Wiki Cirrhosis and Complications of Portal Hypertension

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B
Code: k74.60
Unspecified cirrhosis of liver
Cirrhosis (of liver) NOS
Parent Code Notes: K74
Code also: , if applicable, viral hepatitis (acute) (chronic) (B15-B19)
Excludes1: alcoholic cirrhosis (of liver) (K70.3)
alcoholic fibrosis of liver (K70.2)
cardiac sclerosis of liver (K76.1)
cirrhosis (of liver) with toxic liver disease (K71.7)
congenital cirrhosis (of liver) (P78.81)
pigmentary cirrhosis (of liver) (E83.110)

Category Notes
Diseases of liver (K70-K77)
Excludes 1: jaundice NOS (R17)
Excludes 2: hemochromatosis (E83.11-)
Reye's syndrome (G93.7)
viral hepatitis (B15-B19)
Wilson's disease (E83.0)

Coding Guidelines
Diseases of the digestive system (K00-K95)
Excludes 2: certain conditions originating in the perinatal period (P04-P96)
certain infectious and parasitic diseases (A00-B99)
complications of pregnancy, childbirth and the puerperium (O00-O9A)
congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)
endocrine, nutritional and metabolic diseases (E00-E88)
injury, poisoning and certain other consequences of external causes (S00-T88)
neoplasms (C00-D49)
symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)

sparkle77

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I want to check other coders' opinions as to how to sequence the ICD-10-CM coding in the following situation:

Physician documents "Cirrhosis r/o varices" for the indications for an EGD procedure and it is positive for both EV's and portal hypertensive gastropathy. The physician lists the EV's first under the findings. Based on my understanding of the disease process, EV's that are caused by cirrhosis are a direct result of portal hypertension caused by the increased resistance of blood flow d/t the loss of function of liver cells. I think this situation is kind of like hypertension and CKD but of course we cannot assume a relationship because the guidelines don't say we can but the hospital documentation software automatically codes it as k74.60, i85.10, k76.6, k31.89. I think it really should be k76.6, i85.10, k31.89, k74.60 because really the EV are a complication of the portal hypertension and the physician did give a diagnosis of portal hypertension. Please help, I understand the guidelines but the etiology/manifestation convention applies to both codes.

**this is assuming a subsequent progress note clearly documents the relationship between the portal hypertension and the Cirrhosis because other things can cause portal hypertension
 
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