December 26, 2007

Coding for Inflammatory Bowel Disorders
For The Record
Vol. 19 No. 26 P. 30

Inflammatory bowel disorders are a group of chronic illnesses that inflame the gastrointestinal (GI) tract. The main inflammatory bowel disorders are Crohn’s disease and ulcerative colitis. The characteristic signs and symptoms of inflammatory bowel disorders include bloody diarrhea, abdominal pain, and weight loss.

Crohn’s Disease
Crohn’s disease causes inflammation in the GI tract lining. It may spread into the deep layers of the affected tissue and can be painful and debilitating. Crohn’s disease mainly affects short segments of the small and large intestine.

Crohn’s disease is classified to ICD-9-CM category 555, Regional enteritis. The specific code assignment depends on the site affected by the disease, as follows:

• 555.0, Crohn’s disease of small intestine, including duodenum, ileum, and jejunum (regional ileitis);

• 555.1, Crohn’s disease of large intestine (regional colitis);

• 555.2, Crohn’s disease of small intestine with large intestine (regional ileocolitis); and

• 555.9, Crohn’s disease of unspecified site (regional enteritis, not otherwise specified).

The most common signs and symptoms of Crohn’s disease include abdominal pain and cramping, diarrhea, rectal bleeding, blood in stool, weight loss, reduced appetite, intestinal or mouth ulcers, intestinal abscess, intestinal fistula, arthritis, skin problems, fever, and fatigue.

If a patient is admitted with arthritis associated with Crohn’s disease, first assign the appropriate code from category 555 for the Crohn’s disease followed by code 713.1, Arthropathy associated with gastrointestinal conditions other than infections.

Patients may experience the following complications due to Crohn’s disease: obstruction, ulcers, fistulas, anal fissures, and malnutrition.

According to coding advice, if a patient is admitted with a condition due to Crohn’s disease, sequence the code for the Crohn’s disease as the principal diagnosis followed by a code for the complication. For example, anal and rectal abscesses associated with Crohn’s disease are assigned to codes 555.9 and 566 (AHA Coding Clinic for ICD-9-CM, 1999, third quarter, pages 8-9). Crohn’s disease of the colon with a colonic fistula is classified to codes 555.1 and 569.81 (AHA Coding Clinic for ICD-9-CM, 1999, third quarter, page 8). Bowel obstruction secondary to Crohn’s disease is assigned to codes 555.9 and 560.89 (AHA Coding Clinic for ICD-9-CM, 1997, second quarter, page 3).

Ulcerative Colitis
Ulcerative colitis causes GI tract inflammation and can affect the entire large intestine or rectum. It can affect the innermost lining of the large intestine leading to life-threatening complications.

Ulcerative colitis is classified to category 556 with the specific code depending on the site and type, such as follows:

• 556.0, Ulcerative (chronic) enterocolitis;

• 556.1, Ulcerative (chronic) ileocolitis;

• 556.2, Ulcerative (chronic) proctitis;

• 556.3, Ulcerative (chronic) proctosigmoiditis;

• 556.4, Pseudopolyposis of colon;

• 556.5, Left-sided ulcerative (chronic) colitis;

• 556.6, Universal ulcerative (chronic) colitis (pancolitis);

• 556.8, Other ulcerative colitis; and

• 556.9, Ulcerative colitis, unspecified.

Specific signs and symptoms of ulcerative colitis will depend on the affected site. Common signs and symptoms of ulcerative colitis include abdominal pain, rectal bleeding, bloody diarrhea, and weight loss. Complications associated with ulcerative colitis may include perforated colon, severe dehydration, liver disease, and inflammation of skin, joints, and eyes.

Treatment
Treatment of inflammatory bowel disorders includes medications and surgery. Some common anti-inflammatory drugs used include sulfasalazine (Azulfidine), mesalamine (Asacol, Rowasa), corticosteroids, budesonide (Entocort EC), and balsalazide (Colazal).

Common immune system suppressor medications that treat inflammatory bowel disorders include azathioprine (Imuran), mercaptopurine (Purinethol), infliximab (Remicade), adalimumab (Humira), methotrexate (Rheumatrex), and cyclosporine (Neoral, Sandimmune).

Other medications used to treat inflammatory bowel disorders include metronidazole (Flagyl), ciprofloxacin (Cipro), antidiarrheals, pain relievers, iron supplements, vitamin B12 shots, and calcium and vitamin D supplements.

If the condition is severe enough, surgery may be necessary to resect the affected area of the GI tract.

Coding and sequencing for inflammatory bowel disorders are dependent on the physician documentation in the medical record and application of the Official Coding Guidelines for inpatient care. Also, use specific AHA Coding Clinic for ICD-9-CM and American Medical Association CPT Assistant references to ensure complete and accurate coding.

— This information was prepared by Audrey Howard, RHIA, of 3M Consulting Services. 3M Consulting Services is a business of 3M Health Information Systems, a supplier of coding and classification systems to nearly 5,000 healthcare providers. The company and its representatives do not assume any responsibility for reimbursement decisions or claims denials made by providers or payers as the result of the misuse of this coding information. More information about 3M Health Information Systems is available at www.3mhis.com or by calling 800-367-2447.