1. Understanding ICD-9-CM Coding Mary Jo Bowie MS, RHIA, RHIT Regina Schaffer AAS, RHIA, CPC

2. CHAPTER 14 Diseases of the Digestive System

3. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 3 Digestive System Chapter Nine of the ICD-9-CM: –520-529: Oral Cavity, Salivary Glands, Jaws –530-538: Esophagus, Stomach, Duodenum –540-543: Appendicitis –550-553: Hernia of abdominal cavity –555-558: Noninfectious enteritis and colitis –560-569: Other diseases of intestine and peritoneum –570-579: Other diseases of digestive system Gastrointestinal tract (GI) Alimentary canal Starts with the mouth Through intestines to anus

4. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 4 Accessory Organs Gastrointestinal tract (GI) Alimentary canal (aliment=nourishment) Starts with the mouth Through intestines to anus Secondary organs include –Gallbladder –Liver –Pancreas

5. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 5

6. 6 Diseases of Oral Cavity, Salivary Glands, and Jaws Disorders of oral cavity (520-529) –Tooth development anomalies –Diseases of enamel –Pulp (Pulpitis code 522.0) –Geographic tongue –Gingivitis –Diseases of the jaw and salivary glands Reference to diagram of oral anatomy

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8. 8 Diseases of the Esophagus Category Codes 530-538 Connects throat to stomach Esophagitis (inflammation reflux of acid and pepsin from the stomach into the esophagus) Gastroesophageal Reflux (GERD)

9. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 9 Stomach and Intestines Stomach connects esophagus to duodenum Duodenum—Start of small intestine including jejunum and ileum Cecum—Start of large intestine including ascending, transverse, and descending colon Coders should know where structures are located.

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11. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 11 Remaining Structures Sigmoid colon, rectum, and anus Code assignment requires knowledge of where structures stop and start Structures connecting to other structures

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13. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 13 Ulcers of the Gastrointestinal Tract Code to site of the ulcer –Gastric ulcer- stomach (531) –Duodenal ulcer – upper part of small intestines (532) –Peptic ulcer –unspecified part of digestive tract (533) –Gastrojejunal ulcer (534) Fifth digit code assignment is necessary

14. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 14 Appendicitis Category Codes 540-543 Inflammation of appendix Other complications—present or absent –Generalized peritonitis “0” –Peritoneal abscess “1” –W/O mention of peritonitis “9” Note the use of acute, chronic, or subacute

15. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 15 Hernia of Abdominal Cavity Category Codes 550-553 Protrusion or bulge of tissue –Inguinal – intestines –Hiatal – stomach to chest –Direct or indirect Fifth digit code assignment is necessary in many types of hernias Recurrent Unilateral or bilateral – 4 th and 5 th digits

16. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 16 Enteritis and Colitis Infectious Noninfectious Enteritis—inflammation of intestines –Crohn’s Disease Colitis—inflammation of colon –Ulcerative colitis

17. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 17 Other Diseases of Intestines Diverticulosis Diverticulitis Peritonitis

18. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 18 Accessory Organs Liver (hepatic)—secretes bile Pancreas—part of the endocrine system and digestive system Gallbladder—stores bile needed for digestion

19. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 19

20. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 20 Cholecystitis and Cholelithiasis Cholecystitis—sudden and severe inflammation of the gallbladder Cholelithiasis—gallstones Documentation in coding these conditions is critical Fourth and fifth digit code assignments are necessary (obstruction/acute/other