Gastroenterology Coding Alert

Question: Our gastroenterologist recently made a diagnosis of Narcotic Bowel Syndrome. What ICD-9 code should I use to report this diagnosis? Please help as I am not finding any suitable code to report this.

Texas Subscriber

Answer: Narcotic bowel syndrome (NBS) is type of bowel dysfunction that is characterized by chronic or episodes of recurring pain in the abdomen that worsens with continued or escalating dosages of narcotics. This syndrome is under recognized and may be becoming more prevalent. This may be due to increased usage of narcotics for chronic non-malignant painful disorders, and the development of maladaptive therapeutic interactions around its use. Treatment involves early recognition of the syndrome, an effective physician patient relationship, graded withdrawal of the narcotic according to a specified withdrawal program and the institution of medications to reduce withdrawal effects.

The increased use of opiates will cause reduced GI motility that result in many symptoms such as bloating, constipation, ileus, nausea and pain. When a person experiences pain predominantly, your gastroenterologist will diagnose the condition as narcotic bowel syndrome.

Depending on the location of the pain, you will report the diagnosis using 789.0x (Abdominal pain) series of codes along with an E code (such as E935.2, Other opiates and related narcotics causing adverse effects in therapeutic use) for the adverse effects and the poisoning code for illicit drug use (such as E950.0, Suicide and self-inflicted poisoning by analgesics antipyretics and antirheumatics). It should not be classified as postoperative pain as it is due to an effect of the drugs whether the patient had surgery or not.