Gastroenterology Coding Alert

New diagnosis codes are here, and you must start using them in October If a patient reports to your office on October 1 with an esophagostomy infection, Medicare will expect you to use the new ICD-9 code 530.86 (Infection of esophagostomy) to represent the condition. Don't pull your hair out trying to find the code in your ICD-9 book; it isn't there. But the Centers for Medicare and Medicaid Services (CMS) has created 530.86 -- along with some other gastroenterology-specific diagnosis codes -- for use in physician's offices beginning this autumn.

"There are five new ICD-9 codes that will affect gastroenterology practices," says Linda Parks, MA, CPC, CMC, CCP, coding specialist at GI Diagnostics Endoscopy Center in Marietta, Ga. Read on to find out more about the new diagnosis codes, and how they might be used at your office in October. Link Esophagostomy Codes to E/Ms CMS added two new ICD-9 codes to the 530.8 (Other specified disorders of esophagus) family -- 530.86 (Infection of esophagostomy) and 530.87 (Mechanical complication of esophagostomy). The two new diagnosis codes are most likely to affect your E/M service coding, Parks says.

"You would see these [codes] attached to an E/M service most often," she says. "Anywhere from level 2 to level 5, for new or established patients, depending on the workup performed by the gastroenterologist."

Example: The gastroenterologist performs a level 4 E/M service on a new patient currently being treated for a mediastinal cancer and finds an infection of the esophagostomy. You would report 99204 (Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components: a comprehensive history; a comprehensive examination; and medical decision making of moderate complexity) with the new ICD-9 code 530.86 to reflect the infection. Use V Code if Aspirin Affected Bleeding You'll also need to learn a new secondary code to use when a patient has internal bleeding caused by aspirin intake: V58.66 (Long-term [current] use of aspirin). Coders may use V58.66 with E/M visits for new or established patients, but the code is more likely to be linked to an endoscopy performed due to gastrointestinal (GI) bleeding or anemia, Parks says.

Example: Apatient reports to the emergency room after vomiting blood. The gastroenterologist performs an EGD on the patient and finds evidence of previous bleeding from numerous erosions in the stomach typical of aspirin injury.

He also performs an epinephrine injection in one area of active bleeding to stem the bleeding. The operative notes indicate that the patient had a gastrointestinal hemorrhage that may be linked to his consumption of four aspirin tablets a day. In this instance, you would report 43255 (Upper gastrointestinal endoscopy including esophagus, [...]