Coding Tip: GI Bleeding with Multiple Possible Sources

by Dec 7, 2018Industry News, Kim Carrier, Medical Coding Tips0 comments

Kim Carrier RHIT, CDIP, CCS, CCS-P
Director of Coding Quality Assurance
AHIMA Approved ICD-10-CM/PCS Trainer

ICD-10-CM presumes a causal relationship between two conditions that are linked by the terms “with” or “in” in the Alphabetic Index or instructional note in the Tabular List. With the clarification published of the understanding of the term “with,” there have been many eye-opening clarifications in coding (like in diabetes and now with GI bleeding). This differs from ICD-9-CM as the causal relationship was not assumed.

The word “with” in the Alphabetic Index is sequenced immediately following the main term, not in alphabetical order.

Please Note: Beginning October 1, 2018, the OCG FY 2019 clarify that “with” or “in” either under the main term or subterm presumes a causal relationship between the two conditions. Prior to this, the OCG only stated the main term.

GI Bleeding and Possible Sources “with” Bleeding:

The cause/etiology of GI bleeding is not always easily determined. During procedures, to work the bleeding up, there are often multiple potential sources of bleeding found but not identified as the culprit. Many of these findings have “with” or “in” in the main or subterms. When this is the case, the condition(s) would be coded as bleeding. If there are multiple findings all of these would be reported as bleeding if “with” or “in” is listed.

Causes (Common) of GI Bleeding:

  • Peptic ulcers*
  • Diverticulosis/diverticulitis*
  • Colon or rectal polyps (not specified as inflammatory)
  • Intestinal tumor/malignancy
  • Trauma
  • Varices
  • Angiodysplasia*
  • Colitis
  • Ulcerative esophagitis or esophageal ulcerations*
  • Gastritis*
  • Duodentitis*

The “*” beside the diagnoses/causes above indicate that the causal relationship is made when the conditions are found and the patient also has a diagnosis of GI bleeding.

The publication of this Q&A in the 3Q 2018 AHA Coding Clinic should help coders in determining when to code “with” conditions.

AHA Coding Clinic for ICD-9-CM, Third Quarter 2005 Page 17 to 18
AHA Coding Clinic for ICD-10-CM and ICD-10-PCS, Third Quarter 2018  Page 22 to 23
ICD-10-CM Official Guidelines for Coding and Reporting FY 2019 Page 12-13
ICD-10-CM Official Guidelines for Coding and Reporting FY 2018 Page 12-13

Happy Coding!

The information contained in this coding advice is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly.

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