Gastroenterology Coding Alert
Peptic Ulcers Crosswalk to K27 in ICD-10
Hint: If cause is alcohol abuse, don’t forget to identify it additionally.
When reporting peptic ulcer diagnoses after Oct.1, 2014, you will no longer have to focus on obstructions. ICD-10 codes will require you to concentrate only on chronicity, and the presence or absence of hemorrhage and perforations.
ICD-9: For reporting peptic ulcers in ICD-9, you start out with the base code 533 (Peptic ulcer site unspecified). Then, depending on chronicity, presence or absence of perforation and hemorrhage, you use a 4th digit expansion to report gastric ulcer using the following 9 codes:
Key: Each of the above mentioned codes will further expand into two codes using a 5th digit expansion, depending on the presence or absence of obstruction.
For example, 533.1 will expand into the following two codes:
ICD-10: When you begin to use ICD-10 codes, 533 in the ICD-9 system of codes will crosswalk to K27 (Peptic ulcer, site unspecified). You’ll also use the same diagnosis codes when your clinician diagnoses peptic ulcer NOS or gastroduodenal ulcer NOS. If the cause for the peptic ulcer is due to alcohol abuse, you need to additionally identify it with F10.-. However, you cannot use K27 if the diagnosis of peptic ulcer is made in the newborn. You will report this with P78.82.
Caveat: As with ICD-9, you will have to further expand K27 to identify the presence or absence of hemorrhage and perforation. However, you will not have to worry about checking for the presence or absence of obstruction as this will not form the basis of choosing the code to report the diagnosis.
Based on hemorrhage and perforation, you’ll have to choose from the following nine expansions to K27:
Focus on These Basics Briefly
Documentation spotlight: Some symptoms that you are most likely to encounter in the documentation of a patient suffering from peptic ulcers might include epigastric pain, burning sensation shortly after food consumption, heartburn, dysphagia, dyspepsia, hematemesis, and melena. Upon examination, your clinician might note signs of anemia, epigastric tenderness, and guaiac- positive stools caused due to bleeding.
Tests: If your clinician suspects peptic ulcers, he’ll order tests to check for H. pylori infections such as a rapid urease test or a breath test. In addition, he may withdraw a blood sample to check for CBC, liver function tests (LFT), lipase and amylase.
He might also ask for an x-ray especially if he suspects perforation of the ulcer. He might also perform an upper EGD to directly visualize the GI tract to check for signs and symptoms of the ulcer and to check for complications.
Example: Your gastroenterologist sees a patient in the emergency department of the hospital for complaints of sudden onset severe epigastric tenderness. The patient also complains that he has seen signs of bleeding in his stools for the past few days. The patient also provides a history of coagulopathy and is on previously prescribed anti-coagulants.
Upon examination, your clinician notes paleness of the sclera, skin and nails. He also notes epigastric tenderness, tachycardia and hypotension. He orders for lab tests to check bleeding time, CBC and LFT. He also performs an upper EGD and notices hemorrhage which he controls with the application of electrocautery. Based on signs and symptoms and observations of the EGD, your clinician arrives at a diagnosis of acute peptic ulcer with hemorrhage.
What to report: You report the evaluation of the patient using 99223 (Initial hospital care, per day, for the evaluation and management of a patient…); the EGD procedure done to control the bleeding with 43255 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with control of bleeding, any method).
You report the diagnosis with 533.00 (Acute peptic ulcer of unspecified site with hemorrhage without obstruction) if you’re using ICD-9 codes and K27.0 if you’re using ICD-10 codes.
Because the E&M service was done on the same date, you should be on the look-out for a denial from the carrier. Some carriers are rather strict and consider all E&M services performed on the date of any procedure as included in the procedure fee.
If you get a denial, then you should appeal and append modifier -57 (decision for surgery) to the E&M service for the evaluation a patient who, as a result of that evaluation, requires a procedure that will be performed the same day. This is the decision-making E&M. The same modifier should be used on future claims to that carrier to avoid repeating the denial and appeal cycle
Gastroenterology Coding Alert
- CPT® 2014 Update:
Prepare for Endoscopy, Ablation, ERCP Changes Next Year
Also watch for these new codes in E/M coming your way. Get ready to overhaul [...] - Key Elements:
Tactics Help You Choose the Right E/M Guidelines for Optimum Reimbursement
Hint: You have the choice to switch between the two E/M guidelines for every encounter. [...] - ICD-10 Update:
Peptic Ulcers Crosswalk to K27 in ICD-10
Hint: If cause is alcohol abuse, don’t forget to identify it additionally. When reporting peptic [...] - Clip and Save:
Refer This Handy Chart to Select Exam Levels With Precision
Select the guidelines that will carry the best advantage to your coding. With two sets [...] - You Be the Coder:
Capture Visualization and Obstruction Removals Separately
Question: Our physician performed an EGD with positioning and securing of jejunostomy tube. His findings [...] - Reader Question:
Observe When to Report Imaging Guidance With Endoscopic Procedures
Question: Can the CPT® code ‘76975’ be used on all gastrointestinal endoscopic procedures other than [...] - Reader Question:
Avoid Confusion Over Date of Service for Capsule Endoscopy
Question: When billing a capsule endoscopy 91110 do you put the date of procedure as [...]
