ICD-10-CM Coding Guidelines — Understanding Gastrointestinal Ulcers


Another thing about ICD-10 is that you kind
of need to understand the disease process when coding an ICD-10. You do that with ICD-9
but it’s so much more in ICD-10, so I thought I’d pull out something, like one of the
body systems and then go in and let’s talk about that and understand the disease process.
So, I picked Gastrointestinal Ulcers just because I had information on it, but it would
be something that some of you might be able to learn from.
The first thing with Gastrointestinal Ulcers you would need to know the type of gastrointestinal
ulcers. We have gastric, duodenal, peptic, gastrojejunal. These are the four types of
gastrointestinal ulcers. Now, the next thing when understanding the disease process, you’re
going to need to know the contributing factors, because when you’re coding, unless you’ve
given a definitive diagnosis in physician-based coding, you would code the signs and the symptoms
– so we’re going to talk about those — and to back up the treatments or that the person
has a current condition, you’re going to need to know the contributing factors that
will show up in the case. Contributing factors: reflux, hyperacidity
in the stomach, extended use of anti-inflammatory drugs (aspirin or ibuprofen, there’s a lot
of arthritis medication that will be an influence), steroids, alcohol, smoking, and
presence of Helicobacter pylori bacteria.
They actually will go in and do an EGD and take a sample and make sure that you don’t
have this because if you have these bacteria, it will cause ulcers.
The signs and symptoms to look for: burning pain in the stomach or epigastric region (which
would be up in the esophagus in the back of the throat), weight loss, nausea, vomiting,
anemia – from blood loss, because when you get an ulcer it can actually be a bleeding
ulcer. What type of testing do they do to determine
that you have an ulcer? They do upper GI’s and barium studies (endoscopy) where they
actually have you drink a chalky substance and they take an x-ray. They go in endoscopically
and do an upper GI where they literally take a camera in there and they go in, they take
pictures to see if there’s anything going on. Then they can actually visualize the lining
of the epigastric area and the gastric (the stomach) to see if there’s an ulcer.
Then, there are several blood tests that they can do that would indicate whether a person
was suffering from an ulcer; they can do a hemoglobin test, the hematocrit and serum
gastrin and amylase levels. The hemoglobin and the hematocrit are decreased in
a patient with bleeding from the ulcers, and that’s because this is blood levels. Serum
gastric and serum amylase levels are actually increased. Then, they can do stool samples,
which can be positive for occult blood. That’s where they literally take feces and put it
on this little card and it turns to a specific color if it’s got blood in it.
Treatment – what are they going to do to treat it if you are diagnosed with a gastrointestinal
ulcer? Really the main treatment is treating the signs and the symptoms, but they’re
going to try to eliminate the contributing factors. They’re going to give an antacids
and dietary restrictions to neutralize the gastric acids, so they’re going to tell
you things like, “Don’t eat tomatoes, don’t eat things that are acidic or irritants
to the lining, like chocolate and coffee.” If they do find that this bacteria present,
then you’re given antibiotics. They want you to start on nutritious and regular meals;
a lot of times when a person has some type of a gastric ulcer, they stop eating or they’re
not eating proper foods because it hurts to eat, it’s so uncomfortable. So it’s encouraged
that they start back on regular meals. Then, they give you medication to reduce the acid
in your stomach. This is called anticholinergic drugs or you could call it like antacid-type
drug and you see those advertised on TV all the time, there are several good ones out
there. But you don’t want to have to take them for long periods of time.
Last, if nothing else works, they’ll go in and do surgical intervention especially
with hemorrhages, because you can actually get a perforation or an obstruction or the
pain will be so bad that they need to go in and literally do something to alleviate the
discomfort. So, when you’re doing ICD-10 it’s really
important that if you’re doing a specific body system to familiarize yourself with the
information about the types, the contributing factors to the disease process, the signs
and symptoms. You want to know what type of clinical testing, there’s usually lab testing
done, and what are they going to do to treat it? That is going to help you with your coding
and substantiate that it is an active disease process going on.
Boyd: Awesome! I think somebody was asking about the answer to, when we we’re asking
about all those codes with letter at the beginning, what was the answer to that one, after that
I think. Alicia: The letters in the beginning?
Boyd: Yeah, remember that case study? Alicia: Yeah, it’s just the division on
how they divide up the chapters. So, instead of the first number in ICD-9 telling you,
kind of helping you decide what chapter you’re in, the letter is going to do it now for you.
So, nothing’s really changed except it’s kind of like you have a prefix, and then they
also added suffixes to the end of the codes. Hopefully that will explain it for you.
So, each chapter will have a letter and then you’ll know by that letter what body system
or what diseases you’re working in. And not to say that OB-GYN is a disease, pregnancy
and stuff, but it’s going to be in the “O” section and neoplasms are in the “C” section.
So, if you see a code that starts with a “C” it probably will have something to do with
neoplasms whether benign or malignant, but it will be a neoplasm.
Boyd: Got it.

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