General Surgery Coding Alert

Crosswalk expands with 6th digit.

Just like ICD-9, you’ll find four codes for regional enteritis (Crohn’s disease) in ICD-10, based on the intestinal location.

But unlike ICD-9, you’ll need more clinical information about the patient’s condition so that you can incorporate any complications into a complete, accurate ICD-10 code. You need to be ready for the change with the scheduled conversion to ICD-10 on Oct. 1 this year. 

Look for Direct Crosswalk — Plus 1 Digit

Both ICD-9 and ICD-10 provide four codes to describe Crohn’s disease based on the anatomic site where the surgeon identifies the condition, as follows:

ICD-9:

• 555.0 — Regional enteritis of small intestine 
• 555.1 — … of large intestine
• 555.2 — … of small intestine with large intestine
• 559.9 — … of unspecified site

ICD-10:

• K50.0_ — Crohn’s disease of small intestine
• K50.1_ — … of large intestine
• K50.8_ — … of both small and large intestine
• K50.9_ — … unspecified

You can stop there for ICD-9, because those four codes are all you have to choose from. But ICD-10 expands to a fifth digit, as follows: 

• 0 — without complications
• 1 — with complications (requires 6th digit)

That’s not all: If your ICD-10 fifth digit is 1, you must add a sixth digit from the following list to avoid a truncated code:

• 1 — with rectal bleeding
• 2 — with intestinal obstruction
• 3 — with fistula
• 4 — with abscess
• 8 — with other complication
• 9 — with unspecified complications

Example: For a patient with Crohn’s identified in the large intestine with a fistula, report K50.113 as the findings.