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
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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