Revenue Cycle Management in the Age of ICD-10: Gastroenterology Primer

colonoscopyContinuing our series on ICD-10 basics we are offering high-level primers to illustrate the differences on specific documentation requirements for various specialties. We will also give some samples of how ICD-9-CM codes common for those specialties compare to ICD-10-CM codes. Again, much of the material in these specialty-specific blog posts is based on guidelines and material published by CMS in its Road to 10 Series. There is a lot of questionable information and advice out there and we want to help improve the consistency and reduce the uncertainty by going to the source of regulations. We will summarize and consolidate to enhance readability and brevity. The application of ICD-10 documentation requirements and the common codes for Gastroenterology is the focus of this post. In ICD-10-CM, there are three main categories of changes:

  • Definition Changes
  • Terminology differences
  • Increased specificity

ICD-10-CM codes for most diseases of the digestive system are delineated in Chapter 11: Diseases of Digestive System which covers codes K00-K94. The most significant impact of ICD-10-CM for gastroenterologists is going to come from increased specificity of location (example: benign neoplasm of the colon) and the staging of severity (example: hemorrhoids). There are also instances where two ICD-9-CM codes collapse into one with ICD-10-CM with the combination of chronic conditions with symptoms in ICD-10 (example: 578.1 and 555.0 is needed in ICD-9-CM to code for Regional Enteritis small and large intestine with bleeding while in ICD-10-CM the coding is K50.811). Perhaps the most complicated part of the ICD-10-CM transition for Gastroenterologists will be coding for Crohn's Disease (regional enteritis). ICD-9-CM offers four codes in the 555 series (regional enteritis):

555.0 small intestine
555.1 large intestine
555.2 small intestine with large intestine
555.9 unspecified site

ICD-10-CM includes these four main categories:

K50.0 Crohn’s disease of small intestine
K50.1 Crohn’s disease of large intestine
K50.8 Crohn’s disease of both small and large intestine
K50.9 Crohn’s disease, unspecified

Each of those categories contains two main subcategories for without complications and with complications. The subcategories for with complication include six additional codes to specify the complication. For example, for Crohn’s disease of the large intestine with complications, we would choose from:

K50.111 Crohn’s disease of large intestine with rectal bleeding
K50.112 Crohn’s disease of large intestine with intestinal obstruction
K50.113 Crohn’s disease of large intestine with fistula
K50.114 Crohn’s disease of large intestine with abscess
K50.118 Crohn’s disease of large intestine with other complication
K50.119 Crohn’s disease of large intestine with unspecified complications

Comparison of ICD-9-CM and ICD-10-CM Codes for Gastroenterology

Barrett's esophagus ICD-9-CM

530.85 Barrett's esophagus


K22.70 Barrett's esophagus without dysplasia
K22.710 Barrett's esophagus with low grade dysplasia
K22.719 Barrett's esophagus with dysplasia, unspecified
K22.711 Barrett's esophagus with high grade dysplasia

Benign neoplasm ICD-9-CM

211.40 Benign neoplasm of the rectum/anus
211.3 Benign neoplasm of the colon


D12.8 Benign neoplasm of rectum
D12.7 Benign neoplasm of rectosigmoid junction
D12.9 Benign neoplasm of anus and anal canal
D12.0 Benign neoplasm of cecum
D12.2 Benign neoplasm of ascending colon
D12.1 Benign neoplasm of appendix
D12.3 Benign neoplasm of transverse colon
D12.4 Benign neoplasm of descending colon
D12.5 Benign neoplasm of sigmoid colon
D12.6 Benign neoplasm of colon, unspecified
K63.5 Polyp of colon

Internal hemorrhoids without complication ICD-9-CM

455.0 Internal hemorrhoids without mention of complication


K64.0 1st degree hemorrhoids
K64.1 2nd degree hemorrhoids
K64.2 3rd degree hemorrhoids
K64.3 4th degree hemorrhoids
K64.8 Other hemorrhoids (without mention of degree)
K64.9 Unspecified hemorrhoids

Ulcerative Colitis ICD-9-CM

556.8 Other ulcerative colitis
556.9 Ulcerative colitis, unspecified


K51.80 Other ulcerative colitis without complications
K51.811 Other ulcerative colitis with rectal bleeding
K51.812 Other ulcerative colitis with intestinal obstruction
K51.813 Other ulcerative colitis with fistula
K51.814 Other ulcerative colitis with abscess
K51.818 Other ulcerative colitis with other complications
K51.819 Other ulcerative colitis with unspecified complications
K51.90 Ulcerative colitis, unspecified
K51.911 Ulcerative colitis, unspecified with rectal bleeding
K51.912 Ulcerative colitis, unspecified with intestinal bleeding
K51.913 Ulcerative colitis, unspecified with fistula
K51.914 Ulcerative colitis, unspecified with abscess
K51.918 Ulcerative colitis, unspecified with other complications
K51.919 Ulcerative colitis, unspecified with unspecified complications