Digestive System Cards

Question 1

GI Hemorrhage

Answer 1

“When hemorrhage or bleeding is not clearly expressed in the title of the code for the underlying cause, assign an additional code:
* K92.0 Haematemesis
* K92.1 Melaena
* K92.2 Gastrointestinal haemorrhage, unspecified

When a patient presents for investigations following an episode Of gastrointestinal bleeding and no active hemorrhage is manifest on endoscopy, select an ICD-10-CA combination code indicating ““with bleeding”” or ““with hemorrhage”” in the disease/condition.

Alternatively, if there aren’t any such combination codes, code the underlying condition and an additional code to indicate the presence of bleeding (K92.0, K92.1 or K92.2).”

Question 2

Hematemesis

Answer 2

indicates acute upper GI hemorrhage (K92.0)

“ONLY IF vomiting of blood
- common terms
- - coffee ground emesis
- - bright red blood coming out? Confirm this one janky af”

Question 3

Melena

Answer 3

indicates upper/lower GI hemorrhage (K92.1)

“black tarry stools
- may say blood on toilet paper”

Question 4

Occult blood

Answer 4

considered abnormal lab finding (R19.50)

“presence of blood in stool
- just search occult”

Question 5

Hematochezia

Answer 5

When source of bleeding is rectum – K62.5
When source of bleeding not stated – K92.2

“Indicates lower GI bleed
– passage of bright colored blood from rectum
- - Search hemorrhage Gastrointestinal”

Question 6

Gastroenteritis

Answer 6

Most cases of gastroenteritis are infectious, even in industrialized countries; thus ICD-I O-CA
classifies gastroenterits NOS as infectious (A09.9 Gastroentehtis and colitis of unspecified ohgin).

• Assign gastroenteritis as the MRDx/mp in admissions for treatment of gastroenteritis and dehydration.
• Assign a code for any associated dehydration as a significant pre-admit comorbidity/other problem only when the electrolyte imbalance is severe enough to warrant treatment with intravenous fluids and the physician clearly documents that these fluids are intended to treat the dehydration

“Synonymous terms = colitis, enteritis, diarrhea
Lead term = gastroenteritis

Assumed to be infectious unless otherwise specified/stated”

Question 7

Intestinal infectious diseases

Answer 7

A00-A09

Question 8

Allergic and dietetic gastroenteritis and colitis

Answer 8

K52.2

Question 9

Toxic gastroenteritis and colitis

Answer 9

K52.1

Question 10

Gastroenteritis and colitis due to radiation

Answer 10

K52.0

Question 11

Noninfective gastroenteritis and colitis, unspecified

Answer 11

K52.9

Lead: gastroenteritis then search around the rubric

Question 12

Unspecified diarrhea

Answer 12

A09.9 ~ gastroenteritis and colitis of unspecified origin

Question 13

Diarrhea is classified here only when described by physician as functional

Answer 13

K59.1 ~ functional diarrhea

“diarrhea - functional

Question 14

Drug induced gastroenteritis/diarrhea

Answer 14

K52.1 ~ toxic gastroenteritis and colitis
Additional external cause code to identify drug

“diarrhea - induced”

Question 15

Intestinal Infectious Diseases

Answer 15

Gastroenteritis due to E coli = A04.4
Gastroenteritis due to Amebiasis = A06.0
Viral Gastroenteritis = A08.4
Infectious Gastroenteritis = A09.0
Gastroenteritis = A09.9

Question 16

Clostridium Difficile Associated Disease (CDAD)

Answer 16

A04.7

“Toxins of bacterium C. difficile –
- Cause inflammation of colon →diarrhea →pseudomembraneous colitis (PMC)”

“Most common nosocomial infection

• Associated with antibiotic use (Proton pump inhibitors, immune suppression, antacids, enteral feeds, inflammatory bowel disease and antidepressants)
• When drug use documented as cause, assign additional external cause code (adverse effect in therapeutic use)”

Question 17

IBS

Answer 17

K58.^ ~ irritable bowel syndrome
4th character identifies presence or absence of associated diarrhea

Chronic functional disorder characterized by recurrent abdominal pain and altered bowel habits

Question 18

IBD

Answer 18

When final dx recorded as “IBD” - review record to determine condition can be coded in more specific terms. When not further specified code to K52.9 Noninfective gastroenteritis and colitis, unspecified.

Ulcerative colitis = K51.^
The inflammatory process observed in ulcerative colitis is continuous and limited to the mucosa of the colon

Crohn’s disease = K50.^
characterized by transmural inflammation and skip lesions, located in any region of the gastrointestinal tract.

Question 19

Final Diagnosis of IBD

Answer 19

“Review record for more specific diagnosis
If none found, code to non-infective gastroenteritis and colitis ~ K52.9”

Question 20

Parenteral nutrition

Answer 20

1.LZ.35.HH-C6 ~ pharmacotherapy (local), percutaneous infusion approach, circulatory system NEC of parenteral nutrition
TPN = total parenteral nutrition

Mandatory to code

Question 21

Enteral nutrition

Answer 21

liquid calories into digestive system (NG tube through nose into stomach)

PEG (permanent endoscopic gastrostomy)

Insertion of a nasogastric (NG) tube, or gastrostomy tube is classified to 1.NF.53.AA Implantation of internal device, stomach.
- Mandatory to assign a code for nasogastric tube insertion in the NACRS
And
- Mandatory to assign a code for gastrostomy or jejunostomy tube insertion in DAD & NACRS.
Insertion of a jejunostomy tube is classified to 1.NK.53.NA Implantation of internal device, small intestine.

• A little context -
  Insertion of gastrostomy and jejunostomy tubes through the abdominal wall are most commonly performed using either a gastroscopy or laparoscopy to guide appropriate placement.
• Extra-Unnecessary nonsense -
  The actual administration of artificial nutrition through enteral routes is classified to 1 .OZ. 17.AA Alimentation, digestive system NEC and assignment of this code is not required.

Question 22

Insertion nasogastric tube/gastrostomy tube

Answer 22

1.NF.53.^^ ~ implantation device stomach
1.NK.53.^^ ~implantation device small intestine

“NG tube mandatory to assign in NACRS
Gastrostomy/jejunostomy mandatory both DAD and NACRS”

Question 23

Acute Appendicitis

Answer 23

4th digit presence of generalized or localized peritonitis
Code to K35.3 ~ acute appendicitis with localized peritonitis with no documentation of generalized peritonitis

if show up to ER they tell you, you got appendicitis cause you’re in pain n stuff… it’s appendicitis

Pathology may report normal appendix (vermiform appendix)
With appendectomy performed seek clarification
^^This last bit what?? Confirm meaning

”- localized v.s. generalized from us
- -into blood stream, something like that etc. - generalized
- -
v.s.
- peritonitis comes from physician”

Question 24

Surgery for appendicitis - without actual appendicitis

Answer 24

Code to K35.3 ~ acute appendicitis with localized peritonitis with no documentation of generalized peritonitis

May state vermiform appendix

Question 25

Appendectomy

Answer 25

1.NV.89.^^ ~ excision total appendix Status attribute mandatory Incidental appendectomy assign status attribute “B”

Question 26

Hernia

Answer 26

Protrusion (outpouching) of abdominal viscus through a defect or weak spot in abdominal wall or other structure.

Question 27

Hernias

Answer 27

K40-K46 Abdominal wall hernia’s: - Inguinal/femoral/umbilical/ventral (incisional) Gastrointestinal tract hernia: - Hiatus hernia (diaphragmatic) - 4th digit in hernia code describes complication that can occur: - - Strangulation - - Obstruction of bowel - - Gangrene of bowel - - - Separate combination code provided to indicate hernia with both obstruction + gangrene Classify to “with gangrene” "Obstruction part of gangrene in code block? Confirm true sounded out of pocket

Question 28

Hernia documented due to surgery

Answer 28

K40-K46 With additional external cause code Y83.^ External cause binoculars for searching Y codes some sort of incisional hernia

Question 29

Hernia Repair

Answer 29

Abdominal wall herniorrhaphy = 1.SY.80^^ ~ repair muscle chest/abdomen - location attribute mandatory as it affect CMG assignment - - if non-hernia select '0' "When the diagnosis does not reflect a hernia classifiable to categories K40—K43 and K45-K46, select ?Applicable?, for the mandatory location attribute at 1.SY.80.^^ ~ Repair, muscles of the chest and abdomen. The location attribute at 1 .SY .80.M Repair, muscles of the chest and abdomen is mandatory because it is the only way to identify the intervention as a hernia repair. The location attribute for ventral and ?misional? hernias will vary depending on the location of the hernia" Review table primer page 13.7

Question 30

Unilateral inguinal herniorrhapy via open approach

Answer 30

Assign 2.OT.70.^^~ inspection abdominal cavity   - Location attribute B May use a laparoscope to explore opposite side

Question 31

Hiatus Hernia, diaphragmatic Hernia, repair

Answer 31

1.GX.80.^^ ~ repair diaphragm Protrusion of stomach through opening (hiatus) in diaphragm into thoracic cavity Sliding – portion of stomach and gastroesophageal junction move above diaphragm Complication = GERD (gastroesophageal reflux disease) Rolling or paraesophageal – gastroesophageal junction remains in normal location but part of stomach protrudes above diaphragm Complication = strangulation/obstruction stomach

Question 32

GERD

Answer 32

K21.^ ~ gastro-esophageal reflux disease If caustic nature lead to esophagitis, stricture, ulceration then Barrett’s esophagus = K22.7) "An incompetent lower esophageal sphincter results in reflux ""reflux - gastro*""

Question 33

GERD treatment:

Answer 33

1.NA.80.^^ ~repair esophagus using flap closure Nissen fundoplication

Question 34

Common digestive adenomas

Answer 34

- Often described as adenomatous polyps - Villous adenomas – classify to neoplasm uncertain behavior - About 2/3 of all colorectal carcinoma arise from adenomas - Early detection via colonoscopy - Definitive treatment = surgical removal of primary tumor

Question 35

Diverticulosis/Diverticulitis

Answer 35

Classify to – K57.~ diverticular disease of intestine 4th character site within intestine and presence of perforation/abscess - Diverticulosis – diverticula in colon without inflammation / infection - Diverticulitis – diverticula in colon with inflammation/infection - Diverticular disease – full spectrum signs/symptoms associated with diverticulosis and can lead to complications of diverticulitis

Question 36

Ulcers

Answer 36

Peptic Ulcer Disease (PUD) - Gastric, duodenal, gastrojejunal - 4th character – presence of associated hemorrhage/perforation - K27.^ ~ peptic ulcer Drug induced – external cause code assigned to identify drug Assign additional code – B96.80 ~ Helicobacter pylori [H. pylori] if documented

Question 37

Bleeding ulcers

Answer 37

Acute blood loss anemia - D62 Chronic blood loss anemia – D50.0 - If present and require treatment (transfusion or >LOS) assign code for anemia (1/OP) - If present and do not impact resource use = diagnosis type 3/OP

Question 38

Ulcer Interventions

Answer 38

Vagotomy & Pyloroplasty 1.NE.80.^^ ~ repair pylorus When performed with pyloroplasty, vagotomy is identified in the qualifier field (1.NE.80.M Repair, pylorus) 1.BK.59.^^ ~ destruction vagus nerve (vagotomy alone) Because vagotomy disrupts gastric motility, a gastric drainage intervention is required to facilitate gastric emptying. The most common complementary intervention is pyloroplasty which is performed by incising the pylorus horizontally and closing it vertically. Vagotomy may also be performed concomitantly with partial gastrectomy. In CCI, a selective vagotomy is classified to truncal technique. - i.e. identified as a qualifier in partial gastrectomy Partial gastrectomy (antrectomy) 1.NF.87^^ ~ excision partial stomach Billroth I – gastroduodenostomy Billroth II - gastrojejunostomy Omental patch 1.NK.80.LA-XX-E ~ repair small intestine using local transposition flap - Endoscopy with/without biopsy used to diagnose gastric/duodenal ulcers - Surgical interventions to cure PUD aim to decrease reduction of gastric acid secretion - - Vagotomy/Pyloroplasty - May also require partial gastrectomy

Question 39

Intestinal Obstructions

Answer 39

- Obstruction implied in most codes - - Bilateral inguinal hernia with obstruction = K40.0 - When not implied can assign additional code for obstruction when warranted - Mechanical obstructions results from variety of conditions

Question 40

Adhesions

Answer 40

Adhesions causing bowel obstruction K56.5 ~ intestinal adhesions with obstructions Adhesions without bowel obstruction K66.0 Peritoneal adhesions Result of previous inflammation or surgery Y83.— Surgical operation and other surgical procedures as the cause of abnormal reaction of the patient, or of later complication ..... only when explicitly mentioned as result of previous by physician Result when bands of scar tissue join two surfaces normally separated

Question 41

Adhesions Treatment

Answer 41

Lysis adhesions 1.NP.72.^^ ~ release small and large intestine 1.OT.72.^^~ release abdominal cavity Release By Site

Question 42

Fistula

Answer 42

Abnormal communication between a hollow viscus and another hollow viscus (internal fistula) or the skin (external fistula) Where/how to code fistulas? which part is the site? Confirm and insert!

Question 43

Closure of fistula:

Answer 43

External fistula classified to closure of internal anatomy site (eg. 1.NT.86.^ ~ closure fistula anus) Internal fistula classified to anatomy site of usual/assumed originating organ CCI advanced query – closure fistula + compound term

Question 44

Hemorrhoids Treatment

Answer 44

Treatment : rubber band ligation (encirclage) or excision Outpatient or Day surgery 1.NQ.87.^^ ~ excision partial rectum (internal) 1.NT.87.^^ ~excision partial anus (external) Internal – subepitheal cushions of connective tissue, smooth muscle and arteriovenous communications of superior rectal artery & vein External – arise from inferior hemorrhoidal veins located below the dentate line May be described in grades: - First to fourth degree Complications – strangulation, thrombosis, necrosis, ulceration "

Question 45

Endoscopic Procedures

Answer 45

Esophagoscopy ~ 2.NA.70.BA Gastroscopy ~ 2.NF.70.BA Duodenoscopy ~ 2.NK.70.BA Colonoscopy/Sigmoidoscopy ~ 2.NM.70.BA Sigmoidoscopy vs colonoscope - Sigmoidoscope used to view lower bowel (sigmoid colon into descending colon) - Colonoscope used to view lower and upper bowel plus terminal ileum - Important to distinguish between two and done via device qualifiers: - - BG – rigid sigmoidoscope - - BH – flexible sigmoidoscope - - BJ - colonoscope Classify endoscopic inspections to the further site visualized Do not assign a code for endoscopic inspection when performed at same anatomy site as other diagnostic/therapeutic intervention – captured via qualifier Exception – therapeutic sigmoidoscope/colonoscope interventions At 1.NK.87 and 1.NM.87 use location attribute “U” for removal of polyps (lesions) from intestine

Question 46

Exploratory Laparotomy/Laparoscopy

Answer 46

If only intervention code to: 2.OT.70.^^~ inspection abdominal cavity Diagnostic tools for intra-abdominal disorders Is inherent in most intra-abdominal surgery Exploration is coded only in absence of another intra-abdominal intervention

Question 47

Excision and Destruction

Answer 47

Endoscopic excision - e.g. polypectomy and diverticulectomy - involves excision partial by site Destruction – e.g. control bleeding, debulk tumours and manage vascular lesions within digestive tract - Also called ablation

Question 48

Excision with Anastomosis and Bypass Interventions

Answer 48

Esophagojejunostomy – removal of stomach in total with re-anastomosis of esophagus to jejunum (1.NF.89.^^ ~ excision total stomach) Esophagogastrostomy – partial removal stomach with re-anastomosis of esophagus to remaining stomach (1.NF.87,^^ ~ excision partial stomach) Enteroenterostomy – removal of portion of small intestine with re-anastomosis of remaining segments of intestine (1.NK.87.^^ ~ excision partial small intestine using location attribute to indicate portion removed) Ileoproctostomy – total removal large intestine with reanastomosis of ileum to rectum (1.NM.89.^^ ~ excision total large intestine)

Question 49

Ileostomy/ Colostomy

Answer 49

Classified to excision of small/large intestine with qualifier to identify creation of ileostomy/colostomy 1.NK.87.TF ~ excision partial small intestine, stoma formation 1.NK.87.TG ~ excision partial small intestine, stoma formation with mucous fistula Called a double-barrelled colostomy Temporary Exteriorization of ileum or colon = ileostomy/colostomy Ileostomy = 1.NK.77 ~bypass with exteriorization small intestine - Colostomy = 1.NM.77 ~ bypass with exteriorization large intestine Patients may be admitted for closure of temporary ileostomy/colostomy Assign as MRDX Z43.2 – attention to ileostomy Z43.3 – attention to colostomy CCI closure 1.NK.82.RR – reattachment small intestine 1.NM.82.RS – reattachment large intestine Assign K91.4- colostomy and enterostomy malfunction for complications of ileostomy/colostomy Resected end of intestine brought through opening in abdominal wall

Question 50

CDAD

Answer 50

Clostridium Difficile-Associated Disease

Question 51

GERD

Answer 51

Gastroesophageal Reflux Disease

Question 52

GI

Answer 52

Gastrointestinal

Question 53

IBD

Answer 53

Inflammatory bowel disease

Question 54

IBS

Answer 54

Irritable bowel syndrome

Question 55

PMC

Answer 55

Pseudomembranous colitis

Question 56

PUD

Answer 56

Peptic ulcer disease

Question 57

TPN

Answer 57

Total parenteral nutrition

Question 58

ONTARIO CODING STANDARDS - Reason for lower endoscopy procedure is for a positive FOBT result (Fecal Occul Blood Test Result)

Answer 58

Use prefix V instead of prefix F in fron of R19.50 Mandatory assignment of prefix "V' in front of MP or OP field in NACRS day surgery abstract to indicate intent/reason The assignment of prefix “F” will be replaced with the new code R19.50 and prefix “F” will be disabled. When the reason for a lower endoscopy procedure is for a positive FOBT result, use the prefix “V” in front of the code R19.50.

Question 59

ONTARIO CODING STANDARDS - Revised method for coding colonoscopies/lower endoscopies

Answer 59

"1) Mandatory assignment of Prefix “V” in front of the “Main Problem” or “Other Problem” field in the NACRS Day Surgery abstract to indicate the intent/reason for the lower endoscopy. 2) Mandatory coding of Family History (1st degree relative) of Malignant Neoplasm in range of Z80.0 TO Z80.9 in “Other Problem” field in the NACRS Day Surgery abstract. 3) Mandatory coding of Personal History of Malignant Neoplasm in range of Z85.0 TO Z86.0 in “Other Problem” field in the NACRS Day Surgery abstract. Note: The Canadian Coding Standards will still be in effect. " Broadened the use of V to all reasons why one could have a lower endoscopy - seems a little dicey - is that actually the intent? - clarified use prefix V to be safe for NACRS - according to Rajann

Question 60

Exploration

Answer 60

Diagnostic tools for intra-abdominal disorders Is inherent in most intra-abdominal surgery Exploration is coded only in absence of another intra-abdominal intervention

Question 61

Anastomosis

Answer 61

cutting out part of GI tract and reconnecting e.g. ileoproctostomy

Question 62

Billroth I & Billroth II

Answer 62

Billroth I - reanastomosis gastroduodenostomy Billroth II - reanastomosis gastrojejunostomy