Cracking the Code

Coding Gastrointestinal Conditions with Bleeding

Are you often stumped with deciding whether to code gastrointestinal (GI) conditions with or without bleeding? The cause for GI bleeding isn’t always easily determined; however, there’s guidance from the coding guidelines that help us with selecting the proper diagnosis codes in these cases. Let’s review…

If two conditions are linked by the terms “with” or “in” in the Alphabetic Index or instructional note in the Tabular List, then there’s a presumed causal relationship between those conditions. The ICD-10-CM Coding Guidelines FY 2020 Section I.A.15 state “these conditions should be interpreted to mean “associated with” or “due to” when it appears in the code title UNLESS the provider documentation clearly states the conditions are unrelated or when another guideline exists that specifically requires a documented linkage between the two conditions.

The following are some common conditions that have a causal relationship with GI bleeding: peptic ulcers, varices, gastritis, colitis, duodenitis, diverticulosis/diverticulitis, colon or rectal polyps, angiodysplasia, ulcerative esophagitis or esophageal ulcerations, intestinal tumor or malignancy, and trauma.

Q: A patient who previously tested positive for COVID-19 is seen for a follow-up exam. The physician orders lab testing once again, and the results are now negative for COVID-19.
A: Z09, Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm
Reference: AHA Coding Clinic Third Quarter 2018 pages 21-22:Gastrointestinal bleeding due to multiple possible sources.
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