** This post was reviewed and updated on October 19, 2023. **
Coding For Crohn’s Disease in ICD-10-CM
Is it a mere stomachache or something more complex, like Crohn’s disease? Understanding the complexity of this condition and the anatomy of the digestive system, including the precise location of the descending colon, can make coding for Crohn’s disease in ICD-10-CM a more digestible task. Furthermore, gaining proficiency in locating these codes within the coding manual and comprehending their classification in Chapter 11 is imperative. In this post, I will provide a comprehensive explanation after you’ve completed the ‘Name That Code!’ coding exercise. To enhance your understanding, we’ve also included a brief video on Crohn’s disease at the end of this post.
Name That Code!
Question: The patient is a 72-year-old male admitted to the hospital after having complaints of a “belly ache.” The patient has a history of Crohn’s disease of the large intestine. On exam, the patient has diffuse tenderness over the entire abdomen. CT scan of the abdomen reveals an abscess secondary to Crohn’s disease of the descending colon. Assign the appropriate diagnosis code.
K50.114, Crohn’s disease of the large intestine with abscess
The documentation indicates that the patient has an abscess secondary to Crohn’s disease of the descending colon. That means the abscess is a complication of Crohn’s disease. According to WebMD, the descending colon is part of the large intestine and travels down the left side of the abdomen.
ICD-10-CM Codes for Crohn’s Disease Reside in Chapter 11
In ICD-10-CM, diagnosis codes for Crohn’s disease can be found in Chapter 11, Diseases of the Digestive System (K00-K95). Crohn’s disease [regional enteritis] is broken down further according to location (small intestine, large intestine, both small and large intestine, and unspecified).
Locate and Verify
To locate the correct ICD-10-CM code for this exercise, we need to look in the Index under Disease, diseased/Crohn’s. It tells us to see Enteritis, regional. Looking under Enteritis, regional/large intestine (colon) (rectum)/ with/complication/abscess, it refers us to K50.114.
Verified in the tabular, our correct code is:
K50.114, Crohn’s disease of large intestine with abscess
Other codes for Crohn’s disease of the large intestine with complications include:
- 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
- K50.118, Crohn’s disease of large intestine with other complication
- K50.119, Crohn’s disease of large intestine with unspecified complications
Documentation Related to Crohn’s Disease
When coding for Crohn’s disease, be sure to review the documentation for pertinent details before making a final selection. For instance, if the documentation does not specify any complications, assign the location without complications. Also, according to the ICD-10-CM Official Guidelines for Coding and Reporting, “Codes titled “unspecified” are for use when the information in the medical record is insufficient to assign a more specific code.” Hence, if the documentation does not specify whether it is the small or large intestine, or if it documents the condition as regional enteritis NOS, assign the unspecified code.
Also, follow all Includes, Excludes, and Use additional notes and apply, when applicable. For example, a “Use additional” note indicates if manifestations are identified, such as pyoderma gangrenosum (L88), they should also be reported.
What is Crohn’s Disease?
According to the Mayo Clinic, Crohn’s disease, also known as regional enteritis, is a type of inflammatory bowel disease (IBD) that causes digestive tract inflammation. The inflammation can affect various parts of the digestive tract in different people.
Signs and Symptoms
The signs and symptoms of Crohn’s when active may include:
- Abdominal pain and cramping
- Bloody stool
- Mouth sores
- Reduced appetite and weight loss
- Pain or drainage near the anus due to inflammation from a tunnel into the skin (fistula)
Additional symptoms may occur in severe cases of Crohn’s disease.
The exact cause is unknown. However, factors, such as heredity and a malfunctioning immune system, likely play a role.
Certain factors can put a person at greater risk of Crohn’s disease. They include:
- Age. Most people are diagnosed before the age of 30.
- Ethnicity. Whites are at greater risk, especially those of Jewish descent. Black people living in North America and the United Kingdom are increasingly among those at higher risk.
- Family history. If you have a first-degree relative with the disease, you are at greater risk.
- Cigarette smoking. This not only puts a person at higher risk of Crohn’s disease, but it also can lead to a more severe disease and a greater risk of having surgery.
- Nonsteroidal anti-inflammatory medications. Ibuprofen, naproxen sodium, diclofenac sodium, and others can cause inflammation of the bowel and result in more severe Crohn’s disease.
Crohn’s disease can lead to one or more of the following complications:
- Bowel obstruction. Crohn’s disease can eventually cause scarring and narrowing of the intestinal wall and block the flow of digestive contents. Surgery may be needed to remove the diseased portion of the bowel.
- Ulcers. Open sores (ulcers) can develop due to chronic inflammation. The sores can appear in the digestive tract, including the mouth and anus, and genital area (perineum).
- Fistulas. A fistula is an abnormal connection between different body parts. An ulcer may extend all the way through the intestinal wall and create a fistula. This can occur between the intestine and the skin or between the intestine and another organ.
In some cases, a fistula can get infected and form an abscess. If the abscess is not treated, it can become fatal.
- Anal fissure. A small tear can occur in the tissue surrounding the anus where infections develop. Painful bowel movements are often associated with these fissures and can cause a fistula in the perianal area.
- Malnutrition. Diarrhea, abdominal pain, and cramping can cause problems with eating, resulting in a lack of nourishment. Anemia may even develop in some individuals with Crohn’s disease.
- Colon cancer. A person with Crohn’s has a higher chance of developing colon cancer and may require earlier and more frequent screenings.
- Other health problems. Other problems may develop in the body such as anemia, skin disorders, osteoporosis, arthritis, and gallbladder disease or liver disease.
- Medication risks. Certain drugs for Crohn’s disease are associated with a small risk of developing lymphoma and skin cancers. Corticosteroids can also be associated with certain health issues.
- Blood clots. Crohn’s disease can put a person at increased risk of blood clots in the veins and arteries.
Video About Crohn’s Disease
The following 4-minute video explains Crohn’s disease, including its pathophysiology, symptoms, and risk factors.