DIGESTIVE SYSTEM K00 – K95 - CDPHO

[Pages:36]Chapter 11 DIGESTIVE SYSTEM

K00 ? K95

Presented by Jan Halloran CCS

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The Digestive System

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GASTROINTESTINAL HEMORRHAGE

Gastrointestinal (GI) bleeding manifests itself in several ways:

? Hematemesis (vomiting of blood), which indicates acute upper gastrointestinal hemorrhage

? Melena (presence of dark-colored blood in stool), which indicates upper or lower GI hemorrhage

? Occult bleeding (presence of blood in stool that can be seen only on laboratory examination), which indicates upper or lower GI bleeding

? Hematochezia (presence of bright-colored blood in stool), which indicates lower GI bleeding

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Common Causes of GI Bleeding

Codes for these diseases indicate whether there is associated hemorrhage or bleeding:

Gastric and intestinal ulcers Diverticular disease - diverticulosis and diverticulitis Gastritis Angiodysplasia Duodenitis and Gastroduodenitis Crohn's disease Ulcerative colitis

Examples include the following:

K29.01 Acute gastritis with bleeding K31.819 Angiodysplasia of duodenum without bleeding

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K20.K21.K22.K22.0 K22.1 K22.2 K22.3 K22.4 K22.5 K22.6

K22.7 K22.8 K22.9

Diseases of the Esophagus

Esophagitis Gastro-esophageal reflux disease (with/out esophagitis) Other diseases of the esophagus Achalasia of cardia Ulcer Obstruction Perforation Dyskinesia Diverticulum Gastro-esophageal laceration-hemorrhage syndrome (Mallory-Weiss syndrome) Barrett's esophagus (5th and 6th digit ?with and without dysplasia) Other specified diseases (Hemorrhage) Unspecified

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Hemorrhage of the Esophagus Esophageal Varices

Bleeding of the esophagus is coded as K22.8, Other specified diseases of esophagus, unless the bleeding is due to esophageal varices. Esophageal varices are not classified as a disease of the digestive system but as a disease of the circulatory system. They are coded as follows:

I85.00 Esophageal varices without bleeding I85.01 Esophageal varices with bleeding

When esophageal varices are associated with alcoholic liver disease, cirrhosis of the liver, toxic liver disease, or portal hypertension, dual coding is required, with the underlying condition coded first and a code for secondary esophageal varices (I85.10-I85.11). Examples include:

K74.60 + I85.11 Bleeding esophageal varices with cirrhosis of liver K76.6 + I85.11 Bleeding esophageal varices in portal hypertension

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Ulcers of the Stomach and Small Intestines K25-K28

Combination codes are provided for gastric, gastrojejunal, and duodenal ulcers that indicate whether there is associated bleeding, associated perforation, or both. These combination codes also distinguish between acute and chronic ulcers.

Ulcers of the stomach and the small intestine are often described as peptic without any further identification of the site. The coder should review the medical record for any indication of the site involved; codes from category K27, Peptic ulcer, site unspecified, should not be used when a more specific code can be assigned. Examples of appropriate coding include the following: K25.5 Chronic gastric ulcer with perforation K26.3 Acute duodenal ulcer without hemorrhage or perforation K25.6 Chronic gastric ulcer with both hemorrhage and perforation

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Ulcers of the Stomach and Small Intestines K25-K28

Category and 3rd Character

4th Character

K25-Gastric ulcer K26-Duodenal ulcer K27-Peptic ulcer K28-Gastrojejunal ulcer

0 Acute, with hemorrhage 1 Acute, with perforation 2 Acute, with both hemorrhage and perforation 3 Acute, without both hemorrhage and perforation 4 Chronic or unspecified, with hemorrhage 5 Chronic or unspecified, with perforation 6 Chronic or unspecified, with both hemorrhage and perforation 7 Chronic, without hemorrhage or perforation 9 unspecified as acute or chronic, without hemorrhage or perforation

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