Our next chapter to address in the I-10 Corner is the Digestive System. Please review the table below so that you can see what areas of the chapter have either been expanded or restructured.

Here are a few other note-worthy changes found in the Digestive System chapter.

1. The category on Dentofacial Anomalies Including Malocclusion has been moved to the Musculoskeletal chapter.
2. Some categories were restructured so that related disease groups could be together. Two new chapters:
   1. Diseases of Liver (K70-K77)
   2. Disorders of Gallbladder, Biliary Tract, and Pancreas (K80-K87)
3. New instructional notes:
   1. Oral cavity section:
      Tobacco abuse affects more than our lungs. Smoking and other tobacco products can affect the bone and soft tissue of teeth by impairing blood flow to the gums and affecting the function of gum tissue per WebMD.
      1. Use additional code to identify:Alcohol abuse and dependence (F10.-)
      2. Exposure to environmental tobacco smoke (Z77.22)
      3. Exposure to tobacco smoke in the perinatal period (P96.81)
      4. History of tobacco use (Z87.891)
      5. Occupational exposure to environmental tobacco smoke (Z57.31)
      6. Tobacco dependence (F17.-)
      7. Tobacco use (Z72.0)
   2. Hernia
      Hernia with both gangrene and obstruction is classified to hernia with gangrene.
   3. Ulcerative Colitis
      Use additional code to identify manifestations, such as:
      • Pyoderma gangrenosum
   4. Terminology change
      • Hemorrhage is used with ulcers
      • Bleeding used with Gastritis, Duodenitis, Diverticulosis, and Diverticulitis
   5. Identifying obstruction due to ulcers has been eliminated.
   6. There are two diagnosis codes for GERD now.
      

      Diagnosis	ICD-9	ICD-10
      GERD with Esophagitis	530.81 and 530.10	K21.0
      GERD without Esophagitis	530.81	K21.9

Notice! Currently there are no chapter-specific coding guidelines for the Digestive System.

From ICD-10-CM Coder Training Manual 2014

PROCEDURES

Here are some common procedures performed on the Digestive System:

ICD-10-PCS Official Guidelines for Coding and Reporting Effective October 1, 2013

Rules to consider when coding procedures in the Digestive System

Root Operation, Multiple Procedures

• B. Medical and Surgical Section Guidelines (section 0)
  • B3. Root Operation
  • Multiple procedures

  • B3.2

  • During the same operative episode, multiple procedures are coded if:
    1. The same root operation is performed on different body parts as defined by distinct values of the body part character.
       • Example: Diagnostic excision of liver and pancreas are coded separately.
    2. The same root operation is repeated at different body sites that are included in the same body part value.
       • Example: Excision of the sartorius muscle and excision of the gracilis muscle are both included in the upper leg muscle body part value, and multiple procedures are coded.
    3. Multiple root operations with distinct objectives are performed on the same body part.
       • Example: Destruction of sigmoid lesion and bypass of sigmoid colon are coded separately.
    4. The intended root operation is attempted using one approach, but is converted to a different approach.
       • Example: Laparoscopic cholecystectomy converted to an open cholecystectomy is coded as percutaneous endoscopic Inspection and open Resection.

Root Operation, Biopsy Followed by More Definitive Treatment

• B. Medical and Surgical Section Guidelines (section 0)
  • B3. Root Operation
  • Biopsy followed by more definitive treatment

  • B3.4b

  • If a diagnostic Excision, Extraction, or Drainage procedure (biopsy) is followed by a more definitive procedure, such as Destruction, Excision or Resection at the same procedure site, both the biopsy and the more definitive treatment are coded.
    • Example: Biopsy of breast followed by partial mastectomy at the same procedure site, both the biopsy and the partial mastectomy procedure are coded.

Root Operation, Inspection Procedures

• B. Medical and Surgical Section Guidelines (section 0)
  • B3. Root Operation
  • Inspection procedures

  • B3.11a

  • >Inspection of a body part(s) performed in order to achieve the objective of a procedure is not coded separately.
    • Example: Fiberoptic bronchoscopy performed for irrigation of bronchus, only the irrigation procedure is coded.  

  • B3.11b

  • If multiple tubular body parts are inspected, the most distal body part inspected is coded. If multiple non-tubular body parts in a region are inspected, the body part that specifies the entire area inspected is coded.
    • Examples: Cystoureteroscopy with inspection of bladder and ureters is coded to the ureter body part value.
    • Exploratory laparotomy with general inspection of abdominal contents is coded to the peritoneal cavity body part value.

  • B3.11c

  • When both an Inspection procedure and another procedure are performed on the same body part during the same episode, if the Inspection procedure is performed using a different approach than the other procedure, the Inspection procedure is coded separately.
    • Example: Endoscopic Inspection of the duodenum is coded separately when open Excision of the duodenum is performed during the same procedural episode.

Body Part, Upper and Lower Intestinal Tract

• B. Medical and Surgical Section Guidelines (section 0)
  • B4. Body Part
  • Upper and Lower Intestinal Tract

  • B4.8

  • In the Gastrointestinal body system, the general body part values Upper Intestinal Tract and Lower Intestinal Tract are provided as an option for the root operations Change, Inspection, Removal and Revision. Upper Intestinal Tract includes the portion of the gastrointestinal tract from the esophagus down to and including the duodenum, and Lower Intestinal Tract includes the portion of the gastrointestinal tract from the jejunum down to and including the rectum and anus.
    • Example: In the root operation Change table, change of a device in the jejunum is coded using the body part Lower Intestinal Tract.

How timely it is to review the Digestive System after many of us have consumed mass quantities of hot dogs, barbequed ribs and chicken this past Memorial Day! Like food, I-10 should be reviewed in moderation…one chapter at a time, so you won’t get sick, I mean overwhelmed!