1. ICD-10 CM Training
Gastroenterology

2. ICD-10-CM Compliance Dates
ICD-10-CM will be valid for dates of service on or after October 1, 2015
Outpatient dates of service of October 1, 2015 and beyond.
Inpatient hospital service claims, is effective for dates of discharge after September 30, 2015

3. Covered and Non-Covered Entities
Everyone covered by the Health Insurance Portability Accountability Act (HIPPA)
Non-Covered Entities
Worker’s Compensation
Auto Insurance
Non covered HIPAA entities are exempt but are encouraged to adapt the new code set

4. ICD-10 Code Structure 21 Chapters
Alpha-numeric codes; not case-sensitive
Codes begin with Alpha letter, A-Z, excluding U
Common errors
I verses 1
O verses 0
“X” Placeholder
3 to 7 characters
Decimal following 3rd character

5. ICD-10 Code Structure Placeholder “X”
Used for future expansion of a code
Fills in empty characters when a 6th and/or 7th character apply
The placeholder may be used in different scenarios but should never serve as the final character.
Example: W19.XXXA Unspecified fall, Initial Encounter

6. ICD-10 Code Structure 7th Character
Provides specified information regarding the clinical visit
Is required for certain categories and must be reported in the seventh position
May be alpha or numeric
Has different meanings depending on the coding category

7. ICD-10 Code Structure Laterality
Some ICD-10-CM codes indicate laterality, specifying whether the condition occurs on the left, right or is bilateral.
If no bilateral code is provided and the condition is bilateral, assign separate codes for both the left and right side.
If the side is not identified in the medical record, assign the code for the unspecified side.
OGCR section 1.B.13

8. ICD-10 Code Structure “Other” Codes “Unspecified” Codes
Codes titled “other” or “other specified” are for use when the information in the medical record provides detail for which a specific code does not exist.
“Unspecified” Codes
Codes titled “unspecified” are for use when the information in the medical record is insufficient to assign a more specific code.
OGCR section 1.A.9.a.b

9. ICD-10 Structure Excludes Notes Excludes1 Excludes2
A type 1 Excludes note is a pure excludes note
It means “NOT CODED HERE”
The code excluded should never be used at the same time
When two conditions cannot occur together
Excludes2
Represents “Not included here”
The condition excluded is not part of the condition represented by the code
It is acceptable to use both the code and the excluded code together, when appropriate
OGCR section 1.A.12.a.b

10. ICD-10 Code Structure “Code First” and “Use Additional Code”
ICD-10 has a coding convention that requires the underlying condition be sequenced first followed by the manifestation.
These instructional notes indicate the proper sequencing order of the codes.
OGCR section 1.A.13
The “-” indicates there are additional reporting options

11. Most Common Diagnosis Codes

12. Encounter for screening for malignant neoplasm of colon
ICD-9 Code
ICD-10 Code
Description
Excludes1
Excludes2
V76.51
Z12.11
examinations related to pregnancy and reproduction (Z30-Z36, Z39.-)
encounter for diagnostic examination-code to sign or symptom
N/A
There are more specific code choice selections below:
Z12.10
Z12.12
Z12.13
Use additional code to identify any family history of malignant neoplasm (Z80.-)

13. Documentation Tips
Nonspecific abnormal findings disclosed at the time of these examinations are classified to categories R70-R94.
Screening is the testing for disease or disease precursors in asymptomatic individuals so that early detection and treatment can be provided for those who test positive for the disease.

14. Colon & Appendix Benign Neoplasm
ICD-9 Code
ICD-10 Code
Description
Excludes1
Excludes2
211.3
D12.0
Benign neoplasm of cecum
benign carcinoid tumors of the large intestine, and rectum (D3A.02-)
There are more specific code choices:
D12.1
Benign neoplasm of appendix
benign carcinoid tumor of the appendix (D3A.020)
D12.6
Benign neoplasm of colon, unspecified
inflammatory polyp of colon (K51.4-)
polyp of colon NOS (K63.5)
K63.5
Polyp of colon
adenomatous polyp of colon (D12.6)
polyposis of colon (D12.6)

15. Abdominal pain 789.00 R10.9 Unspecified abdominal pain
ICD-9 Code
ICD-10 Code
Description
Excludes1
Excludes2
789.00
R10.9
Unspecified abdominal pain
renal colic (N23)
dorsalgia (M54.-)
flatulence and related conditions (R14.-)
There are more specific code choice selections below:
R10.0
Acute abdomen
789.09
R10.10
Upper abdominal pain, unspecified
789.01
R10.11
Right upper quadrant pain
789.02
R10.12
Left upper quadrant pain
789.06
R10.13
Epigastric pain
R10.2
Pelvic and perineal pain
R10.30
Lower abdominal pain, unspecified
789.03
R10.31
Right lower quadrant pain
789.04
R10.32
Left lower quadrant pain
789.05
R10.33
Periumbilical pain
789.61
R10.81-
Other abdominal pain
R10.82-
Rebound abdominal tenderness

16. Abdominal Pain Documentation Tips
Document specific location:
LLQ, LUQ, RUQ, RLQ
Periumbilical
Epigastric
Generalized (R10.84)
Colic (R10.83)
Acute abdominal pain (R10.0)
Abdominal tenderness (R R10.819)
Rebound abdominal pain (R R10.829)

17. Personal history of colonic polyps
ICD-9 Code
ICD-10 Code
Description
Excludes1
Excludes2
V12.72
Z86.010
N/A
personal history of malignant neoplasms (Z85.-)
Code first any follow-up examination after treatment (Z09)

18. Documentation Tips
There are two types of history Z codes, personal and family. Personal history codes explain a patient’s past medical condition that no longer exists and is not receiving any treatment, but that has the potential for recurrence, and therefore may require continued monitoring.
Personal history codes may be used in conjunction with follow-up codes and family history codes may be used in conjunction with screening codes to explain the need for a test or procedure. History codes are also acceptable on any medical record regardless of the reason for visit. A history of an illness, even if no longer present, is important information that may alter the type of treatment ordered.

19. Dysphagia, unspecified
ICD-9 Code
ICD-10 Code
Description
Excludes1
Excludes2
787.20
R13.0
Aphagia
Psychogenic aphagia (F50.9)
Psychogenic dysphagia (F45.8)
N/A
R13.10**
**Code first, if applicable, dysphagia following cerebrovascular disease (I69. with final characters -91)
There are more specific code choice selections below:
787.21
R13.11
Dysphagia, oral phase
787.22
R13.12
Dysphagia, oropharyngeal phase
787.23
R13.13
Dysphagia, pharyngeal phase
787.24
R13.14
Dysphagia, pharyngoesophageal phase
787.29
R13.19
Other dysphagia
Cervical dysphagia
Neurogenic dysphagia

20. Dysphagia Documentation Tips
Document phase:
Oral
Oropharyngeal
Pharyngeal
Pharyngo-esophageal
Document if sequelae of nontraumatic hemorrhage:
specify type:
Subarachnoid
Intracerebral
Intracranial
Document if sequelae of:
Cerebral infarction
Cerebrovascular disease

21. Family history of malignant neoplasm of digestive organs
ICD-9 Code
ICD-10 Code
Description
Excludes1
Excludes2
V16.0
Z80.0
N/A
Code also any follow-up examination (Z08-Z09)

22. Documentation Tips
Z80.3 is considered unacceptable as a principal diagnosis as it describes a circumstance which influences an individual's health status but not a current illness or injury, or the diagnosis may not be a specific manifestation but may be due to an underlying cause.
Family history codes are for use when a patient has a family member(s) who has had a particular disease that causes the patient to be at higher risk of also contracting the disease.
Personal history codes may be used in conjunction with follow-up codes and family history codes may be used in conjunction with screening codes to explain the need for a test or procedure. History codes are also acceptable on any medical record regardless of the reason for visit. A history of an illness, even if no longer present, is important information that may alter the type of treatment ordered.

23. Diverticular disease of intestine
ICD-9 Code
ICD-10 Code
Description
Excludes1
Excludes2
562
K57.9-
Diverticular disease of intestine, part unspecified,
congenital diverticulum of intestine (Q43.8)
Meckel's diverticulum (Q43.0)
diverticulum of appendix (K38.2)
There are more specific code choice selections below:
K57.0-
Diverticulitis of small intestine with perforation and abscess
K57.1-
Diverticular disease of small intestine without perforation or abscess
K57.2-
Diverticulitis of large intestine with perforation and abscess
K57.3-
Diverticular disease of large intestine without perforation or abscess
K57.4-
Diverticulitis of both small and large intestine with perforation and abscess
K57.5-
Diverticular disease of both small and large intestine without perforation or abscess
K57.8-
Diverticulitis of intestine, part unspecified, with perforation and abscess

24. Documentation Tips Identify: With or without bleeding
Small and/or large intestine
Perforation and/or Abscess

25. Gastro-Esophageal Reflux Disease
ICD-9 Code
ICD-10 Code
Description
Excludes1
Excludes2
530.81
K21.9
Gastro-esophageal reflux disease without esophagitis
Esophageal reflux NOS
Newborn esophageal reflux (P78.83)
N/A
There are more specific code choice selections below:
530.11
K21.0
Gastro-esophageal reflux disease with esophagitis

26. GERD Documentation Tips
Identify with or without esophagitis

27. Gastroenteritis
ICD-9 Code
ICD-10 Code
Description
Excludes1
Excludes2
787.91
K52.2
Allergic and dietetic gastroenteritis and colitis
Use additional code to identify type of food allergy (Z91.01-, Z91.02-)
N/A
K52.89
Other specified noninfective gastroenteritis and colitis
R19.7
Diarrhea, unspecified
acute abdomen (R10.0)
functional diarrhea (K59.1)
neonatal diarrhea (P78.3)
psychogenic diarrhea (F45.8)
There are more specific code choice selections below:
558.1
K52.0
Gastroenteritis and colitis due to radiation
535.70
535.71
535.41
K52.81
Eosinophilic gastritis or gastroenteritis
Eosinophilic enteritis

28. Barrett's esophagus
ICD-9 Code
ICD-10 Code
Description
Excludes1
Excludes2
530.85
K22.70
Barrett's esophagus without dysplasia
Applicable to:
Barrett's esophagus NOS
Barrett's ulcer (K22.1)
malignant neoplasm of esophagus (C15.-)
N/A
There are more specific code choice selections below:
K22.710
Barrett's esophagus with low grade dysplasia
K22.711
Barrett's esophagus with high grade dysplasia
K22.719
Barrett's esophagus with dysplasia, unspecified

29. Documentation Tips Identify: With or without dysplasia
Type of dysplasia

30. Benign neoplasm of rectum and anal canal
ICD-9 Code
ICD-10 Code
Description
Excludes1
Excludes2
211.4
D12.7
Benign neoplasm of rectosigmoid junction
N/A
D12.8
Benign neoplasm of rectum
benign carcinoid tumor of the rectum (D3A.026)
D12.9
Benign neoplasm of anus and anal canal
Applicable to:
Benign neoplasm of anus NOS
benign neoplasm of anal margin (D22.5, D23.5)
benign neoplasm of anal skin (D22.5, D23.5)
benign neoplasm of perianal skin (D22.5, D23.5)

31. Calculus of bile duct without cholangitis or cholecystitis
ICD-9 Code
ICD-10 Code
Description
Excludes1
Excludes2
574.50
K80.50
Calculus of bile duct without cholangitis or cholecystitis without obstruction
retained cholelithiasis following cholecystectomy (K91.86)
N/A
574.51
K80.51
Calculus of bile duct without cholangitis or cholecystitis with obstruction

32. Gastrointestinal hemorrhage
ICD-9 Code
ICD-10 Code
Description
Excludes1
Excludes2
578.9
K92.2
Gastrointestinal hemorrhage, unspecified
Applicable to:
Gastric hemorrhage NOS
Intestinal hemorrhage NOS
neonatal gastrointestinal hemorrhage (P54.0-P54.3)
acute hemorrhagic gastritis (K29.01)
hemorrhage of anus and rectum (K62.5)
angiodysplasia of stomach with hemorrhage (K31.811)
diverticular disease with hemorrhage (K57.-)
gastritis and duodenitis with hemorrhage (K29.-)
peptic ulcer with hemorrhage (K25-K28)
N/A

33. Gastritis There are more specific code choice selections below:
ICD-9 Code
ICD-10 Code
Description
Excludes1
Excludes2
535.00
K29.00
Acute gastritis without bleeding
eosinophilic gastritis or gastroenteritis (K52.81)
Zollinger-Ellison syndrome (E16.4)
N/A
There are more specific code choice selections below:
535.01
K29.01
Acute gastritis with bleeding
535.30
K29.20
Alcoholic gastritis without bleeding
535.31
K29.21
Alcoholic gastritis with bleeding
535.10
535.40
K29.30
Chronic superficial gastritis without bleeding
535.11
535.41
K29.31
Chronic superficial gastritis with bleeding
K29.40
Chronic atrophic gastritis without bleeding
K29.41
Chronic atrophic gastritis with bleeding
K29.50
Unspecified chronic gastritis without bleeding
K29.51
Unspecified chronic gastritis with bleeding
535.20
K29.60
Other gastritis without bleeding
K29.61
Other gastritis with bleeding
535.50
K29.70
Gastritis, unspecified, without bleeding
535.51
K29.71
Gastritis, unspecified, with bleeding

34. Gastritis and duodenitis
ICD-9 Code
ICD-10 Code
Description
Excludes1
Excludes2
535.60
K29.80
Duodenitis without bleeding
535.61
K29.81
Duodenitis with bleeding
Gastritis and duodenitis
ICD-9 Code
ICD-10 Code
Description
Excludes1
Excludes2
535.61
K29.81
Gastroduodenitis, unspecified, without bleeding
Gastroduodenitis, unspecified, with bleeding

35. Gastritis Documentation Tips
Document acuity:
- Acute or Chronic
Differentiate between:
Gastritis
Gastroduodenitis
Duodenitis
Document type:
Alcoholic
Superficial
Atrophic
Document any related hemorrhage
Document any alcohol or drug use, abuse, dependence or past history
Specify name of medication or drug with purpose of its use

36. Monitor Claims
On October 01, 2015 we will monitor claims for date of service rules
Outpatient claims cannot have crossover dates
Outpatient claims will be coded according to date of service
Inpatient facility claims will be coded per date of discharge
We will monitor claims to resolve any unanticipated problems with the submission process

37. Claim Denial and Management
We will monitor for claim denials
We will monitor editing trends for ICD-10 Coding guidelines
We will provide feedback to the physicians regarding supporting documentation requirements
We will monitor WC or Liability carriers for published rules on use of ICD-9 or ICD-10 code sets

38. Client Responsibilities
Client will need to update
Templates
Order Sets
Superbills
Favorites
Future Orders
Remove ICD-9 code add ICD-10 code

39. Documentation – Start Now
All Conditions treated or assessed must be documented in the medical record. In addition to the documentation tips reviewed, below are more areas to document that will ensure proper ICD-10-CM code selection.
Site specificity
Document notation of qualifiers
Exacerbation
Manifestations
Relapse
Status
Stages
Indicate acute or chronic
Indicate underlying or external cause factors
Medication
Smoke
Accidents
Mechanical failure
Laterality
Bilateral
Right
Left

40. Documentation – Start Now
Episode of Care for injuries, poisoning, external causes and other conditions
Initial Encounter
Use while the patient is receiving active treatment of the condition
Active treatment includes surgical treatment, an emergency encounter, and evaluation and treatment by a new physician
Subsequent Encounter
Used on encounter after the patient has received active treatment of the condition and is receiving routine care for the condition during the healing or recovery phase.
Medication adjustments, aftercare, device adjustments, cast change
Sequela
Used for complications or conditions that arise as a direct result of a condition, late effect

41. Documentation – Start Now
Combination codes that capture
Etiology and manifestation
Related conditions
Disease, injury or other medical condition and complications
Disease or other medical conditions and common signs or symptoms
Add ICD-10 Codes to patient Problem List

42. Official Guidelines for Coding and Reporting
Underdosing
Underdosing refers to taking less of a medication than is prescribed by a provider or a manufacturer’s instruction. For underdosing, assign the code from categories T36-T50 (fifth or sixth character “6”).
Codes for underdosing should never be assigned as principal or first-listed codes. If a patient has a relapse or exacerbation of the medical condition for which the drug is prescribed because of the reduction in dose, then the medical condition itself should be coded.
Noncompliance (Z91.12-, Z91.13-) or complication of care (Y63.6-Y63.9) codes are to be used with an underdosing code to indicate intent, if known.
OGCR Section 1.C.19.e.5.c

43. Questions
Centers for Disease Control and Prevention (ICD-10-CM)
Offical Guidelines, Alpha Index, Tabular Index, Neoplasm Table, Drug Table, External Cause of Injury Index