Esophageal, Gastric varices and Liver cirrhosis and Portal hypertension and Tips

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Hi guys,

Please look this scenario

The pt admitted with Esophageal varices due to alcoholic liver cirrhosis, Physician perfomed banding for varices. What will be PDX.
In same case if Pt admitted with gastric varices due to cirrhosis and portal hypertension. physician workup only for varices.

I am confused i have to go pdx as cirrhosis or varices.
 

tbalasrinivas22

Contributor
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Coding Clinic

Bleeding gastric varices due to alcoholic cirrhosis/hepatitis

ICD-9-CM Coding Clinic, Second Quarter 2002 Page: 4 Effective with discharges: August 1, 2002

Related Information




Question:



What is the correct principal diagnosis code when a patient is admitted for a hematemesis, which is found to be due to a gastric varix that is caused by alcoholic cirrhosis/hepatitis? The patient also had esophageal varices without active bleeding. Creation of transjugular intrahepatic portosystemic shunt (TIPS) was carried out. Would code 456.8, Varices of other specified sites, be assigned as the principal diagnosis? Or, should the cirrhosis/hepatitis be assigned as the principal diagnosis following the coding logic for esophageal varix?



Answer:



Assign code 456.8, Varices of other specified sites, as the principal diagnosis. Since the bleeding is due to the gastric varices, the varices should be listed as the principal diagnosis. Also, assign code 578.0, Hematemesis, to identify the gastrointestinal bleeding. Code 303.90, Other and unspecified alcohol dependence, unspecified, Code 571.2, Alcoholic cirrhosis of liver, code 571.1, Acute alcoholic hepatitis, and code 456.21, Esophageal varices in diseases classified elsewhere, without mention of bleeding, should be assigned as secondary diagnoses. Assign code 39.1, Intra-abdominal venous shunt, for the creation of the TIPS.



Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. For such conditions the ICD-9-CM has a coding convention that requires the underlying condition to be sequenced first followed by the manifestation. Although alcoholic liver cirrhosis with esophageal varices (571.2 and 456.21) requires coding of both the manifestation and etiology with the manifestation sequenced second, this coding convention is not applicable to gastric varices resulting from alcoholic liver cirrhosis.


As per above coding clinic example. If we are talking about esophageal varices due to alcoholic cirrhosis, then alcoholic cirrhosis would be PDX (k70.30), followed by esophageal varices (I85.11) if esophageal varcies is bleeding. I guess esophageal varcies is bleeding, that is why the physician is performing esophageal varices banding. This is example of etiology and manifestation.

In the other case where gastric varix is due to cirrhosis and portal hypertension. Gastric varix would be PDX followed by cirrhosis.
 

rhondatalley

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Just wanted to add that in I10, there is an instructional note at esophageal varices to code first the underlying disease so it cannot be sequenced first. There is not a note at the code for gastric varices so it can be sequenced first.
 
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