Gastroenterology Coding Alert

Descriptor changes help eliminate chronicity confusion.

If you’re reporting alcoholic hepatitis diagnosis after Oct.1, 2014 get set to delve deeper into documentation. Specifically, you will need to focus on the presence or absence of ascites, as this determines the ICD-10 code that you will choose to correctly report the condition.

Single ICD-9 Code Omits Disease Progress

When your gastroenterologist makes a diagnosis of alcoholic hepatitis using ICD-9 codes, you will have to report the condition using 571.1 (Acute alcoholic hepatitis). Note that the presence or absence of ascites does not play a role in choosing the code, which means that you will not be able to discern the progress of the condition.

Identify Ascites for Detailed Reporting in ICD-10

When using ICD-10 codes, 571.1 in ICD-9 crosswalks to K70.1 (Alcoholic hepatitis) in ICD-10. Note that the descriptor in ICD-10 has eliminated the word "acute," thus enabling you to report acute or chronic hepatitis due to alcohol using a single code thereby eliminating confusion.

K70.1 further undergoes a 5th digit expansion into two codes, depending on the presence or absence of ascites. This enables you to provide detailed coding, thus giving a correct idea about the progression of the alcoholic ascites. Depending on the presence or absence of ascites, you can choose from the following two codes to report the diagnosis of alcoholic hepatitis:

• K70.10 -- Alcoholic hepatitis without ascites
• K70.11 -- Alcoholic hepatitis with ascites

Reminder: Under ICD-10 code sets, you will have to also use an additional code to help identify alcohol abuse and dependence (F10.-). The list of exclusions will comprise jaundice NOS (R17), hemochromatosis (E83.11-), Reye’s syndrome (G93.7), viral hepatitis (B15 -- B19) and Wilson’s disease (E83.0).

Note These Dx Basics

When your gastroenterologist arrives at a diagnosis of alcoholic hepatitis, some of the signs and symptoms that you are most likely to see in the documentation of the patient will include fever, nausea, vomiting, malaise and hepatic tenderness. Upon examination, your gastroenterologist might note tachycardia, tachypnea, hepatosplenomegaly, peripheral edema, and dullness on percussion over the abdomen due to ascites.»»

Although history and physical findings are some of the criteria which your gastroenterologist will use to diagnose alcoholic hepatitis, he will generally order some diagnostic tests such as CBC, screening tests to rule out other conditions (see exclusions list) and liver function tests to confirm the diagnosis and to assess the progress of the condition.

In addition, your gastroenterologist might resort to ultrasonography or in some cases, even a liver biopsy to ascertain the diagnosis and to check for signs of liver cirrhosis. These tests also help in differentiating alcoholic hepatitis from other forms of hepatitis that could give rise to similar signs and symptoms.

Example: Your gastroenterologist assesses a 55-year-old male patient who arrives with complaints of abdominal tenderness along with low-grade fever, malaise, nausea and confusion. He also complains of persistent vomiting over several days. He provides a history of alcohol use over several years.

Your gastroenterologist assesses the patient and performs a physical examination. During the examination, he notes peripheral edema, hepatosplenomegaly with signs of tenderness, abdominal dullness due to ascites, and notes tachycardia along with tachypnea. He notes that he doesn’t find signs of spider angiomata, although he does see some signs of muscle wasting and gynecomastia.

Based on history and physical findings, your gastroenterologist arrives at a possible diagnosis of alcoholic hepatitis. He orders diagnostic tests including CBC, liver function tests to measure out albumin and bilirubin levels along with liver enzymes such as AST and ALT levels. He also orders some screening tests such as HBsAg, Hepatitis C antibody, and ferritin levels to rule out other causes for the signs and symptoms of hepatitis. He also orders an abdominal sonogram to help assess the liver contours and density and to check for signs of cirrhosis including ascites and portal hypertension.

What to report: Upon review of the history, signs and symptoms, and results of diagnostic tests, your gastroenterologist arrives at a diagnosis of alcoholic hepatitis. You will have to report this diagnosis with 571.1 if you are using ICD-9. Since your gastroenterologist mentions dullness over the abdomen due to ascites, you can report K70.11, in ICD-10.