Gastroenterology Coding Alert

Question: A referring physician sent us progress notes with this diagnosis: "Crohn's disease with 'malignant variant.'" However, this patient has no known history of intestinal cancer. What does "malignant variant" mean, and how do I code this?
Massachusetts Subscriber Answer: Three diagnosis codes refer specifically to Crohn's:
 • 555.0 (Regional enteritis; small intestine) which includes Crohn's disease of the duodenum, ileum, and jejunum
 • 555.1 (... large intestine) which includes Crohn's disease of the colon, large bowel, and rectum
 • 555.9 (... unspecified site) which includes Crohn's disease not otherwise specified. While Crohn's disease, a chronic inflammation of the digestive tract, is linked to a higher risk of cancer, there's no ICD-9 code for a malignant variant. In this case, you need to ask your physician what the referring doctor meant, or even call the referring physician to clarify. You certainly want to check and recheck before you suggest in documentation that a patient has cancer.