Regarded as the second most common illness in the United States, gastroenteritis is a condition that causes swelling and inflammation of the gastrointestinal tract – the pathway responsible for digestion (that includes the mouth, esophagus, stomach, and intestines). Also called viral gastroenteritis or stomach flu, this condition is caused by a norovirus infection that generally spreads through contaminated food or water or by contact with an infected person. The disease attacks your intestines, causing signs and symptoms such as nausea, vomiting or both, low grade fever, abdominal cramps and occasional muscle aches or headache. Symptoms usually last for a day or two, but occasionally they may persist for as long as ten days. However, if your symptoms do not improve even after five days (two days for children) or if a child (older than 3 months) continues to vomit after 12 hours it is important to immediately consult a physician. Several factors make the process of medical billing and coding for gastroenteritis challenging. Healthcare providers can rely on the services of a reliable gastroenterology medical billing company for accurate clinical documentation and appropriate reimbursement. Coders in such companies are knowledgeable about the condition in detail (including its symptoms, causes and treatment options), which is necessary to assign the right ICD-10 codes for diagnosis of gastroenteritis.

Reports suggest that gastroenteritis affects people of all age groups, but is particularly common in young children. The most common problem with the condition is dehydration – a severe loss of water and essential salts and minerals. This happens when patients do not drink adequate fluids to replace what they lose through vomiting and diarrhea. Dehydration is most common in infants, young children, older adults, and people with weak immune systems. Practicing personal hygiene like avoiding contaminated food and water and frequent hand washing can help prevent the spread of infections in the long run.

Symptoms

One of the main symptoms associated with the condition is diarrhea. When the colon (large intestine) becomes infected during gastroenteritis, it loses its ability to retain fluids, which causes the person’s feces to become loose or watery. Other symptoms include –

  • Abdominal pain or cramping
  • Unintentional weight loss (may be a sign of dehydration)
  • Poor feeding (in infants)
  • Muscle pain or joint stiffness
  • Incontinence (loss of stool control)
  • Fever
  • Excessive sweating
  • Clammy skin

It is very important to watch for signs of dehydration, which generally comprise extreme thirst, dry skin/mouth, sunken cheeks or eyes, and urine that is dark in color.

Diagnosing and Treating Gastroenteritis

Diagnosis of this gastroenterology condition may involve a patient symptom analysis and physical examination. If the symptoms persist for a prolonged period of time, blood and stool tests may be conducted to determine the cause of the vomiting and diarrhea and detect the presence of rotavirus or norovirus. The physician may also perform other laboratory tests, including complete blood count (CBC), electrolytes, and kidney function tests.

Treatment initially consists of self-care measures and other home remedies that are aimed at keeping the patient well hydrated. Drinking fluids regularly throughout the day (especially after bouts of diarrhea), avoiding dairy products (like caffeine, alcohol, nicotine, and fatty or highly seasoned foods) and consuming foods or drinks with potassium (such as fruit juice and bananas) are some of the common home remedies that can be followed. In some cases, medical treatment may be necessary if the patient becomes dehydrated and needs intravenous (IV) fluids to replenish lost fluids. Antibiotics may be prescribed to treat infections, nausea and vomiting. Anti-diarrheal medications are sometimes recommended to reduce the frequency and amount of diarrhea (depending upon the cause of the diarrhea).

As part of the gastroenteritis treatment, the modalities and other screening tests performed by gastroenterologists or other specialists must be carefully documented using the correct medical codes. Medical billing services provided by established medical billing companies help physicians use the correct ICD-10 codes for their billing purposes.

ICD- 10 codes for Gastroenteritis

K52 – Other and unspecified non-infective gastroenteritis and colitis

  • K52.0 – Gastroenteritis and colitis due to radiation
  • K52.1 – Toxic gastroenteritis and colitis
  • K52.2 – Allergic and dietetic gastroenteritis and colitis
    • K52.21 – Food protein-induced enterocolitis syndrome
    • K52.22 – Food protein-induced enteropathy
    • K52.29 – Other allergic and dietetic gastroenteritis and colitis
  • K52.3 – Indeterminate colitis
  • K52.8 – Other specified non-infective gastroenteritis and colitis
    • K52.81 – Eosinophilic gastritis or gastroenteritis
    • K52.82 – Eosinophilic colitis
    • K52.83 – Microscopic colitis
      • K52.831 – Collagenous colitis
      • K52.832 – Lymphocytic colitis
      • K52.838 – Other microscopic colitis
      • K52.839 – Other microscopic colitis, unspecified
    • K52.89 – Other specified non-infective gastroenteritis and colitis
  • K52.9 – Non-infective gastroenteritis and colitis, unspecified

Preventing Gastroenteritis

Practicing good personal hygiene is one of the important ways to stop or reduce the spread of bacterial infections. There are several steps that people can follow to reduce the risk of gastroenteritis, which include –

  • Disinfect any surfaces or objects that could be contaminated
  • Practice good food hygiene
  • Wash hands frequently (especially after going to the bathroom and before consuming food)
  • Drink clean bottled water
  • Consume food that is properly refrigerated and thoroughly cooked
  • Vaccinate infants with a rotavirus vaccine

Medical billing and coding services offered by AAPC-certified coders can help gastroenterologists optimize reimbursement for the services they offer. Make sure that the coders are well-versed in the medical codes pertaining to the diagnosis and treatment of gastroenteritis and its related complications.