Understanding ICD-9-CM Coding

Mary Jo Bowie MS, RHIA, RHIT

Regina Schaffer AAS, RHIA, CPC

CHAPTER

14Diseases of the

Digestive System

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Digestive System• Chapter Nine of the ICD-9-CM:

– 520-529: Oral Cavity, Salivary Glands, Jaws– 530-538: Esophagus, Stomach, Duodenum– 540-543: Appendicitis– 550-553: Hernia of abdominal cavity– 555-558: Noninfectious enteritis and colitis– 560-569: Other diseases of intestine and peritoneum– 570-579: Other diseases of digestive system

• Gastrointestinal tract (GI)• Alimentary canal• Starts with the mouth• Through intestines to anus

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Accessory Organs• Gastrointestinal tract (GI)

• Alimentary canal (aliment=nourishment)

• Starts with the mouth

• Through intestines to anus

• Secondary organs include– Gallbladder– Liver– Pancreas

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Diseases of Oral Cavity, Salivary Glands, and Jaws

• Disorders of oral cavity (520-529)– Tooth development anomalies– Diseases of enamel– Pulp (Pulpitis code 522.0)– Geographic tongue– Gingivitis– Diseases of the jaw and salivary glands

• Reference to diagram of oral anatomy

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Diseases of the Esophagus

• Category Codes 530-538

• Connects throat to stomach

• Esophagitis (inflammation reflux of acid and pepsin from the stomach into the esophagus)

• Gastroesophageal Reflux (GERD)

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Stomach and Intestines• Stomach connects esophagus

to duodenum

• Duodenum—Start of small intestine including jejunum and ileum

• Cecum—Start of large intestine including ascending, transverse, and descending colon

• Coders should know where structures are located.

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Remaining Structures

• Sigmoid colon, rectum, and anus

• Code assignment requires knowledgeof where structures stop and start

• Structures connecting toother structures

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Ulcers of theGastrointestinal Tract

• Code to site of the ulcer– Gastric ulcer- stomach (531)– Duodenal ulcer – upper part of small

intestines (532)– Peptic ulcer –unspecified part of digestive

tract (533)– Gastrojejunal ulcer (534)

• Fifth digit code assignment is necessary

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Appendicitis• Category Codes 540-543

• Inflammation of appendix

• Other complications—present or absent– Generalized peritonitis “0”– Peritoneal abscess “1”– W/O mention of peritonitis “9”

• Note the use of acute, chronic, or subacute

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Hernia of Abdominal Cavity• Category Codes 550-553

• Protrusion or bulge of tissue – Inguinal – intestines– Hiatal – stomach to chest– Direct or indirect

• Fifth digit code assignment is necessary in many types of hernias

• Recurrent

• Unilateral or bilateral – 4th and 5th digits

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Enteritis and Colitis

• Infectious

• Noninfectious

• Enteritis—inflammation of intestines– Crohn’s Disease

• Colitis—inflammation of colon– Ulcerative colitis

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Other Diseases of Intestines

• Diverticulosis

• Diverticulitis

• Peritonitis

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Accessory Organs

• Liver (hepatic)—secretes bile

• Pancreas—part of the endocrine system and digestive system

• Gallbladder—stores bile neededfor digestion

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Cholecystitis and Cholelithiasis

• Cholecystitis—sudden and severe inflammation of the gallbladder

• Cholelithiasis—gallstones

• Documentation in coding these conditions is critical

• Fourth and fifth digit code assignments are necessary (obstruction/acute/other