Consider the following clinical scenario.
A patient with ongoing Crohn's disease presented to the office with cramping, diarrhea, melena and increased abdominal pain. The physician performed a colonoscopy six months prior and diagnosed Crohn’s disease. Due to the severity of the flare up, the physician orders a second colonoscopy. The colonoscopy reveals an abscess in the large intestine with bleeding.
ICD-9 code descriptions are too generic.
In ICD-9, the physician uses regional enteritis of the small and large intestine. This is the same code that was used six months earlier for the original colonoscopy. This claim faces edits and possible denial due to frequency restrictions on diagnostic colonoscopies.
ICD-10 has better descriptions for diagnostic code choices.
In ICD-10, the Severity of Illness warranting this additional colonoscopy would be met with a specific code. The single ICD-10 code for Crohn’s disease of both small and large intestine with abscess (K50.814) reflects a progression in the disease and justifies the repeat colonoscopy.
[See also: How ICD-10 will benefit physicians ]
Adapted with permission from a white paper titled "Helping Physicians Succeed in an ICD-10 World " by Tom Ormondroyd, Bruce Scott, MD, and Christian Oliver.
Photo used with permission from Shuttershock.com.