Gastroenterology Coding Alert

Carry diagnosis codes out to the most specific digit possible When a patient comes in for treatment of diabetes -- even non-complicated diabetes without insulin dependence -- coders must make sure they report a five-digit ICD-9 code. On the other hand, coders should report only a four-digit code for a benign neoplasm of the digestive system. No doubt about it, diagnosis coding can definitely get confusing. And with the Centers for Medicare and Medicaid Services (CMS) demanding immediate implementation of its new ICD-9 codes from now on, it's plain to see that diagnosis coding isn't getting any easier. Note: For more information on the latest ICD-9 code additions and the new rules for reporting them, see "Learn New Codes This Summer to Prevent Autumn Fall" in the June 2004 issue of Gastroenterology Coding Alert. Get Those Digits The first step to becoming a skilled diagnosis coder is remembering to carry ICD-9 codes to the appropriate digit, says Margaret Lamb, RHIT, CPC, coder at Great Falls Clinic in Great Falls, Mont.

Read on for expert tips on third-, fourth-, and fifth-digit ICD-9 coding, and get the most out of your diagnosis coding. Non-Complicated Diabetes Requires 5 Digits Example: The gastroenterologist treats a patient with diabetes. She is having no complications and does not require insulin. If you reported 250 (Diabetes mellitus), the diagnosis code will be rejected, Lamb says. Why? "You need five digits to reflect complications and insulin dependence, or lack thereof. The code for non-insulin-dependent diabetes without complications would be 250.00 (Diabetes mellitus without mention of complication; type II)," Lamb says. To double-check her ICD-9 coding, Lamb asks two questions:

1. Do I have a complete code?
2. Do I have the most specific complete code? How will I know? You can check that you have the most complete and specific code when looking up the code in the ICD-9 book.

Look to the left of the ICD-9 code for non-complicated diabetes, and you'll see a red box with a check mark and "5th" printed in it. This box indicates that a complete ICD-9 code for this diagnosis must be five digits.

"Report the ICD-9 code that provides the highest degree of accuracy and completeness. That 'highest degree'refers to assigning the most precise ICD-9 code that most fully explains the [physician's] narrative description of the symptom or diagnosis," says JoAnn Baker, CCS, CPC-H, CPC, CHCC, an education specialist in East Orange, N.J. 'Complete'Not Always 5 Digits Warning: Don't assume that you need a fifth digit on every ICD-9 code; some diagnoses require fewer than five numbers.

Example: The gastroenterologist removes a polyp from a 45-year-old patient's duodenum using hot biopsy forceps. You should: report 43250 (Upper gastrointestinal endoscopy including esophagus, [...]