Gastroenterology Coding Alert

Question: Is there an ICD-9-CM code for the diagnosis pouchitis? Florida Subscriber Answer: Pouchitis is most common after ileostomy procedures. The ileoanal pouch and the continent ileostomy are alternatives to the standard ileostomy. They eliminate the need to wear an external ostomy appliance because the surgeon uses part of the small intestine to create an internal pouch for stool collection. Sometimes the mucosa, or lining, can become inflamed. This happens in 32 percent of patients with an ileostomy pouch. The causes are unknown but can include an excess of bacteria in the pouch, a recurrence of irritable bowel syndrome, or the misdiagnosis of ulcerative colitis in a patient with Crohn's disease. Symptoms include a large number of stools in one day, rectal bleeding, abdominal cramping, an urgency before bowel movements, and fever. Treatment is most successful with antibiotics, such as metronidazole (Flagyl), given for one to two weeks.

The correct code for this is 558.9 (Other and unspecified noninfectious gastroenteritis and colitis). Be sure to include documentation that substantiates and explains the condition of pouchitis.