Is it a simple belly ache or something more inflammatory like Crohn’s disease? If you know certain facts about the disease and the anatomy of the digestive system, such as where the descending colon is located, coding for Crohn’s disease in ICD-10-CM shouldn’t be hard to digest. It is also imperative that you know how to locate the codes in the coding manual and how they are classified in Chapter 11. I will explain it all in this post after you have completed the Name That Code! coding exercise.
Name That Code!
Question: Patient is a 72-year-old male admitted to the hospital after having complaints of a “belly ache.” Patient has a history of Crohn’s disease of the large intestine. On exam, 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
Before we discuss how to find the correct code, it’s important to have a basic knowledge of the anatomy of the digestive system and where the descending colon is located.
According to WebMD, the descending colon is part of the large intestine and travels down the left side of the abdomen.
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 inflammation of the digestive tract. The inflammation can affect different 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 appeite 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 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 blowel 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 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.
Crohn’s Disease With an Abscess
As mentioned in the coding scenario, the patient has an abscess secondary to Crohn’s disease of the descending colon. That means the abscess is a complication of the Crohn’s disease. And as we discussed previously, the descending colon is part of the large intestine.
Locate and Verify
In the ICD-10-CM coding manual, let’s look 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
In ICD-10-CM, diagnosis codes for Crohn’s disease can be found in Chapter 11, Diseases of the Digestive System (K00-K95), specifically under K50.11 Crohn’s disease of large intestine with complications.
According to the ICD-10-CM Official Guidelines for Coding and Reporting, K50, Crohn’s disease [regional enteritis], is further broken down into specific codes based on site and whether the disease presents with complications.
Sites include small intestine, large intestine, both small and large intestine, and unspecified. Complications include rectal bleeding, intestinal obstruction, fistula, abscess, other, or unspecified.
The codes related to the large intestine and their specific complications found under K50.11 are as follows:
- 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
When coding for Crohn’s disease, be sure to review the documentation for pertinent details before making a final selection. If the documentation does not specify any complications, assign the location without complications. 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 there is a “Use additional” note that indicates if manifestations are identified, such as pyoderma gangrenosum (L88), they too should be reported.
** This post was reviewed and updated on December 16, 2021. **