Coding for Crohn’s disease with an abscess doesn’t have to be difficult as long as you know the coding guidelines and what to look for in the documentation. Anatomy of the digestive system will also help here.
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
We need to know a little about the anatomy of the digestive system here 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.
Crohn’s Disease With an Abscess
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, with, complication, abscess, it refers us to K50.114.
Verified in the tabular, K50.114 refers to Crohn’s disease of large intestine with abscess.
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.
What is Crohn’s Disease?
According to the Mayo Clinic, Crohn’s disease is an inflammatory bowel disease (IBD) that causes inflammation of the digestive tract. This leads to abdominal pain, severe diarrhea, fatigue, weight loss, and malnutrition. Crohn’s disease can lead to a variety of complications, as we mentioned above.
This post has been updated to reflect the 2020 coding guidelines.