care run across. … If a definitive diagnosis has not been established past the cease of the run into, information technology is advisable to study codes for signs and/or symptoms in lieu of a definitive diagnosis." (For more on this topic, see "ICD-10 Coding for the Undiagnosed Problem," FPM, May/June 2014.)

Common GI ICD-10 CODES

This article contains several code lists and tables, which are available hither for download as a single resource.

Download in PDF format

Although signs and symptoms documented during an office visit may or may not outcome in a final diagnosis of a GI disorder, the related codes are grouped into a subsection of Chapter eighteen titled "Symptoms and signs involving the digestive system and abdomen," codes R10–R19.

When using these codes, keep these iii considerations in mind:

Outset, a notation of caution: The codes for signs and symptoms involving the abdomen follow a sequential pattern for tenderness, mass, and rigidity – R10.811, R10.812, R10.813, etc. However, the blueprint does not follow for pain. (See "Intestinal and pelvic pain codes.")
2d, a annotation of frustration: There are no combination codes. If yous see a patient with abdominal hurting, tenderness, nausea, and diarrhea, yous must either make a diagnosis or code all 4 signs and symptoms. (Meet "Other mutual GI symptom codes.")
Third, a note of clarification: The common complaint of diarrhea tin be coded as either a sign/symptom ("Diarrhea, unspecified," R19.7) or a disorder ("Functional diarrhea," K59.1) depending on your patient'due south situation.

ABDOMINAL AND PELVIC PAIN CODES

	Pain	Tenderness	Rebound tenderness	Swelling mass	Rigidity
Right upper quadrant	R10.eleven	R10.811	R10.821	R19.01	R19.31
Left upper quadrant	R10.12	R10.812	R10.822	R19.02	R19.32
Right lower quadrant	R10.31	R10.813	R10.823	R19.03	R19.33
Left lower quadrant	R10.32	R10.814	R10.824	R19.04	R19.34
Periumbilical	R10.33	R10.815	R10.825	R19.05	R19.35
Epigastric	R10.thirteen	R10.816	R10.826	R19.06	R19.36
Generalized	R10.84	R10.817	R10.827	R19.07	R19.37

OTHER COMMON GI SYMPTOM CODES

Colic	R10.83
Nausea (without vomiting)	R11.0
Airsickness without nausea	R11.eleven
Nausea with vomiting	R11.2
Heartburn (excludes dyspepsia)	R12
Dysphagia, unspecified	R13.10*
Abdominal amplification (bloating)	R14.0
Gas pain	R14.1
Eructation	R14.2
Flatulence	R14.3
Hepatomegaly, not elsewhere classified	R16.0
Absent bowel sounds	R19.eleven
Hyperactive bowel sounds	R19.12
Alter in bowel habit	R19.four
Occult blood in carrion/stool	R19.5
Diarrhea	R19.vii
Functional dyspepsia (indigestion)	K30
Constipation	K59.00

Clinical scenario: A 23-year-old female person presents to your part for an urgent visit. Her history includes onset of generalized abdominal pain yesterday with nausea just no vomiting. Her terminal menses was two weeks agone and normal. She uses oral contraceptives for birth control. The hurting has now localized to the right lower quadrant, and she has had a couple episodes of diarrhea. On examination, she has a low-grade fever, rebound tenderness over McBurney'due south point, and absent bowel sounds. A pelvic examination is negative. You perform a white claret cell count in the function that shows 14,000 white claret cells per mmⁱⁱⁱ with a left shift. A urine pregnancy exam is negative. You phone call the emergency section and arrange to have her evaluated at that place with a CT scan and surgery consultation.

Deciding how to lawmaking this office visit presents an interesting dilemma. You are fairly certain that your patient has acute appendicitis, simply at that place could be other etiologies such equally ovarian torsion or tubal pregnancy. The specific diagnosis of acute appendicitis is supported past the medical tape but not definitive. Therefore, per ICD-10 instructions, information technology would be more appropriate to code the signs and symptoms than the specific diagnosis. You would select the following codes:

R10.823, Rebound abdominal tenderness, correct lower quadrant,
R11.0, Nausea without vomiting,
R19.seven, Diarrhea, unspecified,
R19.11, Absent bowel sounds,
D72.820, Lymphocytosis (symptomatic).

Specific diseases of the digestive system

Abstract
Signs and symptoms involving the digestive system and abdomen
Specific diseases of the digestive organization
Breaking it down
References

Affiliate 11 of the ICD-10 lawmaking book is devoted to diseases of the digestive system (K00-K95). Permit'due south explore some of the diagnoses you lot're probable to see in primary care.

Esophagitis. The of import matter to note nearly this section is when to use "other" and when to use "unspecified." Consider the post-obit codes:

K20.0, Eosinophilic esophagitis,
K20.8, Other esophagitis,
K20.nine, Esophagitis, unspecified.

If the esophagitis has previously been determined to be eosinophilic, then patently you would employ the K20.0 code. Even so, the "other" code is not for all other causes of esophagitis simply is used when the information in the medical record provides details of another specific diagnosis for which a specific lawmaking does not be. The "unspecified" lawmaking is used when the data in the medical record is insufficient to assign a more than specific code. The latter situation is more likely with esophagitis.

Merely when you lot think information technology is articulate when to use "other" and "unspecified," ICD-x throws you a curve ball: "For those categories for which an unspecified lawmaking is non provided, the 'other specified' code may correspond both 'other' and 'unspecified.'"

Gastro-esophageal reflux affliction (GERD). There are simply two codes for this condition:

K21.0, Gastro-esophageal reflux disease with esophagitis,
K21.ix, Gastro-esophageal reflux disease without esophagitis.

Reflux esophagitis codes to "with esophagitis," and esophageal reflux codes to "without esophagitis." If you only put GERD in your documentation, it should exist considered NOS (not otherwise specified) and default to K21.ix.

Barrett's esophagus. When you lot're following a patient subsequently a definitive diagnosis has been established by biopsy, you would apply the following codes:

K22.70, Barrett's esophagus without dysplasia,
K22.710, Barrett's esophagus with depression-grade dysplasia,
K22.711, Barrett's esophagus with high-grade dysplasia,
K22.719, Barrett's esophagus with unspecified dysplasia.

It is important to notation that when the test results use a term similar "consistent with," this is not considered a definitive diagnosis. Unfortunately, this term appears on many pathology reports.

Ulcer disease. At that place are carve up lawmaking groups for esophagus (K22.1), gastric (K25), duodenal (K26), unspecified peptic (K27), and gastrojejunal ulcer (K28). Each group has subcodes for astute or chronic, and each subgroup further stratifies to with or without hemorrhage or perforation, neither, or both. If you are evaluating a patient prior to endoscopy, y'all should code the condition of hematemesis (K92.0) rather than use an unspecified peptic ulcer code. Only about l percent of acute upper GI haemorrhage is the result of peptic ulcer disease.1 ICD-10 has adamant that hematemesis is a disease, not a sign or symptom.

Hernias. For unclear reasons, although ICD-10 goes to neat lengths to include laterality (left, right) in every orthopedic code, it does not permit yous to designate which side of the body has a unilateral hernia. Hernias are classified by location – inguinal (K40), femoral (K41), umbilical (K42), ventral (K43), diaphragmatic (K44), other (K45), and unspecified (K46). Each group has additional codes for with or without obstruction, with or without gangrene, and recurrent. ICD-x as well includes the option "not specified equally recurrent," as opposed to first occurrence, but it differentiates this only for inguinal and femoral hernias. So, if you only document the location of the hernia in the medical record, your coder (if y'all have 1) tin consider that shorthand for NOS (not otherwise specified) and default to the "without obstruction or gangrene, not specified as recurrent" code.

Most primary care physicians will use only four of the 45 hernia codes:

K40.20, Bilateral inguinal hernia, without obstacle or gangrene, not specified as recurrent,
K40.90, Unilateral inguinal hernia, without obstruction or gangrene, not specified equally recurrent,
K42.ix, Umbilical hernia without obstruction or gangrene,
K43.two, Incisional hernia without obstruction or gangrene.

Noninfective enteritis and colitis. This grouping is limited to Crohn's disease, ulcerative colitis, and non-specific colitis. (Irritable bowel syndrome will come later.) Each of the inflammatory bowel disorders includes specific codes for with and without complications every bit well as the type of complication (bleeding, obstruction, fistula, or abscess). Each is also stratified by location. Crohn'southward includes the small intestine, large intestine, both small and large intestine, and unspecified. Ulcerative colitis includes pancolitis, proctitis, and rectosigmoiditis.

The "without complications" codes are listed below:

K50.00, Crohn's illness of small intestine without complications,
K50.10, Crohn'due south disease of big intestine without complications,
K50.eighty, Crohn's illness of both modest and large intestine without complications,
K51.00, Ulcerative pancolitis without complications,
K51.30, Ulcerative rectosigmoiditis without complications.

Diverticular disease. The acute diverticulitis codes will be used sparingly in the primary care setting. When y'all see an individual with known diverticular disease who presents with classic diverticulitis findings, you may choose to empirically treat the patient and use sign and symptom codes or a diverticulitis code such as the following:

K57.30, Diverticulosis of large intestine without perforation or abscess without bleeding,
K57.32, Diverticulitis of large intestine without perforation or abscess without haemorrhage.

Clinical scenario: A 57-year-old male person presents with abdominal pain for two days. He has no appetite, and the pain is mostly in the left lower abdomen. Vital signs document a temperature of 101.seven°F and a mild tachycardia (105 beats per minute). He tells yous he ordinarily has a bowel movement every morning simply has not had ane for the by ii days. He had a similar episode two years ago that you empirically treated with antibiotics and resolved. He underwent a colonoscopy that showed significant diverticulosis. Biopsies were negative for inflammatory bowel affliction. Today's physical test shows left lower-abdomen tenderness without rebound. Rectal examination shows no mass and minimal stool, which is heme negative. Bowel sounds are absent. His white claret cell count in the office is 14,000 white blood cells per mm³ with a left shift. Y'all make up one's mind that the most likely diagnosis is acute diverticulitis without hemorrhage or obstruction. Yous make up one's mind to care for with a liquid nutrition and broad-spectrum oral antibiotics. You discuss the need for urgent reevaluation with any worsening of the symptoms and arrange a follow-up visit in the role in 24 to 48 hours.

Unlike the appendix example discussed earlier, this diagnosis does not require boosted imaging and is typically made based on the history and exam. Therefore, given the known history of diverticulosis, the past likely diagnosis of diverticulitis, and the classic presentation, it would be advisable to diagnose the patient with acute diverticulitis, K57.32.

It also would be right to lawmaking this based on the signs and symptoms:

R10.32, Left lower-quadrant pain,
R10.814, Left lower-quadrant tenderness,
R19.11, Absent bowel sounds,
D72.820, Lymphocytosis.

Irritable bowel syndrome (IBS). Diagnosing IBS can exist tricky because in that location is no standardized definition of this condition. Many physicians follow the Rome III diagnostic criteria for defining when an individual should be diagnosed with IBS or other functional gastrointestinal disorders,2 but the World Health System/ICD-10 does not reference these criteria. The World Health Arrangement too has not recognized IBS-C (irritable bowel syndrome with constipation) as a stand-solitary diagnosis, so ICD-x requires apply of both an IBS code and a constipation lawmaking. However, at that place are IBS codes for with and without diarrhea. (Come across "IBS-related codes.")

IBS-RELATED CODES

IBS associated symptoms		ICD-10 code(due south)
Diarrhea	Constipation
Yes	No	K58.0, IBS w/ diarrhea
Yes	Yes	K58.0, IBS due west/ diarrhea	K59.00, Constipation, unspecified
No	No	K58.9, IBS w/o diarrhea
No	Yes	K58.9, IBS w/o diarrhea	K59.00, Constipation, unspecified

Hemorrhoids. These codes are fairly straightforward. Just remember that the degree of hemorrhoidal illness is nigh often established by history rather than examination.

K64.0, First degree hemorrhoids, without prolapse exterior of anal canal,
K64.1, 2nd degree, prolapse with straining but retract spontaneously,
K64.2, Third degree, prolapse with straining and require transmission replacement,
K64.iii, Fourth degree, prolapsed, cannot be manually replaced.

Miscellaneous. Finally, there are a few common codes used for other portions of the digestive organization outside the alimentary tract:

K70.30, Alcoholic cirrhosis of the liver without ascites,
K76.0, Fatty liver, not elsewhere classified (includes nonalcoholic fat liver disease; excludes nonalcoholic steatohepatitis, K75.81),
K80.00, Calculus of gallbladder with astute cholecystitis without obstruction,
K80.2, Calculus of gallbladder without cholecystitis,
K81.0, Acute cholecystitis,
K85.0, Idiopathic acute pancreatitis,
K85.2, Booze induced acute pancreatitis,
K90.0, Celiac affliction.

Breaking information technology downwardly

Abstract
Signs and symptoms involving the digestive organization and abdomen
Specific diseases of the digestive organisation
Breaking information technology down
References

Remember that the codes discussed in a higher place, those virtually common in principal intendance, are only a small-scale fraction of the codes used for the digestive arrangement. ICD-10 has over 700 ICD-10 codes in the chapter devoted to diseases of the digestive arrangement and at least an boosted lxxx in the signs and symptoms chapter.

Also, call up that the coding scenarios presented in this article are specific to the out-patient setting, where uncertain diagnoses typically are coded with signs and symptoms codes. For inpatient care at curt-term, astute, long-term, and psychiatric hospitals, an uncertain diagnosis is allowed. Per ICD-x, Section II-H, "If the diagnosis documented at the fourth dimension of discharge is qualified as 'probable,' 'suspected,' 'likely,' 'questionable,' 'possible,' or 'however to be ruled out,' or other similar terms indicating doubtfulness, code the condition every bit if it existed or was established. The basis for these guidelines are the diagnostic workup, arrangements for further workup or ascertainment, and initial therapeutic approach that correspond most closely with the established diagnosis."

If all of this leaves y'all feeling frustrated by the ICD-10 rules, rest assured that you lot're non alone. The author agrees that this coding is K62.9 – hurting, anal. Nevertheless, by orienting yourself to the new codes, y'all'll be better prepared when the code ready launches.

ARTICLES IN FPM'S ICD-10 SERIES

You can access the following manufactures in FPM's ICD-10 topic drove:

"ICD-x: Major Differences for 5 Common Diagnoses," FPM, September/October 2015.

"ICD-10 Sprains, Strains, and Motorcar Accidents," FPM, May/June 2015.

"Digesting the ICD-10 GI Codes," FPM, January/February 2015.

"Coding Common Respiratory Problems in ICD-ten," FPM, November/December 2014.

"ICD-10 Simplifies Preventive Care Coding, Sort Of," FPM, July/August 2014.

"ICD-10 Coding for the Undiagnosed Problem," FPM, May/June 2014.

"How to Document and Code for Hypertensive Diseases in ICD-x," FPM, March/April 2014.

"10 Steps to Preparing Your Office for ICD-ten – At present," FPM, Jan/Feb 2014.

"Getting Ready for ICD-ten: How It Will Affect Your Documentation," FPM, November/December 2013.

"The Anatomy of an ICD-x Code," FPM, July/August 2012.

"ICD-x: What You Need to Know Now," FPM, March/April 2012.

To run into the full commodity, log in or purchase access.

About the Author

Dr. Beckman is a family physician, former primary medical officer, and consultant with The Beckman Group in Milwaukee, Wis.

Writer disclosure: no relevant financial affiliations disclosed.

References

i. Boonpongmanee Southward, Fleischer DE, Pezzullo JC, et al. The frequency of peptic ulcer as a crusade of upper-GI bleeding is exaggerated. Gastrointest Endosc. 2004;59(seven):788–794.

2. Drossman DA. The functional gastrointestinal disorders and the Rome 3 procedure. Gastroenterology. 2006;130(v):1377–1390.

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