Monday, January 13, 2020

G. I. Bleeding

G. I. bleeding will the topic explored in this “In the kNOW” conversation.  Ever since Coding Clinic clarification of the term “with” in the Index a few years ago, questions have continued to arise about appropriate linking, and coding for G.I. bleeding has been part of that discussion.  

First, it is important to remember that as coding professionals we are always to rely on the Official Coding Guidelines as a primary source of information and assistance for code assignment.  In this circumstance, Section I.A.15 explains the term “with” to mean “associated with” or “due to” when it appears in one of three places:

- A Code title
- Alphabetic Index
- Instructional note in the Tabular List

The definition goes on to state that coding professionals are to assume a causal relationship between the linked terms, and unless the provider specifically indicates another cause, we are to assign the linked code even without provider documentation stating such a linkage exists.  So, in plain English, what does that mean?  If the provider states the patient is a Type 2 diabetic and has neuropathy, the appropriate code assignment would be E11.40.  

This same definition applies to coding for G.I. bleeding conditions.  Let’s look at diverticulosis as an example.  Here is the Alphabetic Index for diverticulosis:

Diverticulosis K57.90
- with bleeding K57.91
- large intestine K57.30
- - with
- - - bleeding K57.31
- - - small intestine K57.50
- - - - with bleeding K57.51
- small intestine K57.10
- - with
- - - bleeding K57.11
- - - large intestine K57.50
- - - - with bleeding K57.51

As you can see, the first entry is “with bleeding” meaning that if the physician documents the patient has a G. I. bleed and diverticulosis, the code K57.91 is correct to assign.  We can use the same reasoning to code for diverticulosis in the large or small intestine with bleeding at K57.91 or K57.11, respectively.  Coding Clinic, which is a secondary source for coding knowledge, supports this coding as well as documented in the 3rd Qtr. 2017 publication.

The same rationale applies if we are coding multiple conditions, such as diverticulosis and angiodysplasia of the intestine, and there is bleeding.  Combination codes for both conditions exist for “with bleeding”, as seen below:

Angiodysplasia (cecum) (colon) K55.20
- with bleeding K55.21
- duodenum (and stomach) K31.819
- - with bleeding K31.811
- stomach (and duodenum) K31.819
- - with bleeding K31.811

In this case, both the diverticulosis and angiodysplasia with bleeding codes should be assigned (K57.91 and K55.21).  The same applies to upper G.I. conditions as well.

Remember that the bleeding does not have to be occurring during the admission in order to assign the “with bleeding” code.  Bleding does not have to be found during an endoscopic exam either in order to assign the code.  This is explained in the 3rd Qtr. 2018 Coding Clinic.  

Keep in mind, that when providers perform procedures to address these bleeding issues, coding professionals should be assigning a “Control” procedure.  This is true even if the condition is not currently bleeding as documented in the 4th Qtr. 2017 and 1st Qtr. 2018 Coding Clinics.
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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