Wiki intestinal metaplasia vs barrett's esophagus

[Morella1]

Hello, I have been coming across a number of pathology reports with a diagnosis of something like "reflux esophagitis and positive for intestinal metaplasia". I'm confused on whether these should be coded as GERD with Esophagitis (K21.00) and Intestinal metaplasia (K31.A1-) or as Barrett's esophagus. The report often indicates something like "consistent with barrett's mucosa/barrett's esophagus", however I know that we cannot code based on "consistent with". Can anybody help clarify when I can use the codes for barrett's vs metaplasia?

 

[danachock]

Hello Morella1,
Let me see if I can help provide some help with Barrett's Esophagus AKA intestinal metaplasia.
If you refer to your ICD book on Barrett's Esophagus, it directs you to utilize the default K22.70 (any mention of dysplasia; there are subcategories to review in your ICD Index).
Next, let's jump over to the Metaplasia section of your ICD Index. Let us scroll through all the subheadings to esophagus and it provides K22.7* ("check" mark icon). Review your tabular for proper assignment.

Next let me share with you what Dr. Kendall (pathologist's) and my mentor since 2012 provided on 9/18/2023 during the semi-annual pathology (coder questions for pathologist's AAPC presentation for anyone that utilizes the pathology report for ICD assignment).
Esophagus Metaplasia (NOTE: these are in my words listening to Dr. Kendall) is usually the result of acid created within the stomach that is creating problematic gastric symptoms for the patient and the patient's body figures out that once that stuff that was in the stomach that is now in the small intestine is no longer an issue.
Well, it hurts when certain things get into the stomach and doesn't hurt when in the small intestine. What if the patient's body to relieve stress of acid wants that small intestine lining moved into the stomach to help with that problematic acid situation? That is clearly what is happening here. Small Intestinal tissue is growing in the esophagus. It is specialized intestinal metaplasia (Barretts). Metaplasia is simply a tissue change (normal tissue that is now found in a different spot).

No doubt you have to be incredibly kind reviewing pathology reports and coding following the ICD guidelines.
I'm hopeful, I provided some insight on this issue. Depending on the pathologist's documentation is how I code this. Every pathologist's document's something absolutely a little different from the next.
The next semi-annual pathology meeting with the pathologist's is in Fall 2024 (it was just held again last month).
Thank you for listening and have a great evening,