General Surgery Coding Alert

Upgrade your Barrett’s esophagus documentation.

One code says it all in ICD-9 -- 530.85 (Barrett’s esophagus). But one code won’t do when ICD-10 goes into effect on Oct. 1, 2014.

For ICD-9, there is a single classification for all forms of Barrett’s esophagus, and you use the same code irrespective of the presence or absence of dysplastic changes.

Dysplasia Leads ICD-10 Options

Under ICD-10, 530.85 will transform into K22.7 (Barrett’s Esophagus). But once you’re using ICD-10, you’ll have to look deeper in the patient notes before you can report the Barrett’s esophagus diagnosis.

That’s because ICD-10 codes are more specific than ICD-9, based on the presence or absence of dysplastic changes. So K22.7 expands into a fourth digit classification based on the presence or absence of dysplasia, as follows:

K22.70 --Barrett’s esophagus without dysplasia

K22.71 -- Barrett’s esophagus with dysplasia

In addition, K22.71 expands to a fifth-digit classification based on the dysplasia grade. So if dysplasia is present, you will have to further look through the documentation to see if there is any mention about the degree of dysplasia that is present to correctly report the diagnosis of Barrett’s esophagus.

K22.710 --Barrett’s esophagus with low grade dysplasia

K22.711 --Barrett’s esophagus with high grade dysplasia

K22.719 --Barrett’s esophagus with dysplasia, unspecified.

You’ll need to be familiar with how to use the new diagnosis codes when your surgeon performs an endoscopy of the esophagus and the stomach, such as 43235 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]).

The presence of any suggestive changes might make your surgeon suspicious of Barrett’s esophagus, thus requiring further investigation. "If during the endoscopy your [surgeon] sees inflammation, erosions, or irregular salmon colored mucosa, he will perform a biopsy (43239, Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with biopsy, single or multiple) of the lower esophagus," says Michael Weinstein, MD, former representative of the AMA’s CPT^® Advisory Panel.. Your surgeon will then send the biopsied specimen to the laboratory for analysis to check for dysplasia, and if present, to check the grade of dysplasia.

You’ll need to use all the patient information, including the pathology report, to assign the final ICD-10 code for Barrett’s esophagus.