Read the following gastroenterology scenarios and know what ICD-9 codes apply.
Question: A patient comes for chemotherapy for treating a secondary liver neoplasm which metastasized from the primary colon neoplasm. How should you report your ICD-9 codes?
Answer: You must describe your diagnoses by reporting the following listed ICD-9 codes in this order:
- V58.11 (Encounter for antineoplastic chemotherapy) as primary diagnosis in case the main focus of the encounter is for chemotherapy;
- 197.7 (Secondary malignant neoplasm of respiratory and digestive systems; liver, specified as secondary) for the site being treated (liver metastasis);
- the accurate 153.x-154.x code to describe your primary cancer irrespective of it being treated or not.
Gastric Inlet Patch Claim
Question: What diagnosis code you must select for gastric inlet patch?
Answer: In case you are referring to an esophageal inlet patch, this condition is taken in account as a congenital anomaly -- a remnant of gastric mucosa which is essentially left behind during the descent of the stomach in embryologic development. Esophageal inlet patch can be spotted in about 4.5 percent of infants and up to 12 percent of children. Its presence is expected to be around 1 to 10 percent in adults. As it is of no clinical significance, patients are not required to experience any treatments or regular follow-ups. You might use ICD-9 code 750.4 (Other specified anomalies of esophagus) to report the diagnosis.
Ultrasound Abnormal Findings
Question: What ICD9 codes must you bill after physician orders a patient for an ultrasound and he writes down "1.9cm hypoechoic focus in liver"? Answer: You must go with 793.6 (Nonspecific [abnormal] findings on radiological and other examination of abdominal area, including retroperitoneum).
At times, gastroenterologists would review radiographic studies or additional studies which, even though abnormal, are not diagnostic and do necessitate further studies. 793.6 helps clarify medical necessity for review of similar tests or for the performance of further diagnostic studies (793.5, Nonspecific [abnormal findings] on radiological and other examination of genitourinary organs).
You can go ahead and use 793.6 on your claim once the physician ends up ordering multiple studies on a patient to come up with a conclusive diagnosis. A lot of insurance companies would like to see you use this code for tracking utilization of high cost radiological studies.
Question: Notes point toward pouchitis. How should you report this? Should you consider another code in case the pouchitis is infectious?
Answer: ICD-9 code
569.71 (Pouchitis) covers usual cases of pouchitis. However, you should report 569.71 and 997.4 (Digestive system complications not elsewhere classified) in case the pouchitis is infectious. Pouchitis, which is categorized by inflammation of the mucosa of the small intestine, can take plae after ileostomy or ileo-anal anastomosis procedures.