Cracking the Code
Cirrhosis with Esophageal Varices
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Cirrhosis is the most common type of liver disease. Most of the patients who have cirrhosis develop esophageal varices due to scarring throughout the liver. Since the esophageal varices are due to the scarring (which is caused by cirrhosis), cirrhosis is sequenced as the primary diagnosis followed by varices as a secondary diagnosis. Also, coders should be sure to follow the instructional note under I85.11 that states to “code first underlying disease”. When reviewing cases with esophageal varices, please be sure to look for documentation specifying the underlying cause. If the provider does NOT document the etiology of the varices, please query for clarification.
Q: A 73-year-old male with history of cirrhosis and colon cancer (status-post resection and colectomy) presents with episodes of hematemesis and blood in colostomy bag. The provider performs an EGD and finds bleeding esophageal varices. The provider performs esophageal banding in order to stop the bleeding.
A: K74.60, cirrhosis of liver; I85.11, secondary esophageal varices with bleeding; Z85.038, personal history of other malignant neoplasm of large intestine; Z93.3, colostomy status; ICD-10-PCS 06L38CZ, occlusion of esophageal vein with extraluminal device, via natural or artificial opening endoscopic
CPT 43244; EGD, flexible, transoral; with band ligation of esophageal/gastric varices
CPT 43244; EGD, flexible, transoral; with band ligation of esophageal/gastric varices
Reference: Instructional Note for Diagnosis Code I85.11