Monday, April 22, 2019

Intestinal Polyps

A polyp, is a polyp, is a polyp.  Right? 

The short answer is no, and in this edition of “In the kNOW”, the discussion looks at the different types of intestinal polyps and the proper code assignment for each.
First, let’s define an intestinal polyp.  A growth in the lining of the intestine is a polyp.  Non-neoplastic or neoplastic are categories of colonic polyps.  Non-neoplastic polyps generally do not evolve into a cancerous condition, whereas neoplastic polyps may progress to cancer.  Non-neoplastic polyps include inflammatory, hyperplastic, and hamartomatous polyps.  Serrated and adenomatous types of polyps are considered neoplastic polyps.  Sessile serrated polyps can be precancerous.  Intestinal polyps described as sessile are flat, while those characterized as pedunculated arise from a stalk. 
If the only description a coding professional has of a polyp of the colon is the term “polyp”, the ICD-10-CM code assigned should be K63.5, which according to a 1st Qtr. 2017 Coding Clinic is the also the code to be assigned when the polyp is described as hyperplastic.  Remember, that an outpatient coder can use the pathology report to determine if the polyp is further specified as adenomatous or inflammatory.  This would permit the assignment of a different code.  However, an inpatient coder may find that same information on a pathology report but would need to query the physician for agreement before assigning the more specific code. 
A diagnosis of an inflammatory polyp of the colon is correctly coded to K51.40 with further specificity if various other complications co-exist such as an abscess, a fistula, rectal bleeding, intestinal obstruction, or other complication.  

Colon polyps described as adenomatous are coded as benign neoplasms with further specification as to the location if it is known.  An adenomatous polyp of the ascending colon codes to D12.2.  The 2nd Qtr. 2018 Coding Clinic clarified that sessile serrated polyps should also be considered to be adenomatous in nature, thereby classifying them as benign neoplasms in the D12 category as well. 
An important point to note is that hyperplastic polyps that are specified by location (i.e. transverse colon) are not to be coded to the D12 benign neoplasm category.  A 2nd Qtr. 2015 Coding Clinic states that hyperplastic and adenomatous polyps are not the same, and that all hyperplastic polyps, regardless of location within the colon, are to be coded to K63.5.

Adenomatous colon polyps may be designated as tubular or tubulovillous and both types are coded to the benign neoplasm D12 category.  However, if the description of the polyp is that of villous adenoma, the complexion changes, and now a coding professional will assign a code from Neoplasm, uncertain behavior, by site - category D37.4.  A Coding Clinic from 2nd Qtr. 2005 made coders aware that when high-grade dysplasia is noted in an adenomatous polyp it does not alter the code assignment.  The code will still be in the D12 category.

Now you are In the kNOW!!

About the Author 

Dianna Foley, RHIA, CHPS, CCS  is OHIMA's Coding Education Coordinator. Dianna has been an HIM professional for 20 years. She progressed through the ranks of coder, department supervisor, and department director, to her current role as a coding consultant. 

She recently served as the program director for Medical Coding and HIT at Eastern Gateway Community College. Dianna earned her bachelor's degree from the University of Cincinnati subsequently achieving her RHIA, CHPS, and CCS certifications. She is an AHIMA Approved ICD-10-CM/PCS Trainer and a a presenter at regional HIM meetings and the OHIMA Annual Meeting.

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