Digestive conditions or diseases are disorders of the digestive tract – called the gastrointestinal (GI) tract. A number of conditions can affect the GI tract and can have an impact on digestion and a person’s overall health. In certain cases, some conditions have similar symptoms and further medical investigations may be required before a physician arrives at a diagnosis. Symptoms can be subtle and mild or severe and obvious. The symptoms of digestive conditions may depend on the location, the extent, and the severity of the condition. Some of the most common symptoms associated with the condition include – bloating, constipation, nausea and vomiting, heartburn, pain in the belly, bleeding, swallowing problems and weight gain or weight loss. Early diagnosis and treatment can help prevent the severity of symptoms and other serious complications. From a medical billing and coding service provider’s point of view, proper documentation by gastroenterologists or other physicians specifying the location of the disease as well as other complications or manifestations is essential for proper code selection. Physicians need to be ready with the associated ICD-10 codes for diagnosing these common digestive conditions and outsourcing medical billing and coding to a reputable service provider is a reliable strategy to ensure this.
Here discussed are five common digestive conditions and their related ICD-10 codes –
Gastroesophageal Reflux Disease (GERD) – GERD is a common digestive disorder that arises when the stomach acid backs up or refluxes into the esophagus (the tube connecting your mouth and stomach). Also called acid regurgitation, this condition can cause a burning sensation (known as heartburn) in the chest. According to reports from the American College of Gastroenterology, GERD affects at least 15 million Americans (2019 statistics). The condition occurs among people of all age groups. However, it is more commonly seen in obese or overweight people, pregnant women, active or secondhand smokers and people who consume certain medications (like antidepressants, sedatives, calcium channel blockers and antihistamines). Heartburn or a burning sensation in your chest, usually after eating (which might become worse at night) is one of the top symptoms associated with the condition. Other symptoms include chest pain, regurgitation of food or sour liquid, difficulty swallowing, nausea or vomiting, and a sensation of a lump in your throat. Making significant lifestyle changes (like maintaining a healthy weight, quitting smoking and reducing stress) along with consumption of over-the-counter medications can help ease the symptoms. Surgery may be recommended as a last option if the above lifestyle modifications do not improve the symptoms of GERD, or medications do not show the expected results. ICD-10 codes for diagnosing GERD include –
- K21 – Gastro-esophageal reflux disease
- K21.0 – Gastro-esophageal reflux disease with esophagitis
- K21.9 – Gastro-esophageal reflux disease without esophagitis
Gallstones – Gallstones are hardened deposits of digestive fluid that can form in your gallbladder. According to Harvard Health Publications, about 80 percent of gallstones are made of cholesterol. The other 20 percent of gallstones are made of calcium salts and bilirubin. Pain in the upper right abdomen is one of the most important symptoms of this condition. Patients may normally experience other symptoms like – dark urine, indigestion, nausea, vomiting and burping. Several diagnostic imaging tests like – Gallbladder radionuclide scan, Ultrasound and Abdominal CT scan are performed to diagnose the severity of the condition. People who experience symptoms from their gallstones usually require gallbladder removal surgery. Gallstones that don’t cause any specific symptoms typically do not require any treatment. ICD-10 codes include –
- K80 – Cholelithiasis
- K80.0 – Calculus of gallbladder with acute cholecystitis
- K80.1 – Calculus of gallbladder with other cholecystitis
- K80.2 – Calculus of gallbladder without cholecystitis
- K80.3 – Calculus of bile duct with cholangitis
- K80.4 – Calculus of bile duct with cholecystitis
- K80.5 – Calculus of bile duct without cholangitis or cholecystitis
- K80.6 – Calculus of gallbladder and bile duct with cholecystitis
- K80.7 – Calculus of gallbladder and bile duct without cholecystitis
- K80.8 – Other cholelithiasis
- K81 – Cholecystitis
Crohn’s Disease – Crohn’s disease involves inflammation in the lining of the digestive tract. The condition can occur at any age but it will more often develop at a younger age. It is more common among people in the age group of 50- 60 years. The symptoms of Crohn’s disease depend on the location, the extent, and the severity of the inflammation. The common signs and symptoms of Crohn’s include bloody diarrhea, abdominal pain, fatigue, weight loss, and skin lesions. Symptoms can be subtle and mild or severe and obvious. If the inflammation spreads deep into the tissues, it can even result in perforation of the intestine. Crohn’s disease cannot be fully cured. However, medications such as steroids and immune-suppressants can help slow the progression of disease. If these treatment modalities are not effective, a patient may require surgery. Additionally, patients with Crohn’s disease may need to receive regular screening for colorectal cancer due to increased risk. ICD-10 codes for Crohn’s disease are –
- K50 – Crohn’s disease [regional enteritis]
- K50.0 – Crohn’s disease of small intestine
- K50.1 – Crohn’s disease of large intestine
- K50.8 – Crohn’s disease of both small and large intestine
- K50.9 – Crohn’s disease, unspecified
Irritable Bowel Syndrome (IBS) – Irritable Bowel Syndrome (also known as irritable bowel disease) is a chronic gastro-intestinal disorder that primarily affects the digestive system, particularly the large intestine. It causes inflammation in the digestive tract, resulting in severe complications. According to reports, IBS is expected to affect about 45 million people in the United States (2018 statistics). It is estimated that women are almost twice as likely to develop this condition as men and the onset is usually before the age of 35 years (in almost half of the cases). The exact cause of IBS is not known. However, certain factors like bacterial infections in the digestive tract, muscle contractions in the intestine, food intolerances/sensitivities, changes in bacteria in the gut (microflora) and hormonal changes are expected to play an active role. Prominent symptoms include – cramping, abdominal pain, diarrhea or constipation and excess gas. As there is no known cure for this condition, complementary health practices combined with medications and correct diet can help control these symptoms in the long-run. ICD-10 codes used for diagnosing IBS include –
- K58 – Irritable bowel syndrome
- K58.0 – Irritable bowel syndrome with diarrhea
- K58.1 – Irritable bowel syndrome with constipation
- K58.2 – Mixed irritable bowel syndrome
- K58.8 – Other irritable bowel syndrome
- K58.9 – Irritable bowel syndrome without diarrhea
Diverticular disease – Regarded as a chronic condition, diverticular disease occurs when small pockets or out-pouchings (called diverticula) occur in the bowel. Diverticula can become inflamed when undigested food gets trapped within them, causing pain and constipation, and in some extreme cases fever, nausea, or cramping. This is called diverticulitis. Diverticular disease most commonly affects people above 60 years. A low fiber diet is one of the main causes of this condition, although some people have a genetic predisposition to the disease. Many people with diverticular disease do not experience any symptoms, and the condition is often discovered during a colonoscopy to screen for colorectal cancer. Treatment involves a high-fiber diet and mild pain medications. ICD – 10 codes include –
- K57 – Diverticular disease of intestine
- 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
- K57.9 – Diverticular disease of intestine, part unspecified, without perforation or abscess
The Centers for Disease Control and Prevention estimate that digestive disease complaints comprise about 51 million emergency room visits annually. The approach to treating and preventing these problems depends on the severity and frequency of the symptoms and medical history of the patient. Changing the patient’s diet and exercise habits are often the first recommended steps to achieve better digestive health.
Gastroenterology medical billing and coding can be challenging. Physicians need to have proper knowledge about the specific ICD-10 codes to report common digestive disorders. Choosing the services of a reliable medical billing and coding company can help physicians with accurate claim submission and proper patient care.
Meghann Drella possesses a profound understanding of ICD-10-CM and CPT requirements and procedures, actively participating in continuing education to stay abreast of any industry changes.